Transcutaneous sacral neurostimulation in children with fecal incontinence

OBJECTIVE: To evaluate the response to transcutaneous sacral neurostimulation (tSNS) treatment in children with refractory functional constipation (RFC), myelomeningocele (MMC), and anorectal malformations (ARM) with fecal incontinence (FI). To compare manometric data before and after treatment. METHODS: A prospective, analytical, quasi-experimental cohort study was conducted in the three populations over a period of 2 years. Twelve 30-min electrostimulation sessions were performed once weekly, using two posterior cutaneous electrodes placed between S2 and S4, with anorectal manometry performed before and after treatment. RESULTS: Forty-two patients with FI were included: 20 with MMC, 14 with ARM, and 8 with RFC. Mean age: 10 years; 71.4% were male. After treatment, complete continence was achieved in 57%, partial continence in 26%, and without improvement in 17% of patients. In manometry, a significant increase in median resting pressure and squeezing pressure was observed as well as an improvement of sensory function, with first sensation occurring at a median pretreatment volume of 100 cc and a median posttreatment volume of 20 cc (p < 0.001). Urge sensation required less volume in 66.7% of patients, and maximum tolerance decreased in 61.9%. Laxatives were discontinued after treatment in 31.4%, and urinary incontinence resolved in 32%. CONCLUSION: tSNS was shown to be effective in improving symptoms of constipation and FI, especially in patients with organic pathology. Urinary incontinence also improved. Favorable changes were observed at the second manometry in patients with total or partial continence, especially for sensory function.