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Neurogastroenterology/motility
A prospective single blinded placebo controlled study into the role of percutaneous and transcutaneous tibial nerve stimulation for faecal incontinence
  1. A George *1,2,
  2. K Kalmar1,
  3. S Sala2,
  4. K Kokopoulis2,
  5. A Panarese2,
  6. R J Nicholls2,
  7. C J Vaizey1
  1. 1Physiology, St Mark's Hospital, London, UK
  2. 2Colorectal Surgery, St Mark's Hospital, London, UK

Abstract

Introduction Posterior tibial nerve stimulation (PTNS) is a safe and effective treatment1 2 for faecal incontinence (FI) but it is not known whether percutaneous or transcutaneous routes of stimulation are better. The efficacy of PTNS was assessed in a prospective randomised placebo-controlled trial.

Methods Patients who had failed conservative treatment for FI were blinded and randomised to one of the three forms of stimulation: Group 1: Percutaneous, Group 2: Transcutaneous, Group 3: Sham transcutaneous. All patients had a 2 week baseline assessment of symptoms. Patients in Group 1 and Group 2 received 30 min sessions of PTNS twice weekly for 6 weeks. In Group 3 transcutaneous electrodes were placed but no stimulation was delivered. All patients were assessed blind at 6 weeks; unblinded and followed up after a further 1 month to assess symptoms. Treatment success was defined as > 50% reduction in weekly episodes of faecal incontinence following the 6 weeks of PTNS when compared to baseline symptoms.

Results Thirty patients (M:F 2:28) were included in the study.

Nine (82%) of 11 patients in Group 1, 5 (45%) of 11 in Group 2 and 1 (12.5%) of 8 in Group 3 had a more than 50% reduction in weekly episodes of FI at the end of the 6 week study phase (table 1). Patients also showed an improvement in their ability to defer defecation and in the St Mark's Continence scores pre and post treatment.

Table 1

PWE-071

The improved continence observed in the above patients of all the 3 groups was sustained at the 1 month post study follow-up.

There were no complications observed in any patient.

Conclusion This study demonstrates the efficacy of PTNS as a treatment option for FI in the short term.

  • fecal incontinence
  • Percutaneous tibial nerve stimulation
  • tibial nerve stimulation
  • transcutaneous tibial nerve simulation

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Footnotes

  • Competing interests None.

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