title: Sacral nerve stimulation for faecal incontinence due to systemic sclerosis.
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.
  
  
  OBJECTIVE
  To evaluate sacral nerve stimulation in patients with systemic sclerosis.
  
  
  METHODS
  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.
authors.affiliation: St Mark's Hospital, London, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Kenefick
authors.forename: C J
authors.initials: CJ
authors.lastname: Vaizey
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology