Skip to main content

Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study

International Journal of Colorectal Disease volume 28, pages 1583–1589 (2013)Cite this article

Abstract

Purpose

Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve.

Method

In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10).

Results

Ten patients (eight females/two males) with a mean age of 50.7 ± 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days.

Conclusions

Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Barton J (2002) Nitroglycerin and lidocaine topical treatment for anal fissure. RxTriad 5(4):1–2

    Google Scholar 

  2. Poh A, Tan KY, Choen FS (2010) Innovations in chronic anal fissure treatment: a systematic review. World J Gastrointest Surg 2(7):231–241

    PubMed  Article  Google Scholar 

  3. Yakovlev A, Karasev SA, Dolgich OY (2011) Sacral nerve stimulation: a novel treatment of chronic anal fissure. Dis Colon Rectum 54:324–327

    PubMed  Article  Google Scholar 

  4. Nelson RL, Thomas K, Morgan J, Jones A (2012) Non surgical therapy for anal fissure. Cochrane Database Syst Rev 2:CD003431, Review. PubMed PMID:22336789

    PubMed  Google Scholar 

  5. Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S (2011) Operative procedures for fissure in ano. Cochrane Database Syst Rev 9(11):CD002199, Review. PubMed PMID: 22071803

    Google Scholar 

  6. Patti R, Territo V, Aiello P, Angelo GL, DiVita G (2012) Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study. Am Surg 78(5):523–527

    PubMed  Google Scholar 

  7. Schornagel IL, Witvliet M, Engel AF (2012) Five-year results of fissurectomy for chronic anal fissure: low recurrence rate and minimal effect on continence. Colorectal Dis 14(8):997–1000

    PubMed  Article  CAS  Google Scholar 

  8. Abramowitz L, Bouchard D, Souffran M et al (2013) Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty. Colorectal Dis 15(3):359–367

    PubMed  Article  CAS  Google Scholar 

  9. Nyam DC, Pemberton JH (1999) Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum 42:1306–1310

    PubMed  Article  CAS  Google Scholar 

  10. Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48(6):1193–1199

    PubMed  Article  Google Scholar 

  11. Renzi A, Izzo D, Di Sarno G et al (2008) Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs. lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial. Dis Colon Rectum 51(1):121–127

    PubMed  Article  Google Scholar 

  12. Shao WJ, Li GC, Zhang ZK (2009) Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure. Int J Colorectal Dis 24(9):995–1000

    PubMed  Article  Google Scholar 

  13. Sinha R, Kaiser AM (2012) Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures. Colorectal Dis 14(6):760–764

    PubMed  Article  CAS  Google Scholar 

  14. Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG (2010) Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J 21(9):1065–1070

    PubMed  Article  Google Scholar 

  15. Queralto M, Portier G, Cabarrot PH et al (2006) Preliminary results of peripheral transcutaneous neuromodulation in the treatment of idiopathic fecal incontinence. Int J Colorectal Dis 21:670–672

    PubMed  Article  CAS  Google Scholar 

  16. Veronique V, Henri D, Sabine R, Francois M (2010) Transcutaneous electrical posterior tibial nerve stimulation for faecal incontinence: effects on symptoms and quality of life. Int J Colorectal Dis 25:1017–1020

    PubMed  Article  Google Scholar 

  17. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685

    PubMed  Article  CAS  Google Scholar 

  18. Corapcioglu A, Aydemir A, Yildiz M, Esen A, Koroglu E (1999) Structured clinical interview for DSM IV Axis I disorders. Hekimler Yayin Birligi Turkish, Ankara

    Google Scholar 

  19. Hamilton MA (1960) Rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  Article  CAS  Google Scholar 

  20. Akdemir A, Orsel S, Dag I (1996) Reliability and validity of Turkish version of Hamilton Depression Scale. Journal of Psychiatry Psychology Psychopharmacology 4:251–259, Turkish

    Google Scholar 

  21. Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    PubMed  Article  CAS  Google Scholar 

  22. Yazici MK, Demir B, Tanriverdi N, Karaoglu E, Yolac P (1998) Interrater reliability and validity of Turkish version of Hamilton Anxiety Scale. Turkish Journal of Psychiatry 9:114–117

    Google Scholar 

  23. Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    PubMed  Article  Google Scholar 

  24. Kocyigit H, Aydemir O, Olmez N et al (1999) Reliability and validity of Turkish version of Short Form 36 (SF-36). İlaç ve Tedavi Dergisi 12:102–106, Turkish

    Google Scholar 

  25. Demiral Y, Ergor G, Unal B et al (2006) Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population. BMC Publ Health 9(6):247

    Article  Google Scholar 

  26. Yakovlev A, Karasev SA (2010) Successful treatment of chronic anal fissure utilizing sacral nerve stimulation. Wisconsin Medical Journal 109(5):279–281

    PubMed  Google Scholar 

  27. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–975

    PubMed  Article  CAS  Google Scholar 

  28. Kathleen A (2003) TENS basic science mechanisms and clinical effectiveness. J Pain 4:109–121

    Article  Google Scholar 

  29. Wilson JK, Sevier TL (2003) A review of treatment for carpal tunnel syndrome. Disabil Rehabil 25:113–119

    PubMed  Article  CAS  Google Scholar 

  30. Papanicolaou GD, McCabe SJ, Firrell J (2001) The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am 26:460–466

    PubMed  Article  CAS  Google Scholar 

  31. Schouten WR, Briel JW, Auwerda JJ (1994) Relationship between anal pressure and anodermal blood flow: the vascular pathogenesis of anal fissures. Dis Colon Rectum 37:664–669

    PubMed  Article  CAS  Google Scholar 

  32. George AT, Kalmar K, Sala S et al (2013) Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg 100:330–338

    PubMed  Article  CAS  Google Scholar 

  33. George AT, Vaizey CJ (2013) Percutaneous posterior tibial nerve stimulation for fecal incontinence: are we all reading from the same page? Dis Colon Rectum 56:e328–e329

    PubMed  Article  CAS  Google Scholar 

  34. Mentes BB, Yüksel O, Aydin A, Tezcaner T, Leventoglu A, Aytaç B (2007) Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury: preliminary report. Tech Coloproctol 11:115–119

    PubMed  Article  CAS  Google Scholar 

  35. van der Pal F, van Balken MR, Heesakkers JP, Debruyne FM, Bemelmans BL (2006) Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary? BJU Int 97:547–550

    PubMed  Article  Google Scholar 

  36. Nuhoglu B, Fidan V, Ayyildis A, Ersoy E, Germiyanoglu C (2006) Stoller afferent nerve stimulation in woman with therapy resistant over active bladder; a 1 year follow-up. Int Urogynecol J17:204–207

    Google Scholar 

  37. Thorsteinsson G, Stonnington HH, Stilwell GK et al (1978) The placebo effect of transcutaneous electrical stimulation. Pain 5:31–41

    PubMed  Article  CAS  Google Scholar 

  38. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ (2004) Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 43:298–302

    Article  Google Scholar 

  39. Madalinski MH (2011) Identifying the best therapy for chronic anal fissure. World J Gastrointest Pharmacol Ther 2(2):9–16

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Neurology, Istanbul Bilim University Medical Faculty, Istanbul, Turkey

    Burcu Altunrende

  2. Department of Surgery, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey

    Neriman Sengul & Edip Erdal Yilmaz

  3. Department of Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey

    Ozden Arisoy

Authors
  1. Burcu Altunrende
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neriman Sengul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ozden Arisoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edip Erdal Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Burcu Altunrende.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Altunrende, B., Sengul, N., Arisoy, O. et al. Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study. Int J Colorectal Dis 28, 1583–1589 (2013). https://doi.org/10.1007/s00384-013-1743-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1743-4

Keywords

  • Chronic anal fissure
  • Transcutaneous electrical nerve stimulation
  • Posterior tibial nerve