title: Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?
abstract: BACKGROUND
  Faecal incontinence is a prevalent and important condition, with a range of treatment options. Neuromodulation via sacral nerve stimulators is efficacious, but expensive and associated with complications due to device implantation. Peripheral neuromodulation via posterior tibial nerve stimulation (PTNS) has been assessed in urinary incontinence, but there is minimal evidence for its use in faecal incontinence and no literature from the UK. This retrospective review aimed to assess the efficacy of PTNS in faecal incontinence.
  
  
  METHODS
  Thirteen consecutive female patients with faecal incontinence of various causes (9 idiopathic, 3 obstetric, 1 surgery) underwent PTNS at a UK hospital. All were investigated with colonic imaging, anorectal physiology and endo-anal ultrasound. Prior treatments included physiotherapy (13), sphincteroplasty (3) biofeedback (3) and PTQ implants (1). PTNS was performed for 30 min, weekly for 12 weeks.
  
  
  RESULTS
  Median monthly episodes of incontinence of wind, liquid and solid reduced from 6, 10 and 18 respectively to 0 with 12 weeks' treatment (P < 0.05). Significant improvements in quality of life indices were also seen. At 1-month follow up, a sustained reduction in incontinence of wind was seen (0 episodes), with non-significant reductions of liquid and solid stool.
  
  
  CONCLUSIONS
  PTNS is a potentially efficacious, technically simple and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium- and long-term follow-up, and a larger randomised trial comparing PTNS with alternative treatments and placebo.
authors.affiliation: Department of Digestive Diseases and Thoracics, Queen's Medical Centre, Nottingham, UK. johnfindlay@doctors.org.uk
authors.forename: John M
authors.initials: JM
authors.lastname: Findlay
authors.forename: Justin M C
authors.initials: JM
authors.lastname: Yeung
authors.forename: Rachel
authors.initials: R
authors.lastname: Robinson
authors.forename: Helen
authors.initials: H
authors.lastname: Greaves
authors.forename: Charles
authors.initials: C
authors.lastname: Maxwell-Armstrong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013979:Tibial Nerve / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography