Introduction: Idiopathic Normal pressure hydrocephalus (iNPH), is a treatable cause of progressive gait disturbance, cognitive decline and urinary urgency and incontinence, termed Hakim’s triad when all symptoms are present, in elderly patients. Bowel incontinence is another symptom observed in iNPH patients, but little is known about the prevalence of bowel incontinence and degree of improvement to bowel incontinence after surgical treatment.
Methods: A retrospective review was conducted on 83 consecutive newly diagnosed iNPH patients treated with implantation of a ventriculoperitoneal shunt at Brigham and Women’s Hospital between 2016 and 2022. Patient age, sex, presence of neurodegenerative disease, symptoms including gait and cognitive decline, urinary urgency and bowel incontinence, and clinical improvement post shunt placement at the 3-month and 12-month follow-up visits were recorded.
Results: Among the 83 patients, the average age was 74.8 years (SD: 7.5). Of these, 65 (78%) presented with the symptom triad, and 19 (23%) experienced bowel incontinence before shunt placement. Of 19 patients with bowel incontinence, 13 (68%) reported improvement of bowel incontinence symptoms at the 3-month and 12-month follow-up. At the 3-month follow-up after VP shunt placement, patients with improved bowel incontinence were significantly younger (mean age of 72 years), than patients who did not improve (mean age 79 years) (t=2.15, p=0.046). For patients presenting with the Hakim’s symptom triad, 20 (30%) saw improvement in all symptoms at the 3-month follow-up, and 31(47%) saw improvement at the 12-month follow-up.
Conclusion : In our sample, bowel incontinence occurs in 1 out of 5 patients with iNPH and improves in the majority of patients after shunt placement. Younger age may be associated with improved symptoms after 3 months. Future studies may continue to work toward establishing the prevalence and underlying neural circuit disruption of bowel incontinence in iNPH patients before and after VP shunt placement.
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