Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Silman AJ. Epidemiology of scleroderma. Curr Opin Rheumatol 1991;3:967–72. - PubMed
    1. Rees WD, Leigh RJ, Christofides ND, et al. Interdigestive motor activity in patients with systemic sclerosis. Gastroenterology 1982;83:575–80. - PubMed
    1. Trezza M, Krogh K, Egekvist H, et al. Bowel problems in patients with systemic sclerosis. Scand J Gastroenterol 1999;34:409–13. - PubMed
    1. Engel AF, Kamm MA, Talbot IC. Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence. Gut 1994;35:857–9. - PMC - PubMed
    1. Leighton JA, Valdovinos MA, Pemberton JH, et al. Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis. Dis Colon Rectum 1993;36:182–5. - PubMed

Publication types