Abstract
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 was available from 135 patients (119 [88%] females, median age: 60 [range: 27 – 82]). 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.
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 was available from 135 patients (119 [88%] females, median age: 60 [range: 27 – 82]). 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.
| Original language | English |
|---|---|
| Journal | Techniques in Coloproctology |
| Publication status | Accepted/In press - 5 Mar 2024 |
Keywords
- Faecal Incontinence
- Percutaneous Tibial Nerve Stimulation
- High Resolution Anorectal Manometry
- Quality of Life