# Bilateral posterior tibial nerve stimulation as a neuromodulation strategy for obstructed defecation: a randomized controlled trial

## TL;DR

A new noninvasive treatment using bilateral posterior tibial nerve stimulation significantly improves symptoms and quality of life for patients with obstructed defecation syndrome.

## Contribution

This study demonstrates the efficacy of bilateral transcutaneous posterior tibial nerve stimulation as a novel treatment for obstructed defecation syndrome.

## Key findings

- Patients receiving bilateral posterior tibial nerve stimulation showed a 10-point greater reduction in symptom scores compared to medical treatment alone.
- Quality of life improvements were 65% in the treatment group versus 37% in the control group.
- Electromyographic analysis revealed significant improvements in pelvic floor muscle function with no adverse events.

## Abstract

Obstructed defecation syndrome (ODS) is a prevalent pelvic floor disorder, often impairing patients’ quality of life. Noninvasive therapies, including posterior tibial nerve stimulation (PTNS), have been explored as alternative treatments. This study evaluates the efficacy of bilateral transcutaneous posterior tibial nerve stimulation (BT-PTNS) compared to medical treatment alone in patients with ODS without anatomical abnormalities.

A prospective randomized controlled study was conducted on 50 patients diagnosed with ODS. Patients were randomly assigned into two groups: group A received BT-PTNS sessions three times weekly for 6–12 weeks alongside medical treatment, while group B received medical treatment only. Outcomes were assessed using the Modified Obstructed Defecation Syndrome (MODS) score, Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and quantitative electromyography of pelvic floor muscles. Statistical analysis was performed using SPSS software.

Group A exhibited a significant reduction in MODS scores (mean decrease = 10 points) compared to group B (mean decrease = 4 points) after 6 weeks (p < 0.001). PAC-QOL scores improved significantly in group A (65% reduction) compared to group B (37% reduction). Electromyographic analysis in group A showed significant improvement in amplitude, number of motor unit turns, and duration (p < 0.001). No adverse events were reported in either group.

BT-PTNS is a safe and effective noninvasive treatment for ODS without anatomical abnormalities, significantly improving symptom severity and quality of life. Further multicentric trials are warranted to standardize treatment protocols and assess long-term outcomes.

Clinical Trial Number IORG0008812; E/C.S/N.R2/2017