Neuromodulation for constipation: Sacral and transcutaneous stimulation

B.P. van Wunnik, C.G.M.I. Baeten, B.R. Southwell

Research output: Contribution to journalArticleAcademicpeer-review

28 Citations (Scopus)

Abstract

Constipation is a frequently occurring digestive ailment that is usually treated conservatively. Neuromodulation is altering function of an organ by altering neural activity. This paper reviews methods of neuromodulation used to treat constipation. This includes direct stimulation of sacral nerves and stimulation across the skin. Direct stimulation of sacral nerves is the most well developed method and is presented in detail. It is generally accepted that the mechanism of action is modulation rather than stimulation so it is called sacral neuromodulation (SNM). SNM involves percutaneous placement of an electrode in the third sacral foramen and implanting a stimulating device under the skin in the buttocks. SNM is founded on the physiological principle that activity in one neural pathway modulates pre-existing activity in another through synaptic interaction. The mechanism of action in constipation may be neuromodulation of the extrinsic neural control of the large bowel or modulation of reflexes inhibiting large bowel function. Limited evidence is available to assess the outcome of SNM in constipation. Results in the medium term seem promising for selected patients with idiopathic slow and normal transit constipation not responding to optimal conservative treatment. Adverse events include electrode migration and infection. The availability of a testing phase provides a predictor of treatment outcome. In addition, transcutaneous stimulation using sticky pad electrodes over the lumbosacral region or acupuncture points has been reported to improve constipation symptoms. In general, the level of evidence is low and further studies are needed.
Original languageEnglish
Pages (from-to)181-191
Number of pages11
JournalBest Practice & Research in Clinical Gastroenterology
Volume25
Issue number1
DOIs
Publication statusPublished - Feb 2011

Keywords

  • Interferential stimulation
  • TES
  • SNM
  • Faecal incontinence
  • TENS
  • SNS
  • SLOW-TRANSIT CONSTIPATION
  • ELECTRICAL NERVE-STIMULATION
  • DYSFUNCTIONAL ELIMINATION SYNDROME
  • IRRITABLE-BOWEL-SYNDROME
  • FECAL INCONTINENCE
  • SINGLE-CENTER
  • IDIOPATHIC CONSTIPATION
  • DETRUSOR OVERACTIVITY
  • VOIDING DYSFUNCTION
  • ACUPUNCTURE POINTS

Cite this

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title = "Neuromodulation for constipation: Sacral and transcutaneous stimulation",
abstract = "Constipation is a frequently occurring digestive ailment that is usually treated conservatively. Neuromodulation is altering function of an organ by altering neural activity. This paper reviews methods of neuromodulation used to treat constipation. This includes direct stimulation of sacral nerves and stimulation across the skin. Direct stimulation of sacral nerves is the most well developed method and is presented in detail. It is generally accepted that the mechanism of action is modulation rather than stimulation so it is called sacral neuromodulation (SNM). SNM involves percutaneous placement of an electrode in the third sacral foramen and implanting a stimulating device under the skin in the buttocks. SNM is founded on the physiological principle that activity in one neural pathway modulates pre-existing activity in another through synaptic interaction. The mechanism of action in constipation may be neuromodulation of the extrinsic neural control of the large bowel or modulation of reflexes inhibiting large bowel function. Limited evidence is available to assess the outcome of SNM in constipation. Results in the medium term seem promising for selected patients with idiopathic slow and normal transit constipation not responding to optimal conservative treatment. Adverse events include electrode migration and infection. The availability of a testing phase provides a predictor of treatment outcome. In addition, transcutaneous stimulation using sticky pad electrodes over the lumbosacral region or acupuncture points has been reported to improve constipation symptoms. In general, the level of evidence is low and further studies are needed.",
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Neuromodulation for constipation: Sacral and transcutaneous stimulation. / van Wunnik, B.P.; Baeten, C.G.M.I.; Southwell, B.R.

In: Best Practice & Research in Clinical Gastroenterology, Vol. 25, No. 1, 02.2011, p. 181-191.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - van Wunnik, B.P.

AU - Baeten, C.G.M.I.

AU - Southwell, B.R.

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N2 - Constipation is a frequently occurring digestive ailment that is usually treated conservatively. Neuromodulation is altering function of an organ by altering neural activity. This paper reviews methods of neuromodulation used to treat constipation. This includes direct stimulation of sacral nerves and stimulation across the skin. Direct stimulation of sacral nerves is the most well developed method and is presented in detail. It is generally accepted that the mechanism of action is modulation rather than stimulation so it is called sacral neuromodulation (SNM). SNM involves percutaneous placement of an electrode in the third sacral foramen and implanting a stimulating device under the skin in the buttocks. SNM is founded on the physiological principle that activity in one neural pathway modulates pre-existing activity in another through synaptic interaction. The mechanism of action in constipation may be neuromodulation of the extrinsic neural control of the large bowel or modulation of reflexes inhibiting large bowel function. Limited evidence is available to assess the outcome of SNM in constipation. Results in the medium term seem promising for selected patients with idiopathic slow and normal transit constipation not responding to optimal conservative treatment. Adverse events include electrode migration and infection. The availability of a testing phase provides a predictor of treatment outcome. In addition, transcutaneous stimulation using sticky pad electrodes over the lumbosacral region or acupuncture points has been reported to improve constipation symptoms. In general, the level of evidence is low and further studies are needed.

AB - Constipation is a frequently occurring digestive ailment that is usually treated conservatively. Neuromodulation is altering function of an organ by altering neural activity. This paper reviews methods of neuromodulation used to treat constipation. This includes direct stimulation of sacral nerves and stimulation across the skin. Direct stimulation of sacral nerves is the most well developed method and is presented in detail. It is generally accepted that the mechanism of action is modulation rather than stimulation so it is called sacral neuromodulation (SNM). SNM involves percutaneous placement of an electrode in the third sacral foramen and implanting a stimulating device under the skin in the buttocks. SNM is founded on the physiological principle that activity in one neural pathway modulates pre-existing activity in another through synaptic interaction. The mechanism of action in constipation may be neuromodulation of the extrinsic neural control of the large bowel or modulation of reflexes inhibiting large bowel function. Limited evidence is available to assess the outcome of SNM in constipation. Results in the medium term seem promising for selected patients with idiopathic slow and normal transit constipation not responding to optimal conservative treatment. Adverse events include electrode migration and infection. The availability of a testing phase provides a predictor of treatment outcome. In addition, transcutaneous stimulation using sticky pad electrodes over the lumbosacral region or acupuncture points has been reported to improve constipation symptoms. In general, the level of evidence is low and further studies are needed.

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KW - DYSFUNCTIONAL ELIMINATION SYNDROME

KW - IRRITABLE-BOWEL-SYNDROME

KW - FECAL INCONTINENCE

KW - SINGLE-CENTER

KW - IDIOPATHIC CONSTIPATION

KW - DETRUSOR OVERACTIVITY

KW - VOIDING DYSFUNCTION

KW - ACUPUNCTURE POINTS

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DO - 10.1016/j.bpg.2010.12.008

M3 - Article

VL - 25

SP - 181

EP - 191

JO - Best Practice & Research in Clinical Gastroenterology

JF - Best Practice & Research in Clinical Gastroenterology

SN - 1521-6918

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