Background and aims Intractable chronic constipation in the form of slow-transit constipation (STC) often resistant to medical treatment. Some children required appendicostomy for antegrade enemas to improve symptoms. Transcutaneous electrical stimulation (TES) was used by physiotherapists to overcome STC in children successfully. This study aimed to examine the effectiveness of home-based TES when STC children were trained by a naïve clinician. We hypothesized TES would improve symptoms with reduce laxative use.
Methods A prospective study (2009–2011) whereby a surgeon was trained to deliver TES method to STC children/parents, who then self-administered TES at home (1 hr/day x 6 months) using a battery-powered interferential stimulator. Daily continence diary (including laxative use) was recorded before and throughout TES; PedsQL4.0 questionnaires and gastrointestinal nuclear transit scintigraphy (NTS) were completed before and after TES. Appendicostomy for antegrade enemas was offered if TES failed to improve symptoms. Statistical analyses performed with paired t-test & chi-square test; p<0.05 considered significant.
Results Sixty-two children (34 female, ages: 2–16yrs, mean: 7yrs) completed home-based TES successfully. Symptoms improved significantly in 56/62 (90%) STC children with gastrointestinal transit index improved after TES (Table 1). The 2 children who stopped laxative prior to TES had symptom improvement without further laxative use. Only 6 children (10%) required appendicostomy for antegrade enemas.
Conclusion Home-based TES is non-invasive. It is a promising treatment for STC children with avoidance of surgery and reduced laxative use with improved symptoms in most children. Success required clinician training and close patient contact.
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