Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review

Abstract

Background Neuromodulation is the application of electrical stimulation on nerve fibers to modulate the neuronal activity. Its use for chronic constipation and fecal incontinence has increased in popularity over the past few years. Invasive and noninvasive techniques are currently available. We reviewed the current literature on the application of the neuromodulation techniques in the management of chronic constipation and fecal incontinence in children. Materials and Methods A search of Healthcare Database Advanced Search, Embase, Medline, and Cochrane database was performed in accordance with PRISMA guideline. Terms used in the search included neuromodulation, nerve stimulation, fecal/fecal incontinence, incontinence, constipation, children, and pediatric/pediatric. Results Two-hundred forty-one papers were screened. Fourteen papers were included for the systematic review: seven were selected for the ISNM (implantable sacral nerve modulation) technique, one for the transcutaneous tibial nerve stimulation), one for the transcutaneous sacral nerve modulation), and five for the transcutaneous interferential sacral nerve stimulation. Results showed an overall improvement in constipation symptoms in 79 to 85.7% of patients, resolution of symptoms in 40%, reduced use of ACE stoma/transanal irrigation system in 12.5 to 38.4%, and improvement in incontinence symptoms in 75%. High complication rate was reported (17–50%) in the ISNM group. No complications were reported in the non-invasive group. Conclusion Neuromodulation is a promising tool in the management of constipation refractory to medical treatment and fecal incontinence in children. Noninvasive techniques provide good results with no complications. A longer term follow-up will provide more information regarding patient compliance and sustainability of benefits of these new techniques.

A Pilot Study of Non-invasive Sacral Nerve Stimulation in Treatment of Constipation in Childhood and Adolescence

“…Conclusively, positive influence of interferential electrical stimulation (short-term, medium-to high frequency) on any kind of chronic constipation could be seen (23). Nevertheless, the optimal stimulation parameters have not yet been determined and, while presented results in children are encouraging, multicenter studies are needed to confirm the positive impact on constipation and fecal incontinence (26).…”

“…However, non-invasive neuromodulation for pediatric patients with chronic constipation has been presented by multiple authors with promising results so far (18)(19)(20)(21)(22)(23)(24). Nevertheless, there are important differences in stimulation variables and outcome of patients.…”

Surgical Interventions for Functional Constipation: An Update

“…They also seem to show an improved quality of life for both children and their families. 28 However, these studies found that the evidence was based only on small retrospective samples with a lot of heterogeneity between them with only two randomized controlled trials performed. 29,30 Also the outcomes were reported in many different ways such as, increased of number of bowel movement, decrease of abdominal pain, decrease of episodes of FI, improvement of colonic motility, or decrease of laxative dose.…”

“…In the future, evaluation of other centers' experience, will make it easier to have a better understanding of the results and the outcomes of SNS. 28,31…”

Controversies in the Management of Functional Constipation in Children

“…Sacral nerve stimulation (SNS) involves low-amplitude electrical stimulation of the sacral nerve via an electrode placed through the sacral foramen [51,52]. In adults, SNS as a treatment option for defecatory symptoms (including constipation) has been under investigation for more than two decades [51].…”