Introduction Scleroderma is a multisystem disorder of unknown aetiology leading to the deposition of excessive connective tissue in the skin, blood vessels and internal organs. GI involvement is present in 90% of cases and the prevalence of faecal incontinence is 38%. The predominant type of faecal incontinence is passive faecal soiling, related to connective tissue deposition and internal anal sphincter (IAS) dysfunction. The only published study of sacral nerve stimulation (SNS) in scleroderma enrolled five patients and reported that temporary SNS was successful in four, all of whom had complete resolution of their incontinence episodes following a permanent implant. The mechanism of SNS in this indication, and others, remains unclear.
The Aim was to assess the outcome on Wexner incontinence values (0–20) post temporary SNS in Scleroderma faecal incontinence.
Methods A retrospective analysis was performed on all scleroderma patients from our two centres who had undergone SNS for faecal incontinence.
Results A total of 10 female patients with a mean age of 54 (37–72) had temporary SNS performed. Faecal incontinence symptom duration ranged from 2 to 25 years. Each patient had pre-procedure anorectal physiology documenting internal sphincter atrophy/fragmentation, a reduced resting pressure and correlation with passive faecal incontinence symptoms.
Overall, there was no significant difference in the total mean Wexner incontinence scores obtained following temporary SNS procedures. Two patients with a significant improvement went on to have permanent SNS with only one patient achieving a favourable outcome at one year. The following table demonstrates pre and post procedure Wexner incontinence scores as a mean on the 10 patients:
Conclusions This study shows that SNS in scleroderma passive faecal incontinence did not achieve favourable results in 9 of 10 patients. The proposed mechanisms of SNS are unlikely to be able to reverse the infiltrative changes of the internal sphincter seen in scleroderma.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.