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Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children
Rebeca Mayara Padilha Rego1, Nilton Carlos Machado2, Mary de Assis Carvalho2
1Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil.
Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS) offers a safe and effective treatment for children with intractable functional constipation. This neuromodulation technique significantly improves bowel function and quality of life, with benefits observed even after treatment cessation.
Area of Science:
- Pediatric Gastroenterology
- Neuromodulation
- Functional Bowel Disorders
Background:
- Functional constipation significantly impacts children's quality of life, causing pain and incontinence.
- Intractable cases often require alternative treatments beyond standard non-pharmacological and pharmacological approaches.
- Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS) is a minimally invasive neuromodulation technique stimulating sacral nerves via ankle electrodes.
Purpose of the Study:
- To assess the clinical effectiveness and applicability of TPTNS as an adjunctive therapy for pediatric functional constipation.
- To evaluate improvements in bowel function and quality of life in children and adolescents receiving TPTNS.
Main Methods:
- A prospective, single-center cohort study involving 36 children diagnosed with functional constipation (Rome IV Criteria).
- Patients underwent TPTNS for 4 or 8 weeks, with assessments at the end of treatment and 4 weeks post-intervention.
- Statistical analysis included Shapiro-Wilk, Wilcoxon, Student's t-test, and McNemar tests.
Main Results:
- 28 patients completed 4 weeks of TPTNS, with 16 extending to 8 weeks.
- Significant improvements were noted in stool consistency, defecation frequency, bowel function scores, and reduced abdominal pain.
- Quality of life, particularly related to bowel habits (lifestyle, behavior, embarrassment), showed substantial enhancement.
- Positive effects were observed early (4 weeks) and sustained post-treatment.
- TPTNS demonstrated good tolerability with a 78% adherence rate and no reported adverse effects.
Conclusions:
- TPTNS is a viable adjuvant treatment for intractable pediatric functional constipation.
- The intervention effectively improves bowel function and enhances patients' quality of life.
- Observed benefits are prompt and demonstrate sustained efficacy even after treatment discontinuation.
