Transcutaneous Tibial Nerve Stimulation as Therapy for Functional Constipation.

Area of Science:

• Gastroenterology
• Neurology
• Physical Medicine and Rehabilitation

Background:

• Functional constipation is a prevalent condition often resistant to standard treatments like diet, exercise, and medication.
• Neuromodulation techniques, particularly nerve stimulation, show promise for managing treatment-resistant constipation.
• Bilateral transcutaneous tibial nerve stimulation (TTNS) offers a noninvasive approach to neuromodulation.

Purpose of the Study:

• To evaluate the efficacy of bilateral transcutaneous tibial nerve stimulation (TTNS) as a noninvasive treatment for functional constipation.
• To assess the impact of TTNS on symptom severity and medication use in patients with functional constipation.

Main Methods:

• 105 patients diagnosed with functional constipation (Rome IV criteria) were enrolled.
• Bilateral TTNS was administered for 6 weeks (3 sessions/week, ≥30 minutes/session).
• Constipation Severity Instrument (CSI) scores, toilet time, and softener use were assessed pre-treatment, at 6 weeks, and at 12 weeks.

Main Results:

• TTNS significantly reduced the time patients spent in the toilet.
• Symptom severity, including obstructive defecation, colonic inertia, and pain, showed significant improvement (P < .001).
• The use of laxative softeners decreased from 76.2% to 20% (P < .001), with effects persisting for 12 weeks.

Conclusions:

• Bilateral TTNS is a safe, noninvasive, and effective treatment for functional constipation, even in cases resistant to standard care.
• The positive effects of TTNS on constipation symptoms are sustained post-treatment.
• Further large-scale randomized controlled trials are warranted to establish TTNS as a mainstream alternative therapy.