Abstract: Objective: The aim of this study was to determine the efficacy of adding a foot stool to help facilitate defecation in patients with fecal outlet obstruction. Methods: Patients (n=53) who experienced evacuation difficulties between June and October 2016 were enrolled in this prospective non-randomized single group study. Cinedefecography was performed with and without a foot stool. Anorectal angle (ARA), perineal plane distance (PPD), and puborectalis length (PRL) during rest and straining in both positions were measured from the radiographs. Rectal pressure was measured with the lateral position and sitting with and without a foot stool. Results: There was no significant difference between with and without a foot stool in ARA, PPD and PRL. In the upper body bent forward group, the time to evacuation was significantly shorter with a foot stool compared to without a foot stool (123 vs 91 sec, p=0.04). The difference of rectal pressure between the lateral position and sitting position significantly increased with a foot stool compared to without a foot stool (22.1 vs 16.7 mmH2O, p<0.01). The difference of rectal pressure between with and without a foot stool increased in the upper body bent forward position compared to the upright sitting position (5.4 vs 1.9 mmH2O, p<0.01). Conclusion: The findings suggest that using a foot stool with structure is a more efficient method for defecation. However, the upper body bent forward position is also important. This technique may be useful for retraining patients with constipation.
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ABSTRACT Context: Posterior tibial nerve stimulation is a new second-line treatment for refractory fecal incontinence. Objective: To assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation (BTPTNS) for treatment of fecal incontinence in Japanese patients and its impact on quality of life. Design: A prospective observational-interventional study was conducted from May 2015 to June 2017 in patients with fecal incontinence in whom conservative treatment had failed. All patients received a 30-minute session of stimulation twice weekly for 6 consecutive weeks. Evaluation at baseline and at 6 weeks involved the Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and anal manometry. Patients recorded episodes of incontinence in a weekly diary. Main Outcome Measures: Reduction of 50% or greater in incontinence episodes, decreased Wexner score, and improved FIQL scores. Results: Twenty-two patients with a median age of 64.1 years (range, 26-81 years) and men:women ratio of 9:13 completed BTPTNS. Mean episodes of fecal incontinence were significantly reduced from 4.7 to 1.5 (p < 0.05). An improvement of 50% or better in episodes of fecal incontinence was achieved in 77.2% of patients. The median Wexner score significantly decreased from 10.2 to 6.9 (p < 0.05). The median FIQL score improved from 2.7 to 3.1 (p = 0.06), and significant improvement was seen in the embarrassment domain (2.2 vs 2.8, p < 0.05). Resting and squeezing anal pressures revealed no significant changes. Conclusion: Our findings suggest that BTPTNS is safe and well tolerated and may improve symptoms of fecal incontinence. This technique offers an additional noninvasive, less expensive form of treatment.
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