title: Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study.
abstract: OBJECTIVE
  Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve.
  
  
  METHODS
  In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10).
  
  
  RESULTS
  Ten patients (eight females/two males) with a mean age of 50.7 ± 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days.
  
  
  CONCLUSIONS
  Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.
authors.affiliation: Department of Neurology, Istanbul Bilim University Medical Faculty, Istanbul, Turkey, burcunoro@gmail.com.
authors.forename: Burcu
authors.initials: B
authors.lastname: Altunrende
authors.forename: Neriman
authors.initials: N
authors.lastname: Sengul
authors.forename: Ozden
authors.initials: O
authors.lastname: Arisoy
authors.forename: Edip Erdal
authors.initials: EE
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003248:Constipation / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D003710:Demography; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013979:Tibial Nerve / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation; D064232:Visual Analog Scale; D055815:Young Adult