World Neurosurg. 2023 Jul 31;S1878-8750(23)01069-0. doi: 10.1016/j.wneu.2023.07.120.Online ahead of print.

Uwe Kehler ¹, Sven Petersen ²

Author information

¹Dept. Neurosurgery, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763 Hamburg, Germany. Electronic address: uwekehler@hotmail.com.

²Dept. Visceral Surgery, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763 Hamburg, Germany.

Abstract

Background: Normal pressure hydrocephalus (NPH) is a frequent disease in elderly patients. The main symptoms are gait disturbance, urine incontinence, and cognitive decline. Fecal urgency and incontinence are described as rare additional symptoms; however, no exact numbers are known. The aim of this study was to investigate the prevalence of fecal disturbances in NPH patients.

Methods: Patients who presented to our department with confirmed diagnosis of NPH between January and December 2021 were interviewed prospectively about fecal function. Additionally, the extent of gait disturbance, cognitive decline, ventriculomegaly (Evans-Index), disproportionate enlarged subarachnoid space hydrocephalus (DESH presence), age, gender, and length of history were documented. In those who were operated with a hydrocephalus shunt postoperative development of stool incontinence was followed-up.

Results: 100 patients were evaluated (67 men, 33 females, medium age 77.5 years, medium Evans Index: 0.37; 87 with DESH). 97 patients showed gait disturbance, 84 cognitive decline, and 87 bladder dysfunctions. 78 patients had the complete Hakim triad. 32 patients complained about fecal incontinence (20 with urge incontinence, 12 with complete incontinence). 29 were shunted, of which 17 (57%) recovered completely, 9 (31%) partially, and 3 (10%) did not show any change.

Conclusion: Fecal urgency and incontinence is a frequent finding in NPH (32%) and is essential for the quality of live. In the general population, fecal incontinence in elderly is found in up to 15%. The more than twofold higher prevalence in NPH patients and the high percentage of post-shunted improvement suggests that NPH causes often directly fecal disturbance.