Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation
Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sac...
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| Veröffentlicht in: | European journal of pediatrics 2023-03, Vol.182 (3), p.1309-1315 |
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| creator | Velasco-Benitez, Carlos Villamarin, Eder Mendez, Melissa Linero, Alfredo Hungria, Gregory Saps, Miguel |
| description | Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children. Single-center, prospective interventional study. Children 4–14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). Twenty completed the study (4–14 years), (8.4 ± 3.2 years, 71.4% female). We found significant improvement in the consistency of bowel movements (BM) (
p
= 0.005), fecal incontinence (FI) (
p
= 0.005), abdominal pain presence (
p
= |
| doi_str_mv | 10.1007/s00431-022-04798-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9838342</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2765775930</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-abe97534de851d8aaee910e84e5b631c944ad0ec876c3c68b963d3e561efe5383</originalsourceid><addsrcrecordid>eNp9kUlLxTAUhYMozn_AhRTcuKkmTZphI4g4geBGwV1I01uN9CXPpFX89-ZZ54WrBM53Tu7NQWiH4AOCsThMGDNKSlxVJWZCyfJlCa0TRquSYMGXf9zX0EZKjzibFJGraI1yTkXNyDq6O-06Z419LUJXDNH4ZMfBeAhjKuYhDRBdiMXgGmf6wkN8hiINbjb2ZnDBF84X3ejt4p51G3wW5-_SFlrpTJ9g--PcRLdnpzcnF-XV9fnlyfFVaZlgQ2kaUKKmrAVZk1YaA6AIBsmgbjglVjFmWgxWCm6p5bJRnLYUak6gg5pKuomOptz52MygteDzFr2eRzcz8VUH4_RvxbsHfR-etZLZzaocsP8REMPTCGnQM5cs9P30C7oSvBaiVhRndO8P-hjGmDdfUDJDlWKLiaqJsjGkFKH7GoZgvShOT8XpXJx-L06_ZNPuzzW-LJ9NZYBOQMqSv4f4_fY_sW_-6qdJ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2787752948</pqid></control><display><type>article</type><title>Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Velasco-Benitez, Carlos ; Villamarin, Eder ; Mendez, Melissa ; Linero, Alfredo ; Hungria, Gregory ; Saps, Miguel</creator><creatorcontrib>Velasco-Benitez, Carlos ; Villamarin, Eder ; Mendez, Melissa ; Linero, Alfredo ; Hungria, Gregory ; Saps, Miguel</creatorcontrib><description>Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children. Single-center, prospective interventional study. Children 4–14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). Twenty completed the study (4–14 years), (8.4 ± 3.2 years, 71.4% female). We found significant improvement in the consistency of bowel movements (BM) (
p
= 0.005), fecal incontinence (FI) (
p
= 0.005), abdominal pain presence (
p
= < 0.001) and intensity (
p
= 0.005), and a significant for improvement in blood in stools (
p
= 0.037). There was 86.3% improvement in abdominal pain. 96.7% reported treatment satisfaction. Only one child required rescue therapy.
Conclusion:
We found significant improvement in stool consistency, FI, abdominal pain, and hematochezia. This suggests that transcutaneous PTNS could be a promising noninvasive treatment for FC in children. Large studies are needed.
What is Known:
• Functional constipation is one of the most common disorders in children.
• Current management of functional constipation consists of an integrative approach that includes medications, diet and behavioral strategies.
What is New:
• Posterior tibial nerve stimulation is a novel noninvasive and easy to use therapy that can improve stool consistency, fecal incontinence and blood in stools.</description><identifier>ISSN: 1432-1076</identifier><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-022-04798-w</identifier><identifier>PMID: 36637541</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdomen ; Abdominal Pain ; Ankle ; Botulinum toxin ; Child ; Children ; Constipation ; Constipation - therapy ; COVID-19 ; Fecal incontinence ; Fecal Incontinence - therapy ; Feces ; Female ; Gastroenteritis ; Humans ; Male ; Medicine ; Medicine & Public Health ; Pain ; Pediatrics ; Prospective Studies ; Quality of Life ; Sacrum ; Tibial nerve ; Tibial Nerve - physiology ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome</subject><ispartof>European journal of pediatrics, 2023-03, Vol.182 (3), p.1309-1315</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-abe97534de851d8aaee910e84e5b631c944ad0ec876c3c68b963d3e561efe5383</citedby><cites>FETCH-LOGICAL-c474t-abe97534de851d8aaee910e84e5b631c944ad0ec876c3c68b963d3e561efe5383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00431-022-04798-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00431-022-04798-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36637541$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Velasco-Benitez, Carlos</creatorcontrib><creatorcontrib>Villamarin, Eder</creatorcontrib><creatorcontrib>Mendez, Melissa</creatorcontrib><creatorcontrib>Linero, Alfredo</creatorcontrib><creatorcontrib>Hungria, Gregory</creatorcontrib><creatorcontrib>Saps, Miguel</creatorcontrib><title>Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children. Single-center, prospective interventional study. Children 4–14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). Twenty completed the study (4–14 years), (8.4 ± 3.2 years, 71.4% female). We found significant improvement in the consistency of bowel movements (BM) (
p
= 0.005), fecal incontinence (FI) (
p
= 0.005), abdominal pain presence (
p
= < 0.001) and intensity (
p
= 0.005), and a significant for improvement in blood in stools (
p
= 0.037). There was 86.3% improvement in abdominal pain. 96.7% reported treatment satisfaction. Only one child required rescue therapy.
Conclusion:
We found significant improvement in stool consistency, FI, abdominal pain, and hematochezia. This suggests that transcutaneous PTNS could be a promising noninvasive treatment for FC in children. Large studies are needed.
What is Known:
• Functional constipation is one of the most common disorders in children.
• Current management of functional constipation consists of an integrative approach that includes medications, diet and behavioral strategies.
What is New:
• Posterior tibial nerve stimulation is a novel noninvasive and easy to use therapy that can improve stool consistency, fecal incontinence and blood in stools.</description><subject>Abdomen</subject><subject>Abdominal Pain</subject><subject>Ankle</subject><subject>Botulinum toxin</subject><subject>Child</subject><subject>Children</subject><subject>Constipation</subject><subject>Constipation - therapy</subject><subject>COVID-19</subject><subject>Fecal incontinence</subject><subject>Fecal Incontinence - therapy</subject><subject>Feces</subject><subject>Female</subject><subject>Gastroenteritis</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pain</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Sacrum</subject><subject>Tibial nerve</subject><subject>Tibial Nerve - physiology</subject><subject>Transcutaneous Electric Nerve Stimulation</subject><subject>Treatment Outcome</subject><issn>1432-1076</issn><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUlLxTAUhYMozn_AhRTcuKkmTZphI4g4geBGwV1I01uN9CXPpFX89-ZZ54WrBM53Tu7NQWiH4AOCsThMGDNKSlxVJWZCyfJlCa0TRquSYMGXf9zX0EZKjzibFJGraI1yTkXNyDq6O-06Z419LUJXDNH4ZMfBeAhjKuYhDRBdiMXgGmf6wkN8hiINbjb2ZnDBF84X3ejt4p51G3wW5-_SFlrpTJ9g--PcRLdnpzcnF-XV9fnlyfFVaZlgQ2kaUKKmrAVZk1YaA6AIBsmgbjglVjFmWgxWCm6p5bJRnLYUak6gg5pKuomOptz52MygteDzFr2eRzcz8VUH4_RvxbsHfR-etZLZzaocsP8REMPTCGnQM5cs9P30C7oSvBaiVhRndO8P-hjGmDdfUDJDlWKLiaqJsjGkFKH7GoZgvShOT8XpXJx-L06_ZNPuzzW-LJ9NZYBOQMqSv4f4_fY_sW_-6qdJ</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Velasco-Benitez, Carlos</creator><creator>Villamarin, Eder</creator><creator>Mendez, Melissa</creator><creator>Linero, Alfredo</creator><creator>Hungria, Gregory</creator><creator>Saps, Miguel</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230301</creationdate><title>Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation</title><author>Velasco-Benitez, Carlos ; 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However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children. Single-center, prospective interventional study. Children 4–14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). Twenty completed the study (4–14 years), (8.4 ± 3.2 years, 71.4% female). We found significant improvement in the consistency of bowel movements (BM) (
p
= 0.005), fecal incontinence (FI) (
p
= 0.005), abdominal pain presence (
p
= < 0.001) and intensity (
p
= 0.005), and a significant for improvement in blood in stools (
p
= 0.037). There was 86.3% improvement in abdominal pain. 96.7% reported treatment satisfaction. Only one child required rescue therapy.
Conclusion:
We found significant improvement in stool consistency, FI, abdominal pain, and hematochezia. This suggests that transcutaneous PTNS could be a promising noninvasive treatment for FC in children. Large studies are needed.
What is Known:
• Functional constipation is one of the most common disorders in children.
• Current management of functional constipation consists of an integrative approach that includes medications, diet and behavioral strategies.
What is New:
• Posterior tibial nerve stimulation is a novel noninvasive and easy to use therapy that can improve stool consistency, fecal incontinence and blood in stools.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36637541</pmid><doi>10.1007/s00431-022-04798-w</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 1432-1076 0340-6199 1432-1076 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdomen Abdominal Pain Ankle Botulinum toxin Child Children Constipation Constipation - therapy COVID-19 Fecal incontinence Fecal Incontinence - therapy Feces Female Gastroenteritis Humans Male Medicine Medicine & Public Health Pain Pediatrics Prospective Studies Quality of Life Sacrum Tibial nerve Tibial Nerve - physiology Transcutaneous Electric Nerve Stimulation Treatment Outcome |
| title | Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation |
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