The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study.
OBJECTIVE
Faecal incontinence is a distressing problem that is often not amenable to surgical correction. Chronic low-frequency electrical stimulation of damaged axons is thought to reduce synaptic resistance, increase the size of motor units by axonal sprouting and increase the rate of conduction of the pudendal nerve. The aim of this study was to prospectively evaluate the effect of chronic low-frequency endo-anal electrical stimulation on faecal incontinence using a home-based unit and hospital-supervised therapy.


METHODS
Forty-eight patients with faecal incontinence completed a prospective randomised trial. Patients were allocated randomly to one of two groups; group 1 was exposed to endo-anal pudendal nerve stimulation daily at home with a portable home unit, group 2 attended the physiotherapy department for endo-anal electrical stimulation under supervision.


RESULTS
Continence scores improved significantly after treatment in both groups (p<0.001). Both groups showed improved manometric scores, although only group 1 showed significant improvement in both resting and squeeze pressures (mean total resting pressure 184-224 mmHg, p<0.001; mean total squeeze pressure 253-337 mmHg, p<0.001). This was also reflected by an improvement in quality of life in both groups.


CONCLUSIONS
Low-frequency endo-anal electrical stimulation significantly improves continence scores and quality of life in patients with faecal incontinence not amenable to surgical correction. It leads to improved manometric values when carried out on a daily basis with a portable home unit.
Department of Colorectal Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. healyciaran@eircom.net
Ciaran F
CF
Healy
Ann E
AE
Brannigan
Elizabeth M
EM
Connolly
Molly
M
Eng
Martin J
MJ
O'Sullivan
Deborah A
DA
McNamara
Cinny
C
Cusack
Joseph M
JM
Deasy
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D011788:Quality of Life; D011930:Reaction Time; D011795:Surveys and Questionnaires; D016896:Treatment Outcome