Abstract:Background:Posterior tibial nerve stimulation (PTNS) is a novel treatment for patients
with faecal incontinence (FI) and may be effective in selected patients;
however, its mechanism of action is unknown. We sought to determine the
effects of PTNS on anorectal physiological parameters.Methods:Fifty patients with FI underwent 30 min of PTNS treatment, weekly for 12
weeks. High-resolution anorectal manometry, bowel diaries and Vaizey
questionnaires were performed before and after treatment. Successful
treatment … Show more
“…This, however, is in contrast to some previous reports in both BF and PTNS. 18 As the variables most likely to improve following BF, for example anal squeeze pressure, 19 and following PTNS, for example anal resting pressure and rectal sensory volumes, 18 were numerically improved in our study but did not reach statistical significance the likely explanation for this finding is the small patient numbers. As physiological changes were defined as a secondary endpoint in the current study, power to detect change was limited, and it is possible that including more patients would replicate previous reports of some physiological improvements.…”
Section: Discussioncontrasting
confidence: 65%
“…This is similar to previous reports of the time line of improvement in PTNS. 18 Nevertheless, data regarding efficacy in this trial should be interpreted with caution, as this was a small cohort, with no sham treatment arm, in a selected group of patients. This probably explains the unusually high rates of success at the end of treatment (92%), even as assessed by the objective measure of 50% or more improvement in FI episodes.…”
Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.
“…This, however, is in contrast to some previous reports in both BF and PTNS. 18 As the variables most likely to improve following BF, for example anal squeeze pressure, 19 and following PTNS, for example anal resting pressure and rectal sensory volumes, 18 were numerically improved in our study but did not reach statistical significance the likely explanation for this finding is the small patient numbers. As physiological changes were defined as a secondary endpoint in the current study, power to detect change was limited, and it is possible that including more patients would replicate previous reports of some physiological improvements.…”
Section: Discussioncontrasting
confidence: 65%
“…This is similar to previous reports of the time line of improvement in PTNS. 18 Nevertheless, data regarding efficacy in this trial should be interpreted with caution, as this was a small cohort, with no sham treatment arm, in a selected group of patients. This probably explains the unusually high rates of success at the end of treatment (92%), even as assessed by the objective measure of 50% or more improvement in FI episodes.…”
Background/Aims: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Methods: Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. Results: A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. Conclusions: In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.
“…TNS, on the other hand, seems to have beneficial effects on the PR of patients with IF. In the study by Heywood et al, patients undergoing TNS showed a 6.8% increase in RP values, however without statistical significance, probably because of the small sample size and the short follow-up interval (13) .…”
BACKGROUND: Evacuation disorders are prevalent in the adult population, and a significant portion of cases may originate from pelvic floor muscle dysfunctions. Anorectal manometry (ARM) is an important diagnostic tool and can guide conservative treatment. OBJECTIVE: To evaluate the prevalence of pelvic dysfunction in patients with evacuation disorders through clinical and manometric findings and to evaluate, using the same findings, whether there are published protocols that could be guided by anorectal manometry. METHODS: A retrospective analysis of a prospective database of 278 anorectal manometries performed for the investigation of evacuation disorders in patients seen at the anorectal physiology outpatient clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto between January 2015 to June 2019 was conducted. The following parameters were calculated: resting pressure (RP), squeeze pressure (SP), high-pressure zone (HPZ), rectal sensitivity (RS) and rectal capacity (RC). The pressure measurements and manometric plots were reviewed to determine the diagnosis and to propose potential pelvic physical therapy procedures. Analysis of variance (ANOVA) and Fisher’s exact test were used to compare the continuous variables and to evaluate the equality of variances between groups of patients with fecal incontinence (FI) and chronic constipation (CC). Results with a significance level lower than 0.05 (P-value <0.05) were considered statistically significant. Statistical analysis was performed using IBM® SPSS® Statistics version 20. RESULTS: The mean age of the sample was 45±22 years, with a predominance of females (64.4%) and economically inactive (72.7%) patients. The indications for exam performance were FI (65.8%) and CC (34.2%). Patients with FI had lower RP (41.9 mmHg x 67.6 mmHg; P<0.001), SP (85.4 mmHg x 116.0 mmHg; P<0.001), HPZ (1.49 cm x 2.42 cm; P<0.001), RS (57.9 mL x 71.5 mL; P=0.044) and RC (146.2 mL x 195.5 mL; P<0.001) compared to those of patients with CC. For patients with FI, the main diagnosis was the absence of a functional anal canal (49.7%). For patients with CC, the main diagnosis was outflow tract obstruction (54.7%). For patients with FI, the main protocol involved a combination of anorectal biofeedback (aBF) with tibial nerve stimulation (TNS) (57.9%). For patients with CC, the most indicated protocol was aBF combined with TNS and rectal balloon training (RBT) (54.7%). CONCLUSION: There was a high prevalence of pelvic floor changes in patients with evacuation disorders. There was a high potential for performing pelvic floor physical therapy based on the clinical and manometric findings.
“…A surface electrode is placed on the ipsilateral foot, medial to the calcaneum. Correct placement is confirmed by demonstrating either a motor response (plantar flexion of the great toe) or a sensory response (tingling to the toes, arch or heel) through incremental stimulation increases[ 9 , 13 ].…”
Background
Faecal incontinence (FI) is common, with a significant impact on quality of life. Percutaneous tibial nerve stimulation (PTNS) is a therapy for FI; however, its role has recently been questioned. Here we report the short-term clinical and manometric outcomes in a large tertiary centre.
Methods
A retrospective review of a prospective PTNS database was performed, extracting patient-reported FI outcome measures including bowel diary, the St Marks’s Incontinence Score (SMIS) and Manchester Health Questionnaire (MHQ). Successful treatment was > 50% improvement in symptoms, whilst a partial response was 25–50% improvement. High-resolution anorectal manometry (HRAM) results before and after PTNS were recorded.
Results
Data were available from 135 patients [119 (88%) females; median age: 60 years (range: 27–82years)]. Overall, patients reported a reduction in urge FI (2.5–1) and passive FI episodes (2–1.5; p < 0.05) alongside a reduction in SMIS (16.5–14) and MHQ (517.5–460.0; p < 0.001). Some 76 (56%) patients reported success, whilst a further 20 (15%) reported a partial response. There were statistically significant reductions in rectal balloon thresholds and an increase in incremental squeeze pressure; however, these changes were independent of treatment success.
Conclusion
Patients report PTNS improves FI symptoms in the short term. Despite this improvement, changes in HRAM parameters were independent of this success. HRAM may be unable to measure the clinical effect of PTNS, or there remains the possibility of a placebo effect. Further work is required to define the role of PTNS in the treatment of FI.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.