title: Effects of transcutaneous tibial nerve stimulation on anorectal physiology in fecal incontinence: a double-blind placebo-controlled cross-over evaluation.
abstract: BACKGROUND
  Transcutaneous electrical tibial nerve stimulation (TENS) is of growing interest for the treatment of fecal incontinence (FI), but its mechanism of action remains uninvestigated. We aimed to further assess the anorectal response to TENS in a dynamic model.
  
  
  METHODS
  We performed a placebo-controlled, randomized, double-blinded crossover study in 19 patients suffering from FI to assess the effects of TENS on anorectal function. Anorectal physiology and perception were recorded through two sequences of rectal isobaric distension using an electronic barostat device to measure anal and rectal pressures, rectal volumes, and perception scores.
  
  
  RESULTS
  Maximal rectal pressure and volume variation were affected by TENS, with higher mean maximal rectal pressure (5.33 and 4.06 mmHg in the active and sham TENS respectively, p < 0.0001) and lower volume variation (11.45 and 14.7 mL in the active and sham stimulation respectively, p < 0.05). Rectal compliance was not modified by active TENS. Pressure of the upper anal canal was significantly lower with raised isobaric distension in sequences assigned to active TENS.
  
  
  CONCLUSIONS
  Acute TENS modified anorectal physiology by strengthening the myogenic response to distension rather than increasing muscle relaxation and related rectal compliance in patients with FI.
authors.affiliation: Service des Maladie de l'Appareil Digestif, Centre Hospitalier Pontchaillou et Université de Rennes 1, Rennes, France; INSERM U991, Université de Rennes 1, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Bouguen
authors.forename: A
authors.initials: A
authors.lastname: Ropert
authors.forename: F
authors.initials: F
authors.lastname: Lainé
authors.forename: P
authors.initials: P
authors.lastname: Pequin
authors.forename: J
authors.initials: J
authors.lastname: Morcet
authors.forename: J-F
authors.initials: JF
authors.lastname: Bretagne
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology*; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation
keywords: fecal incontinence; neuromodulation; physiopathology; transcutaneous electrical nerve stimulation