Electrotherapy in pediatric patients with non-neurological pelvic floor dysfunctions: A systematic review

"Pelvic floor dysfunctions in children, such as enuresis, encopresis, and bladder dysfunction, significantly affect both children and their families. Traditional treatments include behavioral therapies, pharmacological approaches, and physiotherapy. In recent years, the use of electrotherapy, specifically transcutaneous electrical nerve stimulation (TENS), has emerged as a promising non-invasive option for treating urinary and fecal dysfunctions, demonstrating effectiveness in reducing symptoms of overactive bladder, enuresis, and constipation. The aim of this systematic review is to determine the efficacy of electrotherapy in any of its applications and classifications by low, medium or high frequency emission frequency for the treatment of pelvic floor dysfunctions in pediatric patients without neurological pathologies. The most commonly used parameterisation is analysed, as well as its effect on the reduction of faecal and urinary incontinence and its use as an alternative or complement to conventional treatments such as behavioural therapy and pharmacology.

This systematic review adhered to PRISMA guidelines. A literature search was conducted using PubMed, PEDro, and Cochrane databases, focusing on clinical trials published in the last 10 years. Inclusion criteria targeted pediatric patients with non-neurological pelvic floor dysfunctions. Studies involving acupuncture or incomplete data were excluded and also articles below a score of 5 on the PEDro scale.

Eleven studies met the inclusion criteria, involving 495 pediatric participants aged 3-18 years. The studies primarily explored TENS, percutaneous TENS (PTENS), and interferential current stimulation (IFS). Sessions were conducted 2-3 times per week over 3 months, with frequencies ranging from 10 to 55 Hz. Electrodes were predominantly placed externally over the sacral area (S2-S3). Significant improvements were observed in experimental groups, including reduced incontinence, increased bladder capacity, and enhanced quality of life, though one study reported no significant changes.

The reviewed studies highlight the effectiveness of TENS and related techniques for pelvic floor dysfunctions in children. TENS parameters, such as 10 Hz frequency and sacral electrode placement, showed consistent results for urinary and fecal incontinence. Combining TENS with biofeedback or urotherapy further improved outcomes. Despite positive results, disparities remain in session duration and frequency. Further research is needed to refine protocols and confirm long-term effects.

TENS, biofeedback, and behavioral therapies, either independently or combined, are effective, non-invasive treatments for pediatric pelvic floor dysfunctions. These interventions offer a viable alternative to pharmacological methods, though complete symptom resolution remains rare.