Electrical stimulation beneficial in pediatric functional constipation

Reuters Health Information: Electrical stimulation beneficial in pediatric functional constipation

Electrical stimulation beneficial in pediatric functional constipation

Last Updated: 2018-01-15

By Will Boggs MD

NEW YORK (Reuters Health) - Interferential electrical stimulation of the lower abdomen and lower back is a useful adjuvant to pelvic floor muscle exercises for relieving functional constipation in children, researchers from Iran report.

Estimates of the prevalence of functional constipation among children range from 0.7% to 29.6%, they note in The American Journal of Gastroenterology, online December 19. Dietary modification and laxatives relieve symptoms in many children, but more invasive methods may be required for intractable cases.

In patients with myelomeningocele or postoperative Hirschsprung's disease, neuromodulation using interferential (IF) electrical stimulation has shown promise for treating intractable constipation and bladder dysfunction.

Lida Sharifi-Rad and colleagues from Children's Hospital Medical Center, Tehran University of Medical Sciences, assessed the efficacy of IF electrical stimulation as an adjuvant therapy in their sham-controlled study of 90 children 5 to 13 years of age with functional constipation.

Both groups received education about toilet training and correct defecation posture and were instructed in the performance of pelvic floor muscle exercises. Children in the treatment group received 10 courses of IF electrical stimulation through self-adhesive electrodes applied to the lower anterior abdominal wall and the lower back, whereas children in the control group had similar electrodes applied but received no stimulation.

At the end of the treatment sessions, 84.4% (38/45) of the treatment group had achieved the primary outcome of absence of functional constipation according to the Rome III criteria, compared to 43.2% (19/44) of the control group (P<0.003).

Six months later, 71.1% of the treatment group and 36.4% of the control group remained constipation free (P<0.001).

After treatment, children in the treatment group had significantly greater defecation frequency, significantly lower painful defecation rates and significantly lower constipation and pain scores.

Both groups experienced significant improvements in their constipation-related quality of life scores, with no significant differences between the groups.

"More importantly, this method is a safe and non-invasive intervention that prompts further investigations with larger samples and longer follow-up periods," the researchers conclude.

Dr. Ilan Koppen from Emma Children's Hospital/Academic Medical Center in Amsterdam, the Netherlands, has researched various aspects of childhood functional constipation. He told Reuters Health by email, "In this study, the effect of interferential electrical stimulation combined with pelvic floor exercises is compared with sham stimulation combined with pelvic floor exercises. It would have been 'cleaner' to compare interferential electrical stimulation with sham stimulation only, especially since pelvic floor exercises are not part of the standard treatment of functional constipation."

He was surprised by "the high success rate (children no longer fulfilling the Rome III criteria) in the case group, considering that this is a population who did not respond to conventional treatment with behavioral interventions and laxatives for at least 6 months."

"Interferential electrical stimulation is a promising treatment modality for childhood functional constipation," Dr. Koppen concluded. "However, more research is needed to identify patients who are likely to benefit from this novel treatment modality."

Sharifi-Rad did not respond to a request for comments.

SOURCE: http://bit.ly/2mnzhia

Am J Gastroenterol 2017.

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