title: Transcutaneous Sacral Electrical Stimulation for Chronic Functional Constipation.
abstract: BACKGROUND
  Transcutaneous sacral nerve stimulation is reported to improve symptoms of fecal incontinence. Chronic constipation may also respond to stimulation, but this is poorly reported in the literature.
  
  
  OBJECTIVE
  The study assessed the efficacy of transcutaneous electrical stimulation directly over the sacral nerve roots in chronic constipation.
  
  
  METHODS
  Chronic functional constipation was established in all patients using the Rome III criteria.
  
  
  METHODS
  The therapy was self-administered at home.
  
  
  METHODS
  A pilot study was conducted of transcutaneous sacral stimulation given over a 4-week period for 12 hours a day.
  
  
  METHODS
  Patients were assessed using the Patient Assessment of Constipation Symptoms, the Patient Assessment of Constipation Quality of Life, and the Cleveland constipation tool. A Global Rating of Change measure and a 1-week bowel diary was kept for the final week and compared with baseline.
  
  
  RESULTS
  Of the 20 patients recruited (16 female, median age 38.5 years), 80% (16) completed the trial. Five (31%) patients reported at least a point reduction in the Patient Assessment of Constipation Symptoms score, 4 (25%) deteriorated, and 7 (44%) improved by less than one point. Median (interquartile range) Patient Assessment of Constipation Symptoms scores were 2.33 (2.34) at baseline and 2.08 (2.58) at follow-up (p = 0.074). Median scores for the Patient Assessment of Constipation Quality of Life and Cleveland systems were 3.00 (1.64) and 17.15 (18) at baseline and 2.22 (3.04) and 15.31 (12) at follow-up (p = 0.096 and 0.111). One-third of patients reported a positive Global Rating of Change measure, although 68% required concurrent laxatives during the trial.
  
  
  CONCLUSIONS
  This is a pilot study and is limited by its small sample size.
  
  
  CONCLUSIONS
  Continuous transcutaneous sacral stimulation in the short term appears to be ineffective for chronic constipation. Larger well-powered studies with intermittent stimulation regimens are required to investigate this further.
authors.affiliation: 1 St Mark's Hospital & Academic Institute, Sir Alan Parks' Physiology Unit, Harrow, United Kingdom 2 Department of Surgery and Cancer, Imperial College London, South Kensington Campus, United Kingdom 3 Department of Surgery, Chelsea and Westminster Hospital, Fulham Road, London, United Kingdom.
authors.forename: Fareed
authors.initials: F
authors.lastname: Iqbal
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Thomas
authors.forename: Emile
authors.initials: E
authors.lastname: Tan
authors.forename: Alan
authors.initials: A
authors.lastname: Askari
authors.forename: Jamasp K
authors.initials: JK
authors.lastname: Dastur
authors.forename: John
authors.initials: J
authors.lastname: Nicholls
authors.forename: Carolynne J
authors.initials: CJ
authors.lastname: Vaizey
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000294:innervation / Q000503:physiopathology; D010865:Pilot Projects; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012007:Rectum / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods; D016896:Treatment Outcome