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Parasacral transcutaneous electrical nerve stimulation for overactive bladder in constipated children: The role of
Maria Luiza Veiga1, Elen Veruska Costa1, Inaah Portella1
1CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
Insights
Parasacral transcutaneous electrical nerve stimulation (TENS) effectively treats overactive bladder (OAB) and constipation in children. However, OAB improvement was not directly linked to constipation resolution with TENS therapy.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Neuromodulation
Background:
- Parasacral transcutaneous electrical nerve stimulation (TENS) is recognized for treating overactive bladder (OAB) and accelerating bowel transit.
- TENS shows promise in resolving lower urinary tract symptoms (LUTS) and constipation in pediatric populations.
- A potential link between TENS's efficacy in OAB and its effect on constipation warrants investigation.
Purpose of the Study:
- To investigate whether the positive effects of parasacral TENS on OAB in children are a direct result of improved constipation.
- To test the hypothesis that constipation resolution mediates TENS's therapeutic impact on OAB.
Main Methods:
- A prospective study involving children diagnosed with idiopathic OAB.
- Children received 20 sessions of parasacral TENS (20 min each, three times weekly).
- Constipation was diagnosed using Rome III criteria; no dietary or pharmaceutical interventions for constipation were implemented.
Main Results:
- Parasacral TENS demonstrated efficacy in improving both OAB symptoms and constipation.
- Pre-treatment constipation severity did not correlate with OAB symptom resolution.
- No significant association was found between the resolution of constipation and the resolution of OAB following TENS treatment.
Conclusions:
- Parasacral TENS improved OAB symptoms, including urgency and urge incontinence, in both constipated and non-constipated children.
- No statistically significant difference in urinary symptom improvement was observed between constipated and non-constipated groups.
- The resolution of OAB symptoms was independent of constipation improvement with parasacral TENS.
Background:
Parasacral transcutaneous electrical nerve stimulation (TENS) is an effective method for the treatment of overactive bladder (OAB), and, additionally, it accelerates bowel transit time. Therefore, not only does parasacral transcutaneous electrical nerve stimulation (TENS) improve lower urinary tract symptoms (LUTS), but it also resolves the problem of constipation in a significant number of children. Since TENS has a positive effect on LUTS and on the symptoms of fecal retention, it is possible that its action regarding OAB could be directly associated with the improvement in constipation. In other words, the positive effect of parasacral TENS in OAB would be because constipation was resolved. The objective of this study was to test that hypothesis.
Objective:
To test the hypothesis that the positive effect of parasacral TENS in OAB would be because constipation had improved with this method.
Study Design:
In this prospective study, children with OAB alone were submitted to parasacral TENS. The inclusion criteria consisted of children with idiopathic OAB alone The Rome III criteria for children of 4-18 years of age were used to diagnose constipation. All the children were treated with 20 sessions of parasacral TENS applied for 20 min, three times weekly on alternating days (Figure). No instructions were given to the participants with respect to diet, laxatives, or pharmaceutical treatment for constipation throughout the study period. None of the patients used anticholinergics. Standard urotherapy was prescribed.
Results:
Parasacral TENS improves OAB and constipation. The presence of constipation before treatment was not associated with a poorer prognosis insofar as the resolution of the symptoms of OAB was concerned. Likewise, there was no association between the resolution of constipation with parasacral TENS and the resolution of OAB.
Conclusion:
There was no statistically significant difference in urinary symptoms between the constipated and nonconstipated children. There was an improvement in urgency, urge incontinency and in holding maneuvers in both the constipated and non-constipated children; however, there was no significant improvement in enuresis. The resolution of OAB was not associated with the resolution of constipation and vice versa.
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