scholarly journals The role of neuromodulation in chronic functional constipation : a systematic review

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
N Pauwels ◽  
C Willemse ◽  
S Hellemans ◽  
N Komen ◽  
S Van den Broeck ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Statistical Significance ◽  
Functional Constipation ◽  
Current Therapy ◽  
Future Research ◽  
Double Blind ◽  
Surgical Interventions ◽  
Sacral Nerve ◽  
Tibial Nerve Stimulation

Background : Chronic functional constipation is a highly prevalent disorder in which, when conservative measures fail to relieve symptoms, surgical interventions are sometimes indicated. In recent years, neuromodulation for the treatment of functional constipation has gained interest but its role and effectiveness are still unclear. The purpose of this review is to provide a systematic overview on the current literature on the different modalities of neurostimulation and their effect on chronic functional constipation in adults as reported in the literature. Methods : A search in the literature for articles concerning the effect of different types of neuromodulation on constipation was performed in PubMed using extensive search terms for the different modalities of neuromodulation. Studies and trials were checked for eligibility. For all types of neuromodulation together, 27 articles were included. Results : 17 studies were included on SNM (sacral nerve modulation). Although multiple studies show positive results on the effect of SNM in constipation, double-blind crossover RCT’s (randomised controlled trials) showed no significant effect. 3 studies were included for tSNS (transcutaneous sacral nerve stimulation), 2 for PTNS (percutaneous tibial nerve stimulation) and 2 for TTNS (transcutaneous tibial nerve stimulation). Studies and trials on these modalities of neuromodulation reported ambiguous results on statistical significance of the effect. For transcutaneous IFC (interferential current therapy) 2 studies were included, which both reported a statistically significant effect on all outcomes. Conclusion : The beneficial effect of neuromodulation in chronic functional constipation remains questionable. However, neuro-modulation might be worth considering in patients refractory to treatment before turning to more invasive measures. Future research should shed more light on the effects of neuromodulation in constipation.

scholarly journals A novel combined anorectal biofeedback and percutaneous tibial nerve stimulation protocol for treating fecal incontinence

2020 ◽  
Vol 13 ◽  
pp. 175628482091638
Author(s):  
Yoav Mazor ◽  
Gillian M. Prott ◽  
Carol Sequeira ◽  
Michael Jones ◽  
Anastasia Ejova ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Patient Comfort ◽  
Future Research ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Biofeedback Therapy ◽  
Tibial Nerve Stimulation

Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.

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