Neuromodulation for Treatment of Pediatric Defecatory Disorders

Abstract

Defecatory disorders are relatively common in children and can have a significant detrimental impact on a child’s quality of life. Treatment options for constipation and fecal incontinence refractory to conventional treatment are limited and often invasive. Neuromodulation is a promising treatment modality for this population. Evidence for the use of sacral neuromodulation to treat children with refractory constipation and fecal incontinence has been growing over the past decade, and there are reports of clinical response in children with a variety of underlying disorders, including functional constipation, anorectal malformation, and spinal cord abnormalities. However, sacral neuromodulation does require surgery and can be associated with certain known risks of complications, which may require additional procedures. Less invasive forms of neuromodulation, like abdominal transcutaneous electrical stimulation and posterior tibial nerve stimulation, have been used for children with defecatory disorders to a limited extent and with mixed results. In this chapter, we review current applications of neuromodulation for treatment of pediatric defecatory disorders and discuss potential future applications.