According to new research published in The American Journal of Gastroenterology, interferential electrical stimulation of the lower abdomen and lower back is a useful adjuvant to pelvic floor muscle exercises for relieving functional constipation in children.

Estimates of the prevalence of functional constipation among children range from 0.7% to 29.6%. Dietary modification and laxatives relieve symptoms in many children, but more invasive methods may be required for intractable cases.

In patients with myelomeningocele or postoperative Hirschsprung’s disease, neuromodulation using interferential (IF) electrical stimulation has shown promise for treating intractable constipation and bladder dysfunction.

The researchers assessed the efficacy of IF electrical stimulation as an adjuvant therapy in their sham-controlled study of 90 children 5 to 13 years of age with functional constipation. Both groups received education about toilet training and correct defecation posture and were instructed in the performance of pelvic floor muscle exercises.

Children in the treatment group received 10 courses of IF electrical stimulation through self-adhesive electrodes applied to the lower anterior abdominal wall and the lower back, whereas children in the control group had similar electrodes applied but received no stimulation.

At the end of the treatment sessions, 84.4% (38/45) of the treatment group had achieved the primary outcome of the absence of functional constipation according to the Rome III criteria, compared to 43.2% (19/44) of the control group (P<0.003).

Six months later, 71.1% of the treatment group and 36.4% of the control group remained constipation free (P<0.001). After treatment, children in the treatment group had significantly greater defecation frequency, significantly lower painful defecation rates and significantly lower constipation and pain scores.

Both groups experienced significant improvements in their constipation-related quality of life scores, with no significant differences between the groups. More importantly, the method is a safe and non-invasive intervention that prompts further investigations with larger samples and longer follow-up periods.

In the study, the effect of interferential electrical stimulation combined with pelvic floor exercises is compared with sham stimulation combined with pelvic floor exercises. It would have been cleaner to compare interferential electrical stimulation with sham stimulation only, especially since pelvic floor exercises are not part of the standard treatment of functional constipation.

The high success rate (children no longer fulfilling the Rome III criteria) in the case group, considering that this is a population who did not respond to conventional treatment with behavioural interventions and laxatives for at least 6 months.

The researchers concluded that interferential electrical stimulation is a promising treatment modality for childhood functional constipation. However, more research is needed to identify patients who are likely to benefit from this novel treatment modality.