Percutaneous tibial nerve stimulation for the treatment of faecal incontinence

Background. Percutaneous tibial nerve stimulation (pTNS) is increasingly used as a treatment option for patients with faecal incontinence. The evidence is limited to few studies with small numbers of patients, different treatment techniques and outcome measures. Objectives. The aim of this article was to assess the efficacy of pTNS in patients with faecal incontinence and to give an overview over the literature. Methods. For pTNS a small needle was inserted next to the tibial nerve in the ankle, electrical stimulation was applied via the needle. Transcutaneous stimulation was done in a similar way by two pad electrodes. In the last 4 years 4 review articles (2 systematic reviews) with up to 13 case series were published in the current literature. Results. All studies reported that pTNS improved faecal incontinence. Outcome measures and indications (patient heterogeneity) varied, but success rates ranged from 30 to 83.3%. Most of the studies documented an improvement in the Cleveland Clinical Incontinence Score and the episodes of faecal incontinence. Conclusion. pTNS is a minimally invasive and effective treatment for patients with faecal incontinence. Comparing the studies is difficult due to many differences in outcome measures, duration of treatment and two different techniques. Further studies, especially in the long-term, and multicentre placebo-controlled trials are needed to confirm the encouraging initial results.