Gastrointestinal Disorders
Home Transcutaneous Electrical Stimulation Therapy to Treat Children With Anorectal Retention: A Pilot Study

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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 × 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.

Section snippets

INTRODUCTION

Constipation in children is common and symptoms vary from mild and short-lived to severe and chronic. Symptoms such as fecal incontinence, fecal impaction and abdominal pain can persist despite treatment. Current treatments of adults and children with chronic constipation include dietary modifications, laxatives, and behavioral training (1,2), but chronic constipation can persist into adulthood in one third of children, despite medical treatment (3).

Colonic transit is used to categorize

Patient Group

This was a pilot study of children with chronic constipation carried out in a tertiary pediatric centre after institutional Ethics Committee approval (HREC 30029A). For inclusion children had chronic constipation for more than six months (Table 1) and had been referred to surgeons after failure of multiple medical treatments by paediatricians or gastroenterologists. Initial assessment ruled out organic causes of constipation. All were on 1–4 classes of laxatives (Table 1) on presentation.

From

RESULTS

Demographics of each patient and the group is shown in Table 1. Mean (SD) age at diagnosis of AR was 7.8 ± 1.8 years. Mean (SD) symptom duration was 4.6 ± 1.0 years. Three children had delayed passage of meconium at birth. All ten children used laxatives before the study. Two used 1 subclass, six used 2–3 subclasses, and two used 4 subclasses without success in overcoming their constipation. All had straining to defecate. Before stimulation, nine patients had <3 BM/week (0.9 ± 0.8/week). Five

DISCUSSION

This pilot study suggests that TES could improve bowel function in children with AR. After three months of TES for 1 hour/day, 9/10 children had an increased defecation frequency (6 to ≥ 3 BM/wk), decreased fecal incontinence and increased quality of life. Nine children were able to reduce or stop their laxative medication and there was improvement in their quality-of-life into normal range. We thus observed a significant clinical improvement in bowel function. There was a trend to increased

LIMITATIONS

This pilot study has several limitations and hence cannot answer several issues about the efficacy of TES. The patient group is small and the duration of follow-up is short. Efficacy of TES needs to be assessed over a longer time frame and in larger randomized control trials. The mechanisms of action of interferential currents are still unclear. Electrical stimulation could modulate the activity of sensory and motor spinal nerves, sympathetic and parasympathetic nerves, and nerves of the

Acknowledgements

We would like to thank Duncan Veysey for performing the transit studies and Prof David Cook for diagnosis. Thank you to Yee Ling Yik for drawing Fig. 1. A PhD Scholarship from the Malaysian Government supported Yee Ian Yik. This work was presented as an abstract and poster presentation at American Gastroenterology Association, DDW 2013.

Authorship Statements

This work was performed by Yee Ian Yik as part of his PhD study. Bridget Southwell and John Hutson supervised Yee Ian Yik. The Medical Imaging Department at The

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    For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/WileyCDA/Section/id-301854.html

    Source(s) of financial support: Bridget Southwell was supported by an Australian National Health and Medical Research Council Senior Research Fellowship (1023095). This project was also supported by the Victorian Government Operational Infrastructure Program support of the Murdoch Children’s Research Institute. Lefteris Stathopoulos was supported by grants from Fonds de Derfectionnement du Departement Medico-Chirugical de Pediatrie, Fonds de Service, Service de Chirurgie Pediatrique, SICPA and Societe Academique Vaudoise, Switzerland. Yee Ian Yik was supported by a PhD scholarship from the Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. A Senior Research Fellowship from the National Health and Medical Research Council, Australia supported Bridget Southwell.

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