Effects of TENS and Physiotherapy on Chronic Constipation in Myelomeningocele

Öz

Background: Chronic constipation is a common symptom of myelomeningoceles. TENS has been proven to be effective in treating constipation in different populations and parameters. Physiotherapy is a relatively recent treatment for constipation and has not been extensively studied in pediatrics and spina bifida. This study aimed to examine the role of TENS in myelomeningocele and to increase the number of studies on physiotherapy for pediatric constipation. Aims: To determine a new treatment approach that can be applied in chronic constipation in children with spina bifida using physical therapy techniques. Study Design: Randomized Controlled Trial Methods: Constipation symptoms, stool pattern, bladder and bowel dysfunction, muscle strength involved in defecation, pressure pain thresholds (ppt) in these muscles, severity of fecal incontinence, and quality of life were assessed prior to treatment. Physical Therapy (PT) group received manual physical therapy techniques and dietary therapy for six weeks while the Physical Therapy and TENS (PT+T) group also received TENS. The post-treatment evaluations were repeated. Results: A total of 28 children, 14 in each group, were included in the treatment plan. The stool form in both groups of children was constipated. There was a significant difference in stool pattern only PT+T group (p<0.05). Myofascial trigger points (MTrPs) were significantly reduced in both groups (p<0.05). Ppt and muscle strength increased significantly in PT group (p<0.05). Severity of fecal incontinence, constipation symptoms, and bladder-bowel dysfunction decreased significantly in both groups, but satisfaction with treatment increased (p<0.05). Only PT group had a statistically significant improvement in quality of life (p<0.05). Conclusions: TENS and physical therapy are safe and effective approaches that can be executed in clinical practice to reduce the symptoms of chronic constipation in myelomeningoceles.

Anahtar Kelimeler

• Myelomeningocele
• Spina Bifida
• Constipation
• TENS
• Physiotherapy

Kaynakça

1. [1] Acar Arslan E. Nörolojik problemi olan çocuklarda kabızlık. 1st ed. Sarıhan H, editor. Çocuklarda kabızlık: Türkiye Klinikleri. 2020;27-32.
2. [2] Kaplan S.A., Dmochowski R., Cash B.D., Kopp Z.S., Berriman S.J., Khullar V. Systematic review of the relationship between bladder and bowel function: implications for patient management. Int J Clin Pract. 2013 Mar;67(3):205-16.
3. [3] Ashrafi A., Arab A.M., Abdi S., Nourbakhsh M.R. The association between myofascial trigger points and the incidence of chronic functional constipation. J Bodyw Mov Ther. 2021 Apr;26:201-206.
4. [4] Bocchini R., Chiarioni G., Corazziari E. et al. Pelvic floor rehabilitation for defecation disorders. Tech Coloproctol. 2019 Feb;23(2):101-115.
5. [5] Ambartsumyan L., Rodriguez L. Bowel management in children with spina bifida. J Pediatr Rehabil Med. 2018;11(4):293-301
6. [6] Choi E.K., Im Y.J., Han S.W. Bowel Management and Quality of Life in Children With Spina Bifida in South Korea. Gastroenterol Nurs. 2017 May/Jun;40(3):208-215.
7. [7] Dinning P.G., Fuentealba S.E., Kennedy M.L., Lubowski D.Z., Cook I.J. Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation. Colorectal Dis. 2007 Feb;9(2):123-32
8. [8] Veiga M.L., Costa E.V., Portella I., Nacif A.A.M., Braga M., Barroso Jr U. Parasacral transcutaneous electrical nerve stimulation for overactive bladder in constipated children: the role of constipation [Internet) J Pediatr Urol 2016;12(6):396.e1e6).

9. [9] Dombek K., Costa Monteiro L.M., Fontes J.M., Ramos E.G. Immediate effect of transcutaneous electrical nerve stimulation on urodynamic parameters of children with myelomeningocele. Neurourol Urodyn. 2019 Nov;38(8):2351-2358.
10. [10] Balcom A.H., Wiatrak M., Biefeld T., Rauen K., Langenstroer P. Initial experience with home therapeutic electrical stimulation for continence in the myelomeningocele population. J Urol. 1997 Sep;158(3 Pt 2):1272-6.
11. [11] Brochard C., Peyronnet B., Hascoet J., et al. Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches. Neurourol Urodyn. 2019 Feb;38(2):719-725.
12. [12] ] D'Ancona C., Haylen B., Oelke M. et al. Standardisation Steering Committee ICS and the ICS Working Group on Terminology for Male Lower Urinary Tract & Pelvic Floor Symptoms and Dysfunction. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019 Feb;38(2):433-477.
13. [13] Cameron A.P., Rodriguez G.M., Gursky A., He C., Clemens J.Q., Stoffel J.T. The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder. J Urol. 2015 Nov;194(5):1336-41.
14. [14] Carr M.C. Conservative nonsurgical management of spina bifida. Curr Urol Rep. 2010 Mar;11(2):109-13.
15. [15] Zivkovic V., Lazovic M., Vlajkovic M. et al. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med. 2012 Sep;48(3):413-21.
16. [16] Aydın G., van Engelenburg-van Lonkhuyzen M.L., Baktır S., Kaya M.E., Mutlu C., de Bie R.A. The Turkish version of the childhood bladder and bowel dysfunction questionnaire (CBBDQ): Cross-cultural adaptation, reliability and construct validity. Turk J Gastroenterol. 2020 Jun;31(6):482-488.
17. [17] Kajbafzadeh A.M., Sharifi-Rad L., Nejat F., Kajbafzadeh M., Talaei H.R. Transcutaneous interferential electrical stimulation for management of neurogenic bowel dysfunction in children with myelomeningocele. Int J Colorectal Dis. 2012 Apr;27(4):453-8.
18. [18] Dias L.V., Cordeiro M.A., Schmidt de Sales R. et al. Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: Randomised placebo-controlled trial. J Bodyw Mov Ther. 2021 Jul;27:181-190.
19. [19] Celik D., Yeldan I. The relationship between latent trigger point and muscle strength in healthy subjects: a double-blind study. J Back Musculoskelet Rehabil. 2011;24(4):251-6.
20. [20] Sağır K., Kaya M.E. Kronik Pelvik Ağrı: Pelvik Tabana Özgü Değerlendirme ve Manuel Yaklaşımlar. Sağlık Pro Arş Dergisi. 2021; 3(2): 103-113.