Tibial Nerve Stimulation in Combination With Biofeedback
Percutaneous Tibial Nerve Stimulation in Combination With Biofeedback in Patients With Fecal Incontinence - A Randomized Controlled Trial
1 other identifier
interventional
N/A
1 country
1
Brief Summary
Background: Fecal incontinence (FI) affects 2-13% of an adult general population. The prevalence increases with age, and after 50 years of age prevalence rates up to 26% in women have been reported. Quality of life in patients with FI is decreased considerably, in a similar extent as in patients with ulcerative colitis in relapse. Management of FI usually involves a stepwise approach; beginning with more conservative strategies and moving on to more appropriately tailored medications, bowel-retraining, biofeedback and psychosocial support. Although a combination of these treatment alternatives often improves symptoms they are not always successfully. Neuromodulation is a relatively new treatment modality for FI that is based on recruitment of residual anorectal neuromuscular function pertinent to continence by electrical stimulation of the peripheral nerve supply. Sacral Nerve Stimulation (SNS) is one type of neuromodulation and it employs direct electrical stimulation of the sacral nerves. Recently an alternative neuromodulation technique to SNS has been developed in treating FI i.e. tibial nerve stimulation. The tibial nerve contains afferent and efferent fibers originating from the forth and the fifth lumbar nerves and the first, second and third sacral nerves. Thus, stimulation of the tibial nerve may lead to changes in anorectal neuromuscular function similar to those observed with SNS but without the need of a permanent surgically implanted device. Tibial nerve stimulation is therefore an attractive treatment alternative for FI patients since the treatment is well-tolerated and treatment results have been very promising. Aim: The overall aim is to measure the effect of percutaneous tibial nerve stimulation (PTNS) in combination with biofeedback on symptoms in consecutive FI patients compared with biofeedback alone. The investigators also aim to study which FI patients have most profit of the addition of PTNS. Methods: The study will take place at the Pelvic Floor Unit, department of Gastroenterology, University Hospital Linköping. Prior to the first visit to the hospital a symptom diary will be mailed to the FI patients and they are instructed to record their FI symptoms, bowel habits and gastrointestinal symptoms prospectively on a 24-hour diary during 2 weeks. Before consideration of enrolment into the study, gastroenterologists assess all the patients' medical history and perform a physical examination. Subjects will also have an endoanal ultrasonography and the investigators will measure rectal volumes, sensational thresholds and anal sphincter function. FI patients who fulfil inclusion criteria will then be randomly assigned to either PTNS in combination with biofeedback or biofeedback alone. The treatment will be performed by physiotherapists.
Trial Health
Trial Health Score
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Started Mar 2016
Typical duration for not_applicable
1 active site
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Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
March 1, 2016
CompletedFirst Submitted
Initial submission to the registry
August 23, 2016
CompletedFirst Posted
Study publicly available on registry
September 5, 2016
CompletedPrimary Completion
Last participant's last visit for primary outcome
March 1, 2018
CompletedStudy Completion
Last participant's last visit for all outcomes
March 1, 2019
CompletedSeptember 5, 2016
August 1, 2016
2 years
August 23, 2016
August 30, 2016
Conditions
Outcome Measures
Primary Outcomes (1)
Change in fecal leakage episodes with a symptom diary
Change from baseline in fecal leakage episodes at 12 weeks (post-treatment), change from baseline in fecal lekage episodes at 12 months and 24 months
Study Arms (2)
Standard treatment
EXPERIMENTALPTNS in addition to standard treatment
EXPERIMENTALInterventions
Eligibility Criteria
You may qualify if:
- Patients older than 18 years of age with fecal incontinence for more than 6 months
- Patients with at least one or more episodes of fecal incontinence during a period of 2 weeks as recorded by bowel function diary
- Patients from whom written consent was obtained
You may not qualify if:
- Previous congenital or acquired spinal injury, spinal tumour or spinal surgery
- Presence of neurological diseases or peripheral vascular disease
- Uncontrolled diabetes mellitus
- Congenital anorectal malformations
- Colorectal or gastrointestinal surgery ≤24 months
- Presence of external full-thickness rectal prolapse
- Inflammatory bowel disease
- Chronic diarrhoea
- Use of tibial nerve or sacral nerve stimulations
- Ongoing pregnancy
- Any malignant disease
- Pacemaker
- Ongoing or earlier treatment with sacral- or tibial nerve stimulation
- Chronic varicose ulcer
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Pelvic floor unit, University Hospital in Linköping
Linköping, 58185, Sweden
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Jenny Sjödahl, PhD, RPT
University Hospital in Linkoeping
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Purpose
- TREATMENT
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- PhD, RPT
Study Record Dates
First Submitted
August 23, 2016
First Posted
September 5, 2016
Study Start
March 1, 2016
Primary Completion
March 1, 2018
Study Completion
March 1, 2019
Last Updated
September 5, 2016
Record last verified: 2016-08