Long-term effects of transabdominal electrical stimulation
in treating children with slow-transit constipation
Leanne C.Y. Leong
a, b
, Yee Ian Yik
a, c, g
, Anthony G. Catto-Smith
c, d
,
Val J. Robertson
f
, John M. Hutson
a, c,e
, Bridget R. Southwell
a, c, d,
⁎
a
Surgical Research Group, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
b
Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia
c
Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
d
Department of Gastroenterology and Nutrition, Royal Children's Hospital, Melbourne, VIC 3052, Australia
e
Department of Urology, Royal Children's Hospital, Melbourne, VIC 3052, Australia
f
University of Newcastle, Newcastle, NSW 2300, Australia
g
Department of General Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
Received 24 August 2011; accepted 3 September 2011
Key words:
Transabdominal electrical
stimulation;
Chronic treatment-resistant
constipation;
Encopresis;
Fecal soiling
Abstract
Aims: Transcutaneous electrical stimulation (TES) was used to treat children with slow-transit
constipation (STC) for 1 to 2 months in a randomized controlled trial during 2006 to 2008. We aimed to
determine long-term outcomes, hypothesizing that TES produced sustained improvement.
Methods: Physiotherapists administered 1 to 2 months of TES to 39 children (20 minutes, 3 times a
week). Fifteen continued to self-administer TES (30 minutes daily for more than 2 months). Mean long-
term follow-up of 30 of 39 patients was conducted using questionnaire review 3.5 years (range 1.9-4.7
years) later. Outcomes were evaluated by confidence intervals or paired t test.
Results: Seventy-three percent of patients perceived improvement, lasting more than 2 years in 33% and
less than 6 months in 25% to 33%. Defecation frequency improved in 30%. Stools got wetter in 62%
after stimulation and then drier again. Soiling improved in 75% and abdominal pain in 59%. Laxative
use stopped in 52%, and 43% with appendicostomies stopped washouts. Soiling/Holschneider
continence score improved in 81% (P = .0002). Timed sits switched to urge-initiated defecations in 80%
patients. Eighty percent of relapsed patients elected to have home stimulation.
Conclusion: TES holds promise for STC children. Improvement occurred in two thirds of children, lasting
more than 2 years in one third, whereas symptoms recurred after 6 months in one third of children.
© 2011 Elsevier Inc. All rights reserved.
Constipation affects 3% of children, with a third of these
developing chronic constipation [1-3]. Chronic constipation
can be categorized into separate groups including those with
normal proximal transit but hold-up at the anorectum
(anorectal retention/functional fecal retention) and those
with delayed colonic transit (slow-transit constipation, STC).
Presented at the Pacific Association of Pediatric Surgeons 44th Annual
Meeting, Cancun, Mexico, April 10-14, 2011.
⁎
Corresponding author. Surgical Research Group, Murdoch Children's
Research Institute, Royal Children's Hospital, Parkville, VIC 3052,
Australia. Tel.: +61 3 9345 5069; fax: +61 3 93457997.
E-mail address: bridget.southwell@mcri.edu.au (B.R. Southwell).
www.elsevier.com/locate/jpedsurg
0022-3468/$ – see front matter © 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.jpedsurg.2011.09.022
Journal of Pediatric Surgery (2011) 46, 2309–2312