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Tibial nerve electrical stimulation for fecal incontinence: a systematic review and meta-analysis

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Abstract

Tibial nerve stimulation (TNS) therapy is widely used to treat fecal incontinence (FI), but still, some controversy exists. This study aimed to determine whether TNS could improve FI from different evaluation angles. A systematic review and meta-analysis were conducted to provide indirect evidence of TNS treatment for FI. We searched for the original studies in PubMed, Embase, Web of Science, Ebsco Medline, Ovid Medline, and Cochrane Central Register of Controlled Trials published before November 31, 2021. The standardized mean difference was the efficacy analysis statistic, and the effect was expressed by the 95% confidence interval (CI). For the case series, we calculated the mean difference of the number of patients evaluated at baseline and last follow-up. Four randomized controlled trials (RCTs, four hundred and sixty participants) and eighteen case series (eight hundred and thirty-eight participants) were included in the study. The results of the RCTs showed that the number of weekly episodes of FI significantly reduced in the TNS group compared with the sham stimulation group. The results of the case series showed that TNS reduced the number of patients with FI per week. The Cleveland Clinic Florida FI Score significantly reduced. The post-treatment results of maximum squeeze pressure and maximum resting pressure were significantly different from baseline. This study showed that TNS to some extent reduced the number of patients with FI, reduced clinical symptoms, and improved anal physiological function. Despite the low quality of overall evidence, TNS still shows some potential as a safe treatment for FI.

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Data Availability

The data that support the finding of this study are available on request from the corresponding author.The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

CCF-FI:

Cleveland Clinic Florida fecal incontinence

FI:

Fecal incontinence

TNS:

Tibial nerve stimulation

PTNS:

Percutaneous tibial nerve stimulation

TTNS:

Transcutaneous tibial nerve stimulation

SNS:

Sacral nerve stimulation

MSP:

Maximum squeeze pressure

MRP:

Maximum resting pressure

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Funding

This study was supported by National Natural Science Foundation of China (grant no. 81904208).

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Author notes

  1. Qi Jin, Ying Zhu and Ping Yin are co-first author.

Authors and Affiliations

  1. Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China

    Qi Jin & Xiaojia Li

  2. Shanghai University of Traditional Chinese Medicine, No. 1200 Cailun Road, Pudong New Area, Shanghai, 201203, China

    Ying Zhu

  3. Long-Hua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Ping Yin

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Contributions

QJ: acquisition of data, analysis and interpretation of data, drafting the article, final approval; YZ: acquisition of data, analysis and interpretation of data, drafting the article, final approval; PY: interpretation of data, revising the article, final approval; X-JL: conception and design of the study, critical revision, final approval.

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Correspondence to Xiaojia Li.

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Jin, Q., Zhu, Y., Yin, P. et al. Tibial nerve electrical stimulation for fecal incontinence: a systematic review and meta-analysis. Updates Surg 75, 1059–1070 (2023). https://doi.org/10.1007/s13304-022-01444-w

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