Bilateral transcutaneous tibial nerve stimulation for chronic constipation.
OBJECTIVE
Chronic constipation is difficult to treat when symptoms are intractable. Colonic propulsion may be altered by distal neuromodulation but this is conventionally delivered percutaneously. Transcutaneous tibial nerve stimulation is noninvasive and cheap: this study aimed to assess its efficacy in chronic constipation.


METHODS
Eighteen patients (median age 46 years, 12 female) with chronic constipation were recruited consecutively. Conservative and behavioural therapy had failed to improve symptoms in all 18. Thirty minutes of daily bilateral transcutaneous tibial nerve stimulation was administered by each patient at home for 6 weeks. The primary outcome measure was a change in the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. Change in Patient Assessment of Constipation Symptoms (PAC-SYM), weekly bowel frequency and visual analogue scale (VAS) score were also measured.


RESULTS
Fifteen patients (12 female) completed the trial. The PAC-QoL score improved significantly with treatment [pretreatment, median 2.95, interquartile range (IQR) 1.18; posttreatment, median 2.50, IQR 0.70; P = 0.047]. There was no change in PAC-SYM score (pretreatment, median 2.36, IQR 1.59; posttreatment, median 2.08, IQR 0.92; P = 0.53). Weekly stool frequency improved as did VAS score, but these did not reach statistical significance (P = 0.229 and 0.161). The PAC-QoL and PAC-SYM scores both improved in four (26%) patients. Two patients reported complete cure. There were no adverse events reported.


CONCLUSIONS
Bilateral transcutaneous tibial nerve stimulation appears to be effective in a quarter of patients with chronic constipation. Carefully selected patients with less severe disease may benefit more. This requires further study.
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Iqbal
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Collins
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Thomas
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Askari
Department of Surgery and Cancer, Chelsea and Westminster Hospital, London, UK.
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Tan
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Nicholls
Sir Alan Parks' Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
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Vaizey
D000328:Adult; D002908:Chronic Disease; D003248:Constipation / Q000523:psychology / Q000628:therapy*; D003672:Defecation; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D064232:Visual Analog Scale
Constipation; neuromodulation; stimulation; tibial nerve