Abstract
Aim: This study reports on the preliminary results of external neuromyogenic electrostimulation (ENS) for the treatment of anorectal continence problems.
Patients and Methods: A total of seventeen paients with anorectal malformations (n=11), Hirschsprung's disease (n=5) or pelvi-perineal trauma (n=1) were included in the study. All patients were evaluated using clinical, radiological, and manometric methods prior to ENS. The Holschneider Continence Scale and the Quality of Life (QOL) Score were used for clinical assessment. The ENS stimulator is a two-channel ambulatory device providing a pulse current. ENS was performed by parents in a home setting twice daily for 6 weeks using skin electrodes attached to the sides of the anus. Three of the 11 preset programs were used (lack of sensitivity, pelvic floor work out and building up endurance). Clinical and manometric variables were reevaluated following completion of the 6-week program.
Results: Mean age was 9.7 years (range 5–22 years). The Holschneider Continence Score increased from a mean value of 5.3±3.2 to 12.4±1.7 (p=0.002) and mean QOL scores increased from 5.6±2.3 to 11.6±1.8 (p=0.01) following ENS. Mean anal canal resting pressures prior to ENS were 20.3±6 cmH2O and increased to 28.7±14.1 cmH2O after 6 weeks (p>0.05). Maximum voluntary squeeze pressures before and after ENS were 56.1±16.7 cmH2O and 100.7±16.9 cmH2O respectively (p=0.001).
Conclusion: Preliminary results for ENS have shown that patients achieved higher maximum voluntary squeeze pressures, and showed a marked improvement in their continence and QOL scores. Given the advantage of ambulatory use in a home setting, the ENS seems promising in terms of achieving improved anorectal continence in selected patients.
Key words
external neuromyogenic electrostimulation - anal continence - fecal incontinence
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Correspondence
Assoc. Prof. Orkan Ergun
Ege University School of
Medicine
Pediatric Surgery
35100 Izmir
Turkey
Phone: +90 232 390 28 14
Fax: +90 232 390 28 02
Email: orkan.ergun@ege.edu.tr
