Percutaneous Tibial Nerve Stimulation Is Ineffective for Fecal Incontinence

Sacral nerve stimulation has become an important part of fecal incontinence treatment. An alternative, simpler procedure is tibial nerve stimulation. The tibial nerve can be accessed for either percutaneous or transcutaneous stimulation as it passes behind the medial malleolus of the ankle.

In the current trial, investigators in the U.K. randomized 227 patients with fecal incontinence to undergo percutaneous tibial nerve stimulation (PTNS) or sham stimulation once weekly for 12 weeks. Results were as follows:

• A similar percentage of patients in the PTNS and sham groups achieved a ≥50% reduction in the weekly number of incontinence episodes (38% and 31%, respectively).

• St. Mark's Incontinence Scores, disease-specific fecal incontinence quality-of-life scale scores, and generic quality-of-life measures were similar between groups.

• Compared with the sham group, the PTNS group experienced significant decreases in weekly incontinence episodes and weekly urge incontinence episodes.

• More patients in the PTNS group versus the sham group reduced loperamide use (29% vs. 11%).

• The PTNS group showed a borderline-significant improvement (P=0.05) in patient-reported outcomes and a near-significant improvement (P=0.07) in global impression of success.

The sham techniques were not fully effective in blinding patients to treatment status, as 54% who received PTNS thought they had received it versus 31% of the sham group.