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Home Transcutaneous Electrical Stimulation Therapy to Treat Children With Anorectal Retention: A Pilot Study
Yee Ian Yik1,2,3, Lefteris Stathopoulos1,4, John M Hutson1,2,5
1Gut Motility Laboratory, Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
Insights
Transcutaneous electrical stimulation (TES) improved constipation symptoms in children with anorectal issues. This treatment increased bowel movements and reduced soiling, enhancing quality of life.
Area of Science:
- Pediatric Gastroenterology
- Neuromodulation
- Constipation Management
Background:
- Chronic constipation affects many children, with some cases resistant to standard treatments.
- Slow-Transit Constipation (STC) and anorectal dysfunction are key diagnostic considerations.
- Transcutaneous electrical stimulation (TES) has shown promise in improving defecation in adults and children with STC.
Purpose of the Study:
- To evaluate the efficacy of TES in improving bowel movements and soiling in children with chronic constipation.
- To assess TES as a treatment for children with constipation and isolated anorectal transit delay, excluding STC.
- To determine if TES can improve quality of life in this pediatric patient group.
Main Methods:
- A pilot study involving children with treatment-resistant constipation and anorectal holdup confirmed by nuclear transit study (NTS).
- Home-based TES administered for 1 hour daily over 3 months, alongside existing laxative treatments.
- Evaluation through daily continence diaries and PedsQL 4.0 quality-of-life questionnaires before and after intervention.
Main Results:
- Nine out of ten children experienced an increase in defecation frequency (mean 0.9 to 4.1 BM/week, p=0.004).
- Soiling episodes significantly reduced from 5.9 to 1.9 days/week (p=0.004) in 90% of participants.
- Quality of life scores improved to normal ranges, and 90% of children reduced or stopped laxative use.
Conclusions:
- TES is a viable treatment option for children suffering from treatment-resistant constipation with isolated anorectal holdup.
- The study indicates TES can significantly improve key constipation symptoms and quality of life.
- Further randomized controlled trials (RCTs) are recommended to confirm these findings in a larger pediatric population.
Aim:
As transcutaneous electrical stimulation (TES) increased defecation in children and adults with Slow-Transit Constipation (STC), we performed a pilot study to test if TES can improve symptoms (defecation and soiling) in children with chronic constipation without STC and transit delay in the anorectum.
Methods:
Children with treatment-resistant constipation presenting to a tertiary hospital had gastrointestinal nuclear transit study (NTS) showing normal proximal colonic transit and anorectal holdup of tracer. TES was administered at home (1 hour/day for 3 months) using a battery-powered interferential stimulator, with four adhesive electrodes (4 × 4 cm) connected so currents cross within the lower abdomen at the level of S2-S4. Stimulation was added to existing laxatives. Daily continence diary, and quality-of-life questionnaires (PedsQL4.0) were compared before and after TES.
Results:
Ten children (4 females: 5-10 years, mean 8 years) had holdup in the anorectum by NTS. Nine had <3 bowel motions (BM)/week. After three months TES, defecation frequency increased in 9/10 (mean 0.9-4.1 BM/week, p = 0.004), with 6/9 improved to ≥3 BM/week. Soiling reduced in 9/10 from 5.9 to 1.9 days/week with soiling, p = 0.004. Ten were on laxatives, and nine reduced/stopped laxative use. Quality-of-life improved to within the normal range.
Conclusion:
TES improved symptoms of constipation in >50% of children with treatment-resistant constipation with isolated holdup in the anorectum. Further studies (RCTs) are warranted in these children.
