Techniques in Coloproctology

, Volume 22, Issue 11, pp 875–879 | Cite as

Medium-term outcome of percutaneous tibial nerve stimulation in the treatment of fecal incontinence

  • M. Hidalgo-Pujol
  • V. Andriola
  • L. M. Jimenez-Gomez
  • F. Ostiz
  • E. Espin
Original Article



Fecal incontinence (FI) is a multifactorial disease that affects patients’ quality of life. The aim of this study was to evaluate the efficacy of posterior tibial nerve stimulation (PTNS) in the treatment of FI and to assess the medium-term results.


A prospective cohort of patients with FI treated with PTNS between 2012 and 2014 was analysed. Endoluminal ultrasound and anorectal physiologic studies were performed in all patients. The efficacy of PTNS was assessed using a validated questionnaire (Cleveland Clinic Incontinence Score) at baseline, after treatment, and 2 years later. The Vaizey score was also used at 2-year follow-up to assess urge incontinence.


Fifty-six patients (38 females; mean age 59.7 years) with FI were treated. The causes of FI were mainly obstetric injury and previous colorectal surgery. A decrease of 50% from baseline CCIS was seen in 41.1% of patients after PTNS. One-third maintained a minimum of 50% decrease of their initial CCIS after 2 years. Comparing CCIS at baseline, after treatment, and at 2-year follow-up, a statistically significant difference was observed (p < 0.0001 and p < 0.0004 respectively). Medium-term improvement was not maintained in patients with passive and mixed FI, while it was maintained in those with urge incontinence. At 2 years, patients with mild incontinence maintained the greatest response.


PTNS is a safe, effective, non-invasive treatment for FI with good results in almost half of the patients at the end of the treatment. There is also an acceptable maintained response at 2-year follow-up. It seems to be most successful in patients with mild incontinence and urge incontinence.


Fecal incontinence Posterior tibial nerve stimulation 


Compliance with ethical standards

Conflict of interest

The authors have no commercial associations that might be a conflict of interest in relation to this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.


  1. 1.
    Benezech A, Bouvier M, Vitton V (2016) Faecal incontinence: current knowledges and perspectives. World J Gastrointest Pathophysiol 7(1):59–71CrossRefGoogle Scholar
  2. 2.
    Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91(1):33–36PubMedGoogle Scholar
  3. 3.
    Madoff RD, Parker SC, Varma MG, Lowry AC (2004) Faecal incontinence in adults. Lancet 364:621–632CrossRefGoogle Scholar
  4. 4.
    Norton C, Cody JD (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  5. 5.
    Shafik A, Ahmed I, El-Sibai O, Mostafa RM (2003) Perrcutaneous peripheral neuromodulation in the treatment of fecal incontinence. Eur Surg Res 35(2):103–107CrossRefGoogle Scholar
  6. 6.
    Gupta P, Ehlert MJ, Sirls LT et al (2015) Percutaneous tibial nerve stimulation and sacral neuromodulation: an update. Curr Urol Rep 16(2):4. CrossRefPubMedGoogle Scholar
  7. 7.
    Cooperberg MR, Stoller ML (2005) Percutaneous neuromodulation. Urol Clin N Am 32(1):71–78 (vii. Review) CrossRefGoogle Scholar
  8. 8.
    Peña Ros E, Parra Baños PA, Benavides Buleje JA, Muñoz Camarena JM, Escamilla Segade C, Candel Arenas MF, Gonzalez Valverde FM, Albarracín Marín-Blázquez A (2016) Short-term outcome of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of faecal incontinence. Tech Coloproctol 20(1):19–24CrossRefGoogle Scholar
  9. 9.
    Thomas GP, Dudding TC, Rahbour G, Nicholls RJ, Vaizey CJ (2013) A review of posterior tibial nerve stimulation for faecal incontinence. Colorectal Dis 15:519–526CrossRefGoogle Scholar
  10. 10.
    Horrocks EJ, Thin N, Thaha MA et al (2014) Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg 101:457–468CrossRefGoogle Scholar
  11. 11.
    Tan E, Ngo NT, Darzi A, Shenouda M, Tekkis PP (2011) Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis 26:275–294CrossRefGoogle Scholar
  12. 12.
    Edenfield AL, Amundsen CL, Wu JM, Levin PJ, Siddiqui NY (2015) Posterior tibial nerve stimulation for the treatment of fecal incontinence: a systematic evidence review. Obstet Gynecol Surv 70(5):329–341CrossRefGoogle Scholar
  13. 13.
    Knowles CH, Horrocks EJ, Bremner SA, Stevens N, Norton C, O’Connell PR (2015) Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet 386(10004):1640–1648CrossRefGoogle Scholar
  14. 14.
    De la Portilla F, Rada R, Vega J, González CA, Cisneros N, Maldonado VH (2009) Evaluation of the use of posterior tibial nerve stimulation for the treatment of fecal incontinence: preliminary results of a prospective study. Dis Colon Rectum 52(8):1427–1433. CrossRefPubMedGoogle Scholar
  15. 15.
    Glasgow SC, Lowry AC (2012) Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum 55:482–490CrossRefGoogle Scholar
  16. 16.
    Halverson AL, Hull TL (2002) Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 45:345–348CrossRefGoogle Scholar
  17. 17.
    Hotouras A, Murphy J, Walsh U, Allison M, Curry A, Williams NS, Knowles C, Chan CL (2014) Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: a prospective cohort study. Ann Surg 259(5):939–943CrossRefGoogle Scholar
  18. 18.
    Marti L, Galata C, Beutner U, Hetzer F, Pipitone N, Wolff K, Borovicka J, Brunner W, Sulz MC, Maurus C (2017) Percutaneous tibial nerve stimulation (pTNS): success rate and the role of rectal capacity. Int J Colorectal Dis 32(6):789–796CrossRefGoogle Scholar
  19. 19.
    Van der Wilt AA, Giuliani G, Kubis C, van Wunnik BPW, Ferreira I, Breukink SO, Lehur PA, La Torre F, Baeten CGMI (2017) Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg 104(9):1167–1176CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • M. Hidalgo-Pujol
    • 1
  • V. Andriola
    • 2
  • L. M. Jimenez-Gomez
    • 3
  • F. Ostiz
    • 4
  • E. Espin
    • 3
  1. 1.Department of Gastrointestinal SurgeryVall d’Hebron HospitalBarcelonaSpain
  2. 2.Colorectal UnitAldo Moro University BariBariItaly
  3. 3.Department of Colorectal SurgeryVall d’Hebron HospitalBarcelonaSpain
  4. 4.CAP Sant AndreuBarcelonaSpain

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