A Pilot Study of Non-invasive Sacral Nerve Stimulation in Treatment of Constipation in Childhood and Adolescence

Manuel Besendörfer, Martin Kohl, Vera Schellerer, Roman Carbon, Sonja Diez, Manuel Besendörfer, Martin Kohl, Vera Schellerer, Roman Carbon, Sonja Diez

Abstract

Background/Aims: Constipation shows both, a high prevalence and a significant impact. However, it is often perceived as minor and treatment choices are limited. The neuromodulation approach is a valuable option to be considered. This study assesses the use of non-invasive sacral nerve stimulation to reduce constipation in children. Methods: Between February 2013 and May 2015, pediatric patients with chronic constipation were treated with this non-invasive neuromodulation procedure, adapted from classical sacral nerve stimulation. A stimulation device attached to adhesive electrodes on the lower abdomen and back generated an electrical field with a stable frequency of 15 Hz via variable stimulation intensity (1-10 V). The effect of therapy was evaluated in routine check-ups and by specialized questionnaires. Results: The study assessed non-invasive sacral nerve stimulation in 17 patients (9 boys, 8 girls, mean age 6.5 years). They underwent stimulation with 6-9 V for a mean of 11 h per day (range 0.5-24 h) over a mean of 12.7 weeks. Improvement of constipation was achieved in more than half of the patients (12/17) and sustained in almost half of these patients (5/12). Complications were minor (skin irritation, electrode dislocation). Conclusions: Non-invasive sacral nerve stimulation appears to be effective in achieving improvement in pediatric patients with chronic constipation. As an additional external neuromodulation concept, this stimulation may represent a relevant addition to currently available therapeutic options. Further studies are needed to confirm these results.

Keywords: Hirschsprung's disease; electrostimulation; non-invasive sacral nerve stimulation; pediatric surgery; slow-transit constipation.

Copyright © 2020 Besendörfer, Kohl, Schellerer, Carbon and Diez.

Figures

Figure 1
Figure 1
Placement of the adhesive electrodes: the ventral electrode is set paraumbilically on the left side, the dorsal one paravertebrally on the right side.

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