Journal
NEUROMODULATION
Volume 19, Issue 5, Pages 515-521Publisher
WILEY
DOI: 10.1111/ner.12451
Keywords
chronic constipation; interferential current; neuromodulation; paediatric
Funding
- Australian National Health and Medical Research Council [1023095]
- Victorian Government Operational Infrastructure Program of the Murdoch Children's Research Institute
- Fonds de Derfectionnement du Departement Medico-Chirugical de Pediatrie
- Fonds de Service
- Service de Chirurgie Pediatrique
- SICPA
- Societe Academique Vaudoise, Switzerland
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- National Health and Medical Research Council, Australia
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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 3 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.
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