A randomized controlled trial comparing the efficacy of bilateral posterior tibial nerve stimulation versus biofeedback pelvic floor muscle training in the management of obstructed defecation

Author:

Ashoush Fouad1,Abdelrahim Ahmed2,Reddy Anil3,Elshazly Walid4,Sultan Mohamed4,Saafan Tamer5,Ali Omer6,Rezkallah Emad7,Harrison Sanjay7,Ahmed Mooyad6

Affiliation:

1. Gateshead Health NHS Foundation Trust

2. Health Education England

3. South Tees Hospitals NHS Foundation Trust

4. Alexandria University

5. Northumbria Healthcare NHS Foundation Trust

6. East Lancashire Hospitals NHS Trust

7. County Durham and Darlington NHS Foundation Trust

Abstract

Abstract Introduction: The intricate process of normal defecation relies on the coordinated function of the somatic and autonomic innervation coupled with pelvic muscle activity. Obstructive defecation (OD) is a common disorder in the developed countries with a prevalence reported in literature between 3-18% of the adult population. Aim: This study aims to compare the efficacy of Bilateral posterior Tibial Nerve Stimulation (Bi-PTNS) compared to Pelvic Floor Muscle training with Biofeedback therapy (BFT) in treatment of adult patients with OD. Methods: Prospective randomised control study was conducted on adult patients aged ≥18 years, diagnosed with OD, who were referred to the Colorectal Surgery Department at Alexandria Main university Hospitals between 2018 and 2020. Computerized 1:1 block randomization allocated patients into two groups: Bi-PTNS group and BFT group. Wexner constipation score and Patient assessment of Constipation Quality of Life Score (PAC-QoL) were used to assess the severity of patient’s symptoms prior to and after treatment. The primary outcome was the Wexner constipation score. The secondary outcome was the PAC-QoL score. Results: Statistically significant differences were achieved in patients who underwent Bi-PTNS as compared to BFT group with 66% Versus 50% on the Wexner score and 60% Versus 42% on the PAC-QoL score. Conclusion: Bi-PTNS intervention was more effective than BFT in alleviating symptoms of OD compared to BFT evidenced by improvements in both Wexner and PAC-QoL scores.

Publisher

Research Square Platform LLC

Reference29 articles.

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3. "Innervation of the levator ani muscles: description of the nerve branches to the pubococcygeus, iliococcygeus, and puborectalis muscles";-Grigorescu BA;Int Urogynecol J Pelvic Floor Dysfunct,2008

4. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact;-Drossman DA;Dig Dis Sci,1993

5. Treatment strategies in obstructed defecation and fecal incontinence;-Khaikin M;World J Gastroenterol,2006

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