Utility of Bilateral Posterior Tibial Nerve Electrostimulation in the Treatment of Idiopathic Constipation in the Mexican Population
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Abstract
Background: Constipation has a prevalence in the Mexican population of up to 14.4% (Remes-Troche 2018). Posterior tibial electrostimulation from L4 to S3 modulates sacral roots through multiple afferent pathways in the spinal cord via a spinal and supraspinal somatovisceral reflex that activates sympathetic nerve flow, increasing rectal distensibility, improving rectal sensory thresholds and favoring anterograde and retrograde colonic propagation sequences through stimulation of S2 and S3 thus improving the defecation mechanism.
Objective: To describe the usefulness of bilateral posterior tibial nerve electrostimulation in the treatment of idiopathic constipation in the Mexican population.
Materials and Methods: Prospective, longitudinal analytical study including 49 patients with idiopathic constipation from the coloproctology and gastroenterology outpatient department of Hospital General Regional no. 1, Orizaba, Veracruz. Two non-randomized groups were formed: group 1 received bilateral posterior tibial stimulation via transcutaneous electrodes 3 times a week for 6 weeks; group 2 was treated with fecal bolus modifiers and dietary habit changes. Constipation status was evaluated at the beginning and end of treatment using a custom survey where higher scores indicated greater symptoms and scores closer to zero indicated fewer symptoms. Descriptive statistics, frequencies, percentages, and central tendency measures were applied. The study took place from September 2023 to February 2024.
Results: A total of 49 patients were selected; group 1 consisted of 15 patients (31%) who underwent bilateral posterior tibial nerve electrostimulation and were compared with 34 participants (69%) in group 2 who were treated with fecal bolus modifiers and changes in dietary habits. The mean age of the bilateral posterior tibial nerve electrostimulation group was 45 ± 18 and 55 ± 14 for the fecal bolus modifiers. The female sex predominated in both groups; group 1 with 12 participants (80%) and the second group with 28 (82%) female participants. Of all the patients in group 1, the mean improvement of symptoms was 16% at 6 weeks with bilateral posterior tibial electrostimulation as a treatment for idiopathic constipation, compared to the mean of 33% reported with the use of fecal bolus modifiers and changes in dietary habits; the use of laxatives was also evidenced, in group 1 only 2 participants (13%) continued with their use and in group 2, 22 participants (65%) continued with their use at the end of 6 weeks.
Conclusion: Bilateral posterior tibial electrostimulation treatment for idiopathic constipation reduced symptom perception and laxative use compared to fecal bolus modifiers and dietary habit changes.
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