Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children
Background: Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child’s quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interve...
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MDPI AG
2024-01-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/12/1/164 |
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| author | Rebeca Mayara Padilha Rego Nilton Carlos Machado Mary de Assis Carvalho Johann Souza Graffunder Crhistiano Fraguas Erika Veruska Paiva Ortolan Pedro Luiz Toledo de Arruda Lourenção |
| author_facet | Rebeca Mayara Padilha Rego Nilton Carlos Machado Mary de Assis Carvalho Johann Souza Graffunder Crhistiano Fraguas Erika Veruska Paiva Ortolan Pedro Luiz Toledo de Arruda Lourenção |
| author_sort | Rebeca Mayara Padilha Rego |
| collection | DOAJ |
| description | Background: Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child’s quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. Aim: To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. Methods: Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro–Wilk test. The Wilcoxon test and Student’s <i>t</i>-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. Results: Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. Conclusions: TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation. |
| first_indexed | 2024-03-08T09:56:58Z |
| format | Article |
| id | doaj.art-867792c3c34b4ab0ab36360d6f1e3476 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-08T09:56:58Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-867792c3c34b4ab0ab36360d6f1e34762024-01-29T13:47:39ZengMDPI AGBiomedicines2227-90592024-01-0112116410.3390/biomedicines12010164Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in ChildrenRebeca Mayara Padilha Rego0Nilton Carlos Machado1Mary de Assis Carvalho2Johann Souza Graffunder3Crhistiano Fraguas4Erika Veruska Paiva Ortolan5Pedro Luiz Toledo de Arruda Lourenção6Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilDepartment of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilDepartment of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilBotucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilDr. José Bahia Sapucaia Private Clinic, Salvador 41830-492, BA, BrazilDepartment of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilDepartment of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, BrazilBackground: Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child’s quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. Aim: To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. Methods: Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro–Wilk test. The Wilcoxon test and Student’s <i>t</i>-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. Results: Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. Conclusions: TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation.https://www.mdpi.com/2227-9059/12/1/164constipationtranscutaneous electric nerve stimulationchildadolescent |
| spellingShingle | Rebeca Mayara Padilha Rego Nilton Carlos Machado Mary de Assis Carvalho Johann Souza Graffunder Crhistiano Fraguas Erika Veruska Paiva Ortolan Pedro Luiz Toledo de Arruda Lourenção Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children Biomedicines constipation transcutaneous electric nerve stimulation child adolescent |
| title | Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children |
| title_full | Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children |
| title_fullStr | Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children |
| title_full_unstemmed | Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children |
| title_short | Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children |
| title_sort | transcutaneous posterior tibial nerve stimulation an adjuvant treatment for intractable constipation in children |
| topic | constipation transcutaneous electric nerve stimulation child adolescent |
| url | https://www.mdpi.com/2227-9059/12/1/164 |
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