Percutaneous tibial nerve stimulation (PTNS) with pelvic floor exercise (PFE) is safe and efficacious for treating childhood constipation, especially for patients with pelvic floor dysfunction, according to study findings published in The American Journal of Gastroenterology.
Researchers conducted a randomized, double-blind controlled trial to assess the safety and efficacy of PTNS and PFE in treating children with intractable constipation. Patients underwent machine-assisted PFE with progressive resistance training for 15 minutes twice a day for 4 weeks. Data was collected using electromyography biofeedback from an electrode that was inserted through the anus of participants. PTNS used the same instrument as PFE, with an electrode placed behind the unilateral lower limb of the patient, 8 to 10 cm above the malleolus medialis. The current was applied for 15 minutes twice daily.
Study participants were aged 4 to 14 years and were admitted to the Constipation Clinic of Shengjing Hospital of China Medical University. Of the 545 eligible patients screened, 84 were included in the final analysis.
Participants were divided into 2 groups: the PFE and PTNS group and the PFE and PTNS control group. PFE was consistent between both groups, and the PTNS control group received anterior instep stimulation in place of the standard PTNS treatment.
The primary outcome was the change in spontaneous bowel movements (SBM) per week from baseline to the end of treatment. Secondary outcomes were large-diameter or scybalous stools, painful bowel movements, excessive volitional stool retention, and encopresis.
Full remission was defined by at least 3 SBM per week and most of the secondary outcomes recovered. Improvement was characterized by at least 3 SBM per week and 1 secondary outcome recovered.
A total of 75 patients completed the trial, with 38 patients remaining in the treatment group and 37 in the control group.
At the end of the trial, 29 patients in the treatment group and 15 patients in the control group had at least 3 SBM per week. The effectiveness rate was 69.0% (29/42) in the PTNS with PFE group and 35.7% (15/42) in the control PTNS with PFE group, with a net difference of 33.3% (95% CI, 13.2%-53.5%; risk ratio [RR], 3.000 [95% CI, 1.612-5.585]; P <0.05).
At the 12-week follow-up, the effectiveness rate was 61.9% (26/42) in the PTNS with PFE group and 35.7% (15/42) in the control PTNS with PFE group, with a net difference of 26.2% (95% CI, 5.6%-46.8%; RR, 2.750 [95% CI, 1.384-5.466]; P <0.05).
Of the 75 patients who completed the treatment, pelvic floor dysfunction remission was documented in 49 children (78.6% [33/42] in the treatment group and 38.1% [16/42] in the control group; RR, 2.063 [95% CI, 1.360-3.128]; P <0.05).
Study limitations are the subjective evaluation of symptoms and the placebo effect.
“In this study, only PFD was assessed; the effect of colonic function was not considered,” the study authors stated. “Therefore, the treatment of constipation still needs an individualized treatment based on a comprehensive evaluation.”
Yu ZT, Song JM, Qiao L, et al. A randomized, double-blind, controlled trial of percutaneous tibial nerve stimulation with pelvic floor exercises in the treatment of childhood constipation. Am J Gastroenterol. Published online February 3, 2023. doi:10.14309/ajg.0000000000002188