The Efficacy of External Neuromyogenic Stimulation on Neuromuscular Anorectal Incontinence

Abstract

This study reports on the preliminary results of external neuromyogenic electrostimulation (ENS) for the treatment of anorectal continence problems. A total of seventeen patients 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. 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 cmH (2)O and increased to 28.7+/-14.1 cmH (2)O after 6 weeks (p>0.05). Maximum voluntary squeeze pressures before and after ENS were 56.1+/-16.7 cmH (2)O and 100.7+/-16.9 cmH (2)O respectively (p=0.001). 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.