Transcutaneous electrical nerve stimulation therapy for intractable childhood constipation: a clinical observational and comparative study

PURPOSE: To determine the efficacy of transcutaneous electrical nerve stimulation (TENS) on children with intractable constipation and compare treatment success between TENS application twice weekly and three times weekly. METHODS: We recruited otherwise healthy consecutive children aged 6-17 years old suffering from intractable constipation over a 6-month period. Anatomic causes and organic pathologies were ruled out. All children received TENS treatment for 20 min, during 4 weeks, three times a week in group 1 and twice a week in group 2 for 4 weeks. Patients were evaluated for defecation frequency, stool consistency, symptom relief, and fecal incontinence before, at the first week, at the end, and 4 weeks after treatment was discontinued. RESULTS: Twenty patients were enrolled in group 1 and 15 in group 2. Age, gender, and duration of constipation were indifferent among groups. After treatment, there was a significant increase in the number of weekly defecations ( P < 0.001), improvement in fecal incontinence ( P < 0.05), and painful defecation ( P < 0.001) in both groups; however, each group's improvements did not persist 4 weeks after the treatment's discontinuation ( P > 0.05). Meanwhile, twice weekly TENS was as effective as three-times weekly TENS ( P > 0.05). CONCLUSION: TENS treatment appears to improve weekly defecation, fecal incontinence, and pain in children with intractable constipation; however, effects are not sustained after discontinuation. The twice-weekly and three-times weekly protocols yielded comparable results; however, the study lacked sufficient power to conclusively demonstrate noninferiority.