Transcutaneous Posterior Nerve Stimulation inTreatment of Fecal Incontience
Condition: Fecal Incontinence
MeSH terms: Fecal Incontinence
Study type: Interventional

Summary: 
      Shafik and colleagues were the first to report the use of posterior tibial nerve stimulation
      (PTNS) for FI, and they documented improved continence after 4 weeks course. Subsequent
      studies documented percutaneous and transcutaneous PTNS as effective methods for treatment of
      FI, with a short term reduction in incontinence episode by 50-80 %. Percutaneous PTNS (PPTNS)
      showed a greater effect than transcutaneous PTNS (TPTNS) and this may be assumed due to the
      presence of the stimulating electrode very close to the posterior tibial nerve. However,
      TPTNS is more preferable to percutaneous PTNS because of the concern about the insertion of a
      needle may result in stimulation that is sufficient to produce a neuromodulatory effect.
    

Detailed description: 
      Treatment of FNRFI is often difficult and requires prolonged therapies with unexpected
      responses and frequent relapses. The corner-stones in treatment of FNRFI are education,
      positive motivation, and toilet training. Preparation of children and their parents for a
      long-lasting treatment is mandatory with the expectation of many ups and downs. The main goal
      is to have regular bowel movements and normal continence and this can be achieved by teaching
      the child the importance of regular toilet use and avoid urges.

      Many previous studies, reported the short term effect of TPTNS in treatment of FNRFI.
      However, there are sufficient studies evaluating the long term effect of TPNS and this has
      motivated the authors to conduct of this study The aim of this study is to evaluate the Long
      term outcome and quality of life in children with Functional non-retentive fecal incontinence
      and received Bilateral Transcutaneous posterior tibial nerve stimulation therapy.
    

Intervention name(s): Transcutanous Posterior Tibial Nerve Stimulation; Sham Transcutanous Posterior Tibial Nerve Stimulation
Intervention type(s): Device; Device
Intervention description(s): children were managed by bilateral TPTNS following the procedure described in 2006 by Queralto et al(11). A positive auto-adhesive electrode was applied 1.5 inch above the medial malleolus over the S3 dermatome. A second negative electrode was applied just below the same malleolus. Electrical stimulation device (EMS physio Ltd, OX129 F, England) was connected to both electrodes. This device delivers a low frequency current (10 Hz), and the intensity was gradually increased till flexion of the big toe or spread out of the other toes in a fan shape occurred. Then the intensity was lowered to (10 Hz) again to avoid the motor response of the toes. Intensity was determined by the child's sensitivity. The procedure was done for 20-30 minutes and repeated2 times per week for 3 months; Sham transcutaneous stimulation Patients also had twice-weekly 20-30-min sessions for 3 months. The same self-adhesive electrodes as used for group A were employed, placed in a similar position. The stimulator was briefly switched on for 30 s to induce only a minor electrical sensation in the skin, and was then turned off for the rest of the treatment. This short duration was given for only for a few seconds to avoid lower limb stimulation. Patients in all TWO groups were told that they may or may not have any perception of the electrical stimulation. Without prior knowledge of what to expect from treatment, this enabled the sham group to act as a control. In order to improve on the blinding effect of the study, the electronic display window of the stimulators was shielded from the patients in the TWO groups. All patients underwent therapy in individual screened cubicles to prevent comparison between patients of the treatment being administered.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The current single-blind randomized controlled study included 102 children with FNRF who were randomly allocated into two groups. Group 1, Bilateral transcutaneous posterior tibial nerve stimulation and group B, Sham TPTNS. Inclusion criteria included those with FI and normal defecation frequency, normal bowel habits and stool consistency. Children younger than 4 years or those who are not cooperative, or those with traumatic sphincter injury, fecal impaction, spinal diseases causing incontinence, anorectal malformation, were excluded from the study.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Posterior Tibial Nerve Stimulation; Fecal Incontinence; Long Term Effect