JLE

Hépato-Gastro & Oncologie Digestive

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Posterior tibial nerve stimulation and fecal incontinence Volume 16, issue 3, mai-juin 2009

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Authors
Service de physiologie digestive, hospices civils de Lyon, hôpital Édouard-Herriot, 69437 Lyon cedex, France

The Egyptians of the fifth dynasty already knew electrical stimulation for therapeutic ends. Only in the 21th century has this technique been applied to the management of fecal incontinence through stimulation of the posterior tibial nerve. There are two methods of stimulation: percutaneous stimulation (pTENS) with an electrode-needle and non-invasive transcutaneous stimulation (TENS) with adhesive electrodes. The first method is used in sessions of 20 to 30 minutes, up to three times a week. Transcutaneous stimulation is used daily. The precise mechanisms of action are little understood, but they probably involve a somatosympathetic reflex. To this day, only a handful of open trials have evaluated this method. In France, only TENS has been evaluated in the treatment of fecal incontinence. Results of the three available studies are encouraging, with reported rates of improvement of symptoms and/or quality of life ranging from 40 to 100%. However, the trials are few, heterogeneous and small. Because this technique is harmless, cheap and easy to implement, it deserves to be further evaluated in the impending French randomised trial.