Efficacy of transcutaneous electrical nerve stimulation on slow transit constipation in children with cerebral palsy

Introduction: Slow transit constipation ended up causing persistent symptoms that do not respond to medical treatment. Children have common soiling, irregular bowel movements, and colicky abdominal pain. Treatment-resistant slow-transit constipation in children has improved with transcutaneous electrical nerve stimulation (TENS). Several studies reported that TENS therapy was successful in prolonging colonic transit time in children with chronic constipation and reported no side effects. Thus in this study, we would like to investigate the effectiveness of TENS in conjunction with standard therapies for constipated children with cerebral palsy (CP). Method: This was a cross-section study with a consecutive random sampling technique. This study was conducted from April 2022 – October 2022, in the faculty of medicine, Universitas Airlangga, Surabaya, Indonesia. Patients from 2 until 18 years with cerebral palsy suffering from constipation with slow transit time were recognized according to Rome-IV criteria of constipation and colonic transit colon (CTT) based on radio-opaque markers, Sitzmarks®. In two treatment groups, the intervention group was given laxatives with TENS, and the control group was given laxatives without TENS. Patient records the history of defecation frequency/week, type of stool, and colonic transit colon (CTT) based on radio-opaque markers. Analyses based on statistical parametric comparisons were performed before and after therapy (paired t-test). Result: Defecation frequency was increased significantly in the intervention group (pre 1.33 ± 0.5 vs post 3.56 +2.0 defecation/week p=0.019) compared with the control group (pre 1.9 ± 01.9 vs post 3 ± 1.8 defecation/week p=0.117). Stools got wetter after stimulation significantly in the intervention group (p = 0.02). Colonic transit was a shorter duration in the children intervention group compared to their based line (p = 0.039). Conclusion: Transcutaneous electrical nerve stimulation can speed up colonic transit time to be considered for constipation in CP children.