Posterior tibial nerve stimulation in the treatment of fecal incontinence: a systematic review

Abstract

Fecal incontinence severely impacts on quality of life, causing stigmatization and social exclusion. Posterior tibial nerve stimulation {(PTNS)} is one technique used for treatment. This systematic review aims to assess the effectiveness of {PTNS} for the treatment of fecal incontinence. A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and {Meta-Analyses} {(PRISMA)} declaration. Pubmed, Scopus, Web of Knowledge and {PEDro} databases were searched for both randomized clinical trials and cases series. The outcome variables were treatment effectiveness, severity of incontinence and quality of life; all were measured in the short, mid and long-term after performing both percutaneous and transcutaneous {PTNS.} Twenty-three studies met the selection criteria. Two clinical trials found significant differences in treatment effectiveness compared to the placebo response. Fifteen cases series observed significant differences in terms of effectiveness, severity and quality of life. All clinical trials achieved a reduction in the number of incontinence episodes and an increase in the deferral time for defecation. Optimal results were achieved by interventions consisting of one or two weekly sessions of a 30-60 minutes duration and the use of pulse widths of 200 {\textmu}s and frequencies of 10-20 Hz. Percutaneous stimulation did not demonstrate better results compared to transcutaneous application. {PTNS} is an effective technique for the treatment of fecal incontinence, although long-term interventions are required in order to prolong its effects in the long-term.