Posterior tibial nerve stimulation and faecal incontinence: a review
- 513 Downloads
Faecal incontinence is a common and important multifactorial disorder with a range of treatment options. Over the last two decades, neuromodulation via sacral nerve stimulators has been shown to be effective for both faecal and urinary incontinence, although associated with complications. Peripheral neuromodulation, via the posterior tibial nerve, is widely used in urinary incontinence; however, its use in faecal incontinence, whilst evolving is limited to eight small heterogeneous studies.
These eight studies are discussed in the context of the methodology and underlying neurophysiology of peripheral neuromodulation, as are thus far unanswered questions. The eight studies include a total of 129 patients with faecal incontinence (of variable aetiology), all of whom had failed conservative management. One study was prospective and controlled, six were uncontrolled and one was retrospective and uncontrolled. Five different neuromodulatory protocols were used over six different study periods. Outcome measures varied, but short term primary endpoint success ranged from 30.0% to 83.3%. The limitations to this early evidence, whilst encouraging, are significant, and it remains to be seen whether this novel treatment modality represents the minimally invasive, well-tolerated, cost-effective and flexible panacea hoped for this common and debilitating disease. Three upcoming multicentre placebo-controlled trials will better be able to delineate its role.
KeywordsFaecal Incontinence Neuromodulation Percutaneous Stimulation
Conflict of interest
The authors declare they have no conflict of interest.
- 14.Malouf AJ, Vaizey CJ, Norton CS, Kamm MA (2001) Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial. Dis Colon Rectum Apr;44(4):595–600.Google Scholar
- 18.Maxwell-Armstrong CA, Bush D, Indar A, Speake W, Scholefield JH Armitage NC (2001) Long term results of surgery for faecal incontinence. Colorectal Dis 3(S1):83Google Scholar
- 20.Herold A, Bruch HP, Hocht B, Muller G (1989) Biofeedback training and functional electrostimulation for improving incontinence in children with anal atresia. Langenbecks Arch Chir. Supplement II, Verhandlungen der Deutschen Gesellschaft für Chirurgie. Deutsche Gesellschaft für Chirurgie. Kongress S2:991–995Google Scholar
- 22.Fraser C, Glazener C, Grant A, Graham M (2004) Review body for interventional procedures. Systematic review of the efficacy and safety of sacral nerve stimulation for faecal incontinence. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
- 29.Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, Siegel SW, Tate SB, Jarnagin BK, Rosenblatt PL, Feagins BA (2009) Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 182(3):1055–1061CrossRefPubMedGoogle Scholar
- 32.Michelsen HB, Buntzen S, Krogh K, Laurberg S (2006) Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. Dis Colon Rectum. (7):1039-44Google Scholar
- 37.Chang CJ, Huang ST, Hsu K et al (1998) Electroacupuncture decreases c-fos expression in the spinal cord induced by noxious stimulation of the rat bladder. J Urol 160(3Pt1):821–824Google Scholar
- 45.Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, Macdiarmid SA (2010) Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol 183(4):1438–1443CrossRefPubMedGoogle Scholar
- 51.Stoller M (1999) Afferent nerve stimulation for pelvic floor dysfunction. Eur Urol 35:16Google Scholar
- 57.Govaert B, Pares D, Delgado-Aros S, La Torre F, van Gemert WG, Baeten CG (2009) A prospective multicenter study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Colorectal Dis. [Epub ahead of print]Google Scholar
- 63.Findlay JM, Yeung JMC, Robinson R, Greaves H, Maxwell-Armstrong C (2010) Peripheral neuromodulation via posterior tibial nerve stimulation—a potential treatment for faecal incontinence? Annals of the Royal College of Surgeons (in press)Google Scholar