title: Parasacral transcutaneous electrical nerve stimulation for overactive bladder in constipated children: The role of constipation.
abstract: BACKGROUND
  Parasacral transcutaneous electrical nerve stimulation (TENS) is an effective method for the treatment of overactive bladder (OAB), and, additionally, it accelerates bowel transit time. Therefore, not only does parasacral transcutaneous electrical nerve stimulation (TENS) improve lower urinary tract symptoms (LUTS), but it also resolves the problem of constipation in a significant number of children. Since TENS has a positive effect on LUTS and on the symptoms of fecal retention, it is possible that its action regarding OAB could be directly associated with the improvement in constipation. In other words, the positive effect of parasacral TENS in OAB would be because constipation was resolved. The objective of this study was to test that hypothesis.
  
  
  OBJECTIVE
  To test the hypothesis that the positive effect of parasacral TENS in OAB would be because constipation had improved with this method.
  
  
  METHODS
  In this prospective study, children with OAB alone were submitted to parasacral TENS. The inclusion criteria consisted of children with idiopathic OAB alone The Rome III criteria for children of 4-18 years of age were used to diagnose constipation. All the children were treated with 20 sessions of parasacral TENS applied for 20 min, three times weekly on alternating days (Figure). No instructions were given to the participants with respect to diet, laxatives, or pharmaceutical treatment for constipation throughout the study period. None of the patients used anticholinergics. Standard urotherapy was prescribed.
  
  
  RESULTS
  Parasacral TENS improves OAB and constipation. The presence of constipation before treatment was not associated with a poorer prognosis insofar as the resolution of the symptoms of OAB was concerned. Likewise, there was no association between the resolution of constipation with parasacral TENS and the resolution of OAB.
  
  
  CONCLUSIONS
  There was no statistically significant difference in urinary symptoms between the constipated and nonconstipated children. There was an improvement in urgency, urge incontinency and in holding maneuvers in both the constipated and non-constipated children; however, there was no significant improvement in enuresis. The resolution of OAB was not associated with the resolution of constipation and vice versa.
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Veiga
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
authors.forename: Elen Veruska
authors.initials: EV
authors.lastname: Costa
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
authors.forename: Inaah
authors.initials: I
authors.lastname: Portella
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
authors.forename: Ananda
authors.initials: A
authors.lastname: Nacif
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil.
authors.forename: Ana Aparecida
authors.initials: AA
authors.lastname: Martinelli Braga
authors.affiliation: CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil. Electronic address: ubarroso@uol.com.br.
authors.forename: Ubirajara
authors.initials: U
authors.lastname: Barroso
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D004561:Transcutaneous Electric Nerve Stimulation; D053201:Urinary Bladder, Overactive / Q000150:complications* / Q000628:therapy*
keywords: Constipation; Enuresis; Incontinence; Overactive bladder; Urinary tract infection