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Transcutaneous Sacral Electrical Stimulation for Chronic Functional Constipation
Fareed Iqbal1, Gregory P Thomas, Emile Tan
11 St Mark's Hospital & Academic Institute, Sir Alan Parks' Physiology Unit, Harrow, United Kingdom 2 Department of Surgery and Cancer, Imperial College London, South Kensington Campus, United Kingdom 3 Department of Surgery, Chelsea and Westminster Hospital, Fulham Road, London, United Kingdom.
Background:
Transcutaneous sacral nerve stimulation is reported to improve symptoms of fecal incontinence. Chronic constipation may also respond to stimulation, but this is poorly reported in the literature.
Objective:
The study assessed the efficacy of transcutaneous electrical stimulation directly over the sacral nerve roots in chronic constipation.
Patients:
Chronic functional constipation was established in all patients using the Rome III criteria.
Setting:
The therapy was self-administered at home.
Design/Intervention:
A pilot study was conducted of transcutaneous sacral stimulation given over a 4-week period for 12 hours a day.
Main Outcome Measures:
Patients were assessed using the Patient Assessment of Constipation Symptoms, the Patient Assessment of Constipation Quality of Life, and the Cleveland constipation tool. A Global Rating of Change measure and a 1-week bowel diary was kept for the final week and compared with baseline.
Results:
Of the 20 patients recruited (16 female, median age 38.5 years), 80% (16) completed the trial. Five (31%) patients reported at least a point reduction in the Patient Assessment of Constipation Symptoms score, 4 (25%) deteriorated, and 7 (44%) improved by less than one point. Median (interquartile range) Patient Assessment of Constipation Symptoms scores were 2.33 (2.34) at baseline and 2.08 (2.58) at follow-up (p = 0.074). Median scores for the Patient Assessment of Constipation Quality of Life and Cleveland systems were 3.00 (1.64) and 17.15 (18) at baseline and 2.22 (3.04) and 15.31 (12) at follow-up (p = 0.096 and 0.111). One-third of patients reported a positive Global Rating of Change measure, although 68% required concurrent laxatives during the trial.
Limitations:
This is a pilot study and is limited by its small sample size.
Conclusions:
Continuous transcutaneous sacral stimulation in the short term appears to be ineffective for chronic constipation. Larger well-powered studies with intermittent stimulation regimens are required to investigate this further.
