Skip to main content Skip to main navigation menu Skip to site footer

Efficacy of transcutaneous electrical nerve stimulation on slow transit constipation in children with cerebral palsy

  • Rifah Zafarani Soumena ,
  • Andy Darma ,
  • Reza Gunadi Ranuh ,
  • Prastiya Indra Gunawan ,
  • Alpha Fardah Athiyyah ,
  • Khadijah Rizky Sumitro ,
  • Subijanto Marto Sudarmo ,

Abstract

Introduction: Slow transit constipation ended up causing persistent symptoms that do not respond to medical treatment. Children have common soiling, irregular bowel movements, and colicky abdominal pain. Treatment-resistant slow-transit constipation in children has improved with transcutaneous electrical nerve stimulation (TENS). Several studies reported that TENS therapy was successful in prolonging colonic transit time in children with chronic constipation and reported no side effects. Thus in this study, we would like to investigate the effectiveness of TENS in conjunction with standard therapies for constipated children with cerebral palsy (CP).

Method: This was a cross-section study with a consecutive random sampling technique. This study was conducted from April 2022 – October 2022, in the faculty of medicine, Universitas Airlangga, Surabaya, Indonesia. Patients from 2 until 18 years with cerebral palsy suffering from constipation with slow transit time were recognized according to Rome-IV criteria of constipation and colonic transit colon (CTT) based on radio-opaque markers, Sitzmarks®. In two treatment groups, the intervention group was given laxatives with TENS, and the control group was given laxatives without TENS. Patient records the history of defecation frequency/week, type of stool, and colonic transit colon (CTT) based on radio-opaque markers. Analyses based on statistical parametric comparisons were performed before and after therapy (paired t-test).

Result: Defecation frequency was increased significantly in the intervention group (pre 1.33 ± 0.5 vs post 3.56 +2.0 defecation/week p=0.019) compared with the control group (pre 1.9 ± 01.9 vs post 3 ± 1.8 defecation/week p=0.117). Stools got wetter after stimulation significantly in the intervention group (p = 0.02). Colonic transit was a shorter duration in the children intervention group compared to their based line (p = 0.039).  

Conclusion: Transcutaneous electrical nerve stimulation can speed up colonic transit time to be considered for constipation in CP children.

References

  1. Faleiros-Castro FS, Paula EDR de. Paralisia cerebral tetraplégica e constipação intestinal: avaliação da reeducação intestinal com uso de massagens e dieta laxante. Rev da Esc Enferm da USP [Internet]. 2013;47:836–42. Available from: http://dx.doi.org/10.1590/s0080-623420130000400010
  2. Hasosah M. Chronic Refractory Constipation in Children : Think Beyond Stools. 2021;
  3. Blackmer A, Farrington E. Constipation in the pediatric patient: an overview and pharmacologic considerations. J Pediatr Heal Care. 2010;24:385–99.
  4. Sharifi-Rad L, Ladi-Seyedian SS, Manouchehri N, Alimadadi H, Allahverdi B, Motamed F, et al. Effects of Interferential Electrical Stimulation Plus Pelvic Floor Muscles Exercises on Functional Constipation in Children: A Randomized Clinical Trial. Am J Gastroenterol [Internet]. 2018;113:295–302. Available from: http://dx.doi.org/10.1038/ajg.2017.459
  5. Orhan C, Kaya Kara O, Kaya S, Akbayrak T, Kerem Gunel M, Baltaci G. The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial. Disabil Rehabil [Internet]. 2016;40:10–20. Available from: http://dx.doi.org/10.1080/09638288.2016.1236412
  6. Ostaszkiewicz J, Hornby L, Millar L, Ockerby C. The Effects of Conservative Treatment for Constipation on Symptom Severity and Quality of Life in Community-Dwelling Adults. J Wound Ostomy Continence Nurs. 2010;37:193–8.
  7. Silva CAG, Motta MEFA. The use of abdominal muscle training, breathing exercises, and abdominal massage to treat paediatric chronic functional constipation. Color Dis [Internet]. 2013;15:e250–5. Available from: http://dx.doi.org/10.1111/codi.12160
  8. Fatmawati E, Nusi IA, Setiawan PB, Purbayu H, Sugihartono T, Maimunah U, et al. Chronic Constipation Management in Adults [Internet]. Proceedings of Surabaya International Physiology Seminar. SCITEPRESS - Science and Technology Publications; 2017. Available from: http://dx.doi.org/10.5220/0007339703970404
  9. Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence. Rev pain [Internet]. 2007;1:7–11. Available from: https://pubmed.ncbi.nlm.nih.gov/26526976
  10. van Wunnik BP, Peeters B, Govaert B, Nieman FH, Benninga MA, Baeten CG. Sacral Neuromodulation Therapy. Dis Colon & Rectum [Internet]. 2012;55:278–85. Available from: http://dx.doi.org/10.1097/dcr.0b013e3182405c61
  11. Clarke MCC, Chase JW, Gibb S, Hutson JM, Southwell BR. Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. J Pediatr Surg [Internet]. 2009;44:1268–73. Available from: http://dx.doi.org/10.1016/j.jpedsurg.2009.02.031
  12. Ferreira ACFM, Mayer MPA, Kawamoto D, Santos MTBR. Constipation, antiepileptic drugs, and gingivitis in children and adolescents with cerebral palsy. Int J Paediatr Dent [Internet]. 2019;29:635–41. Available from: http://dx.doi.org/10.1111/ipd.12488
  13. Prastiya IG, Risky VP, Mira I, Retno AS, Darto S, Erny P. Risk Factor of Mortality in Indonesian Children with Cerebral Palsy. J Med Investig [Internet]. 2018;65:18–20. Available from: http://dx.doi.org/10.2152/jmi.65.18
  14. CARAMICO-FAVERO DCO, GUEDES ZCF, MORAIS MB de. Food Intake, Nutritional Status And Gastrointestinal Symptoms In Children With Cerebral Palsy. Arq Gastroenterol [Internet]. 2018;55:352–7. Available from: http://dx.doi.org/10.1590/s0004-2803.201800000-78
  15. Suryawan A, Jalaludin MY, Poh BK, Sanusi R, Tan VMH, Geurts JM, et al. Malnutrition in early life and its neurodevelopmental and cognitive consequences: a scoping review. Nutr Res Rev [Internet]. 2021;35:136–49. Available from: http://dx.doi.org/10.1017/s0954422421000159
  16. Yik YI, Hutson J, Southwell B. Home-Based Transabdominal Interferential Electrical Stimulation for Six Months Improves Paediatric Slow Transit Constipation (STC). Neuromodulation Technol Neural Interface [Internet]. 2018;21:676–81. Available from: http://dx.doi.org/10.1111/ner.12734
  17. Leong LCY, Yik YI, Catto-Smith AG, Robertson VJ, Hutson JM, Southwell BR. Long-term effects of transabdominal electrical stimulation in treating children with slow-transit constipation. J Pediatr Surg [Internet]. 2011;46:2309–12. Available from: http://dx.doi.org/10.1016/j.jpedsurg.2011.09.022
  18. Southwell BR, Yik YI, Tan A, Jordan-ely J, Hutson JM. Transcutaneous electrical stimulation over the belly in slow-transit constipation. 2013;
  19. Li H, Wang P, Huang L, Li P, Zhang D. Effects of regulating gut microbiota on the serotonin metabolism in the chronic unpredictable mild stress rat model. Neurogastroenterol Motil. 2019;31:1–13.
  20. Dinning PG, Fuentealba SE, Kennedy ML, Lubowski DZ, Cook IJ. Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation. Color Dis [Internet]. 2007;9:123–32. Available from: http://dx.doi.org/10.1111/j.1463-1318.2006.01096.x
  21. van Wunnik BPW, Baeten CGMI, Southwell BR. Neuromodulation for constipation: Sacral and transcutaneous stimulation. Best Pract & Res Clin Gastroenterol [Internet]. 2011;25:181–91. Available from: http://dx.doi.org/10.1016/j.bpg.2010.12.008

How to Cite

Soumena, R. Z. ., Darma, A., Ranuh, R. G. ., Indra Gunawan, P., Fardah Athiyyah, A., Rizky Sumitro, K., & Marto Sudarmo, S. . (2023). Efficacy of transcutaneous electrical nerve stimulation on slow transit constipation in children with cerebral palsy. Bali Medical Journal, 12(1), 192–196. https://doi.org/10.15562/bmj.v12i1.3897

HTML
22

Total
16

Share

Search Panel

Rifah Zafarani Soumena
Google Scholar
Pubmed
BMJ Journal


Andy Darma
Google Scholar
Pubmed
BMJ Journal


Reza Gunadi Ranuh
Google Scholar
Pubmed
BMJ Journal


Prastiya Indra Gunawan
Google Scholar
Pubmed
BMJ Journal


Alpha Fardah Athiyyah
Google Scholar
Pubmed
BMJ Journal


Khadijah Rizky Sumitro
Google Scholar
Pubmed
BMJ Journal


Subijanto Marto Sudarmo
Google Scholar
Pubmed
BMJ Journal