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Sacral nerve stimulation stops faecal incontinence in scleroderma

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Patients with scleroderma who develop faecal incontinence will benefit from a promising new technique which gives lasting improvement.

A study in a small group of these patients by a team of gastroenterologists has confirmed that permanent stimulation of the sacral nerves restores function safely when other treatments have failed.

In four patients who had a temporary device implanted through a sacral foramen their weekly episodes of faecal incontinence fell dramatically (max 23 beforehand, 0 after). With a permanent device urgency was resolved (median <1 min before to 12.5 min after), and physiological measures of anorectal function were all improved. Quality of life, assessed by SF36 questionnaire, showed better social and physical function after implantation. Continence was maintained at the longest follow up (median 24, 6–60 months), and there were no complications.

The team tested five patients (median age 61; range 30–71) who had at least three episodes of faecal incontinence a week for which conventional treatments had failed. The patients had had incontinence and scleroderma for a median of five (5–9) and 13 (4–29) years, respectively. All were screened after insertion of a temporary implant and sacral nerve stimulation for three weeks by self reported and clinical measures of anorectal function, and four who responded favourably received a permanent implant. The connecting leads of the temporary implant came adrift 24 hours after implantation in the fifth patient.

Scleroderma commonly affects the gut, and a third of patients develop faecal incontinence which defies conventional treatments—antidiarrhoeal drugs and behavioural therapy (biofeedback).

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