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. 2002 Dec;51(6):881-3.
doi: 10.1136/gut.51.6.881.

Sacral nerve stimulation for faecal incontinence due to systemic sclerosis

N J Kenefick  1 , C J Vaizey, R J Nicholls, R Cohen, M A Kamm
Affiliations

Sacral nerve stimulation for faecal incontinence due to systemic sclerosis

N J Kenefick et al. Gut. 2002 Dec.

Abstract

Background: Faecal incontinence occurs in over one third of patients with systemic sclerosis. The aetiology is multifactorial. Conventional treatment is often unsuccessful. Sacral nerve stimulation is a new effective treatment for resistant faecal incontinence.

Aims: To evaluate sacral nerve stimulation in patients with systemic sclerosis.

Patients: Five women, median age 61 years (30-71), with scleroderma associated faecal incontinence were evaluated. All had failed maximal conventional treatment. Median number of preoperative weekly episodes of incontinence was 15 (7-25), median duration of incontinence was five years (5-9), and scleroderma 13 years (4-29).

Methods: All patients were screened with temporary stimulation. Those who benefited underwent permanent implantation. At baseline and after stimulation a bowel diary, the SF-36 quality of life assessment, endoanal ultrasound, and anorectal physiology were performed.

Results: Four patients were continent at a median follow up of 24 months (6-60). One patient failed temporary stimulation and was not permanently implanted. The weekly episodes of incontinence decreased from 15, 11, 23, and 7 to 0. Urgency resolved (median time to defer <1 minute (0-1) v 12.5 minutes (5-15)). Quality of life, especially social function, improved. Endoanal ultrasound showed an atrophic internal anal sphincter (median width 1.0 mm (0-1.6)). Anorectal physiology showed an increase in median resting pressure (37 pre v 65 cm H(2)O post) and squeeze pressure (89 v 105 cm H(2)O). Stimulation produced enhanced rectal sensitivity to distension. There were no major complications.

Conclusions: Sacral nerve stimulation is a safe and effective treatment for resistant faecal incontinence secondary to scleroderma. The benefit is maintained in the medium term.

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Figures

Figure 1
Figure 1
Operative position of patient showing bony landmarks and position of the sacral foramen.
Figure 2
Figure 2
Lateral view of the sacrum and bony landmarks.
See this image and copyright information in PMC

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