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Randomized, Controlled Trial of Anal Electrical Stimulation for Fecal Incontinence

Diseases of the Colon & Rectum volume 49, pages 190–196 (2006)Cite this article

Purpose

Anal electric stimulation has been described as effective for fecal incontinence in several case series, but no study has addressed possible mechanism of benefit. We wished to examine whether anal electric stimulation, using an anal probe electrode, used on a daily basis at home for eight weeks, in the absence of any adjunctive exercises or advice, would improve symptoms of fecal incontinence and anal sphincter pressures when compared with “sham” electric stimulation.

Methods

Ninety patients (9 males, 81 females), with median age of 55 (range, 30–77) years were randomized, 47 to active anal stimulation at 35 Hz and 43 to “sham” stimulation at 1 Hz. Outcome measures included a one-week bowel diary, symptom questionnaire, manometry, and patients' evaluation of outcome.

Results

Seventy patients completed the study. On an intention-to-treat analysis, there was no difference between the two groups on any of the outcome measures after eight weeks. Of those who completed stimulation, 44 (63 percent) felt the stimulation had improved their continence. Those with intact anal sphincters were not likely to rate their change more positively than those with sphincter disruption (P = 0.71). Median patient rating of bowel control increased from 3 of 10 before stimulation to 5 of 10 after stimulation (P = 0.001).

Conclusions

Eight weeks of anal electric stimulation was rated by patients as having improved their bowel control to a modest extent. There was no statistically significant difference detected between the groups, suggesting that 1 Hz was as effective as 35 Hz. This raises the possibility that the main effect is not sphincter contraction but sensitization of the patient to the anal area, or simply the effect of intervening per se. Home electric stimulation is a relatively cheap and generally well-tolerated therapy in the conservative treatment of fecal incontinence.

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Authors and Affiliations

  1. Burdett Institute of Gastrointestinal Nursing, St. Mark's Hospital, Harrow, United Kingdom

    Christine Norton Ph.D., R.N.

  2. Florence Nightingale School of Nursing, King's College London, London, United Kingdom

    Christine Norton Ph.D., R.N.

  3. Physiology Unit, St. Mark's Hospital, Harrow, United Kingdom

    Angela Gibbs R.N. & Michael A. Kamm M.D., F.R.C.P.

  4. St Mark's Hospital, Northwick Park, Watford Road, Harrow, HA1 3UJ, United Kingdom

    Christine Norton Ph.D., R.N.

Authors
  1. Christine Norton Ph.D., R.N.
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  2. Angela Gibbs R.N.
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  3. Michael A. Kamm M.D., F.R.C.P.
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Corresponding author

Correspondence to Christine Norton Ph.D., R.N..

Additional information

Supported by Action Medical Research, a medical research charity. The charity had no role in design, data collection, analysis, or interpretation of data, nor in the decision to submit for publication.

Work was conducted at St Mark's Hospital, Harrow, United Kingdom.

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Norton, C., Gibbs, A. & Kamm, M.A. Randomized, Controlled Trial of Anal Electrical Stimulation for Fecal Incontinence. Dis Colon Rectum 49, 190–196 (2006). https://doi.org/10.1007/s10350-005-0251-1

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  • DOI: https://doi.org/10.1007/s10350-005-0251-1

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