Background/Purpose: Scleroderma (SSc) is a chronic autoimmune disorder involving multiple organs, the gastrointestinal system (GI) commonly involved in up to 90% of the sufferers. Faecal incontinence (FI) is frequent manifestation of SSc but data on prevalence of FI are lacking. Treatment options are limited. This study aims to estimate the prevalence of FI in patients with SSc managed at a tertiary referral centre and to determine the efficacy of sacral neuromodulation (SNS) in cases of failed medical management.

Methods: Data was extracted from the STRIKE observational cohort database (Stratification for risk of progression in scleroderma) between 2015 and 2020. Collected data included Patient Reported Outcomes included gastrointestinal VAS scores. Data were categorised into 2 groups based on GI involvement using descriptive statistics, including uni- and multii-variate analysis were applicable. SHAQ-DI indices were calculated for the 2 groups. Faecal incontinence was defined as the inability to control bowel movements causing passive leakage of faeces from the rectum. Prevalence of FI was estimated in this cohort. Anorectal involvement was identified using anorectal manometry and endoanal ultrasound. A positive response to SNS was defined as a >50% improvement in continence score leading to insertion of a permanent SNS implant. Improvements were measured based on improvements FIQL scores and reduction in the frequencies of bowel movements on follow up.

Results: 539 patients were available in the dataset of which 300 had all follow up information available to be included in the study. Among the 300 patients analysed 26 patients had FI (8.66%). 25 were females (96%). Mean age was 62.4 years, 17 (65.38%) patients had limited SSc and 4 (15.38%) with diffuse SSc. Mean disease duration of 14 years. 70.2% were ANA positive, 50% were ACA, and 19.23% were SCL70 positive. Median (IQR) GI VAS for patients with FI was 60 (40-85) as compared to 10 (0-50) for patients without FI. Median HAQ-DI for FI was 2.75 (0-5.25) as compared to 3.06 (0.6-5.65) for patients without FI. In patients with FI, internal anal sphincter (IAS) atrophy was found in 42.23%, anterior sphincter defect was seen 23.07%. Pudendal neuropathy was observed in 21.73% patients with FI. Anorectal intussusception with perianal descent was seen in 15.38% patients with FI. Pelvic physiotherapy did not benefit any patients. 34.61% patients received a permanent SNS of which 88.5% had a good treatment effect.

Conclusion: The prevalence of FI in our cohort of patients with SSc was 8.6% but is probably underestimated given the reservations that patients feel in declaring FI as a symptom. Patients with FI had higher GI VAS whereas higher overall HAQ scores in non FI patients. FI does affects the quality of life considerably. The finding of sphincter atrophy and pudendal neuropathy warrant further investigation and comparison with non SSc FI cohorts. Despite the need of large controlled studies, the high response to SNS supports its potential role for treating FI in SSc patients. However, reasons for failure of SNS need to be investigated further.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/faecal-incontinence-in-scleroderma-prevalence-impact-and-response-to-sacral-neuromodulation-in-an-single-centre-observational-cohort/