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Bilateral Transcutaneous Posterior Tibial Nerve Stimulation for the Treatment of Fecal Incontinence

Thomas, Gregory P. M.R.C.S.; Dudding, Thomas C. F.R.C.S.; Nicholls, R. J. F.R.C.S.; Vaizey, Carolynne J. F.R.C.S.

doi: 10.1097/DCR.0b013e31829bf940
Original Contributions: Pelvic Floor
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BACKGROUND: Unilateral posterior tibial nerve stimulation has been shown to improve fecal incontinence in the short term. Posterior tibial nerve stimulation is believed to work by stimulation of the ascending afferent spinal pathways. Bilateral stimulation may activate more of these pathways. This may lead to an improved therapeutic effect.

OBJECTIVE: The aim of this study was to assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation for fecal incontinence.

DESIGN: This was a single-group pilot prospective study.

SETTING: The study was conducted from June 2012 to September 2012 at the authors’ institution.

PATIENTS: Twenty patients with fecal incontinence were recruited consecutively. Conservative therapy had failed to improve the fecal incontinence in all 20 patients.

INTERVENTION: All patients received 30 minutes of daily bilateral stimulation for 6 weeks. The bilateral stimulation was administered by each patient at home. No further stimulation was given after 6 weeks, and the patients were followed up until their symptoms returned to the prestimulation state (baseline).

MAIN OUTCOME MEASURE: The primary outcome measure was a change in the frequency of incontinent episodes per week.

RESULTS: Seventeen patients completed 6 weeks of treatment. Two patients achieved complete continence. Ten (59%) achieved a ≥50% reduction in frequency of incontinent episodes. Overall, there was a significant reduction in median (interquartile range) frequency of incontinent episodes per week of 6 (8.25) to 2 (7.25) (p = 0.03). There was a significant improvement in the ability to defer defecation from 3 (4) to 5 (8) minutes (p = 0.03). There was no change in the St Mark's incontinence score. One domain of the Rockwood fecal incontinence quality-of-life score and of the Medical Outcomes Study Short Form 36 score improved significantly.

LIMITATIONS: This study was limited by its small size and its lack of blinding and control.

CONCLUSIONS: Bilateral transcutaneous posterior tibial nerve stimulation appears to be a cheap and effective treatment for fecal incontinence. It can easily be used by the patient at home.

The Sir Alan Parks Department of Physiology, St Mark’s Hospital and Academic Institute, Harrow, United Kingdom

Funding/Support: Funding for this study was provided by the St Mark’s Hospital Foundation (registered charity number 1140930).

Financial Disclosure: None reported.

Presented at the meeting of the Royal Society of Medicine, London, UK, January 23, 2013.

Correspondence: Carolynne J. Vaizey, F.R.C.S., The Sir Alan Parks Department of Physiology, St Mark’s Hospital and Academic Institute, Watford Rd, Harrow, HA1 3UJ, United Kingdom. E-mail: cvaizey@nhs.net.

© 2013 The American Society of Colon and Rectal Surgeons