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Posterior tibial nerve stimulation and faecal incontinence: a review

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

Review

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.

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Conflict of interest

The authors declare they have no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Royal Berkshire Hospital, Reading, RG1 5AN, UK

    John M. Findlay

  2. Directorate of Digestive Diseases and Thoracics, Queen’s Medical Centre, Nottingham, NG7 2UH, UK

    Charles Maxwell-Armstrong

  3. Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK

    John M. Findlay

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  1. John M. Findlay
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  2. Charles Maxwell-Armstrong
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Correspondence to John M. Findlay.

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Findlay, J.M., Maxwell-Armstrong, C. Posterior tibial nerve stimulation and faecal incontinence: a review. Int J Colorectal Dis 26, 265–273 (2011). https://doi.org/10.1007/s00384-010-1085-4

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