Despite the availability of numerous treatment options for managing pelvic floor dyssynergia-type constipation, many children continue to experience therapy-resistant constipation [1]. Neuromodulation, particularly in the form of interferential therapy (IFT), is a well-established treatment modality primarily recognized for addressing slow transit constipation. [2] The aim of this study was to evaluate the effectiveness of IFT in the treatment of therapy-resistant pelvic floor dyssynergia-type constipation in children.

Children with chronic treatment-resistant constipation received baseline investigations to select patients with pelvic floor dyssynergia-type constipation. Defecation frequency, soiling frequency, stool consistency and laxative use were recorded at baseline using a stool diary. First sensation and urge to defecate was recorded at baseline using anal manometry. Quality of life scores of parents and children were recorded. All children received IFT at home (3 times a week, 20 minutes, for three months). IFT was administered through an interferential stimulator, with four adhesive electrodes (two on the lower abdomen, two on the back), so currents cross within the lower abdomen.  IFT is easy to use, non-invasive and can be administered at home. After three months, therapy was increased or decreased depending on the results. Primary outcome measures were achieving a defecation frequency between three times a week to three times a day, 50% reduction in soiling episodes and improvement in stool consistency to a consistency of 3 – 4 – 5 on the Bristol Stool Chart for 50% of the bowel movements. Secondary outcome measures were reduced use of laxatives, improvement in rectal sensation and improvement in quality of life (QoL) scores. The follow-up period was one year.

This pilot study, conducted at a tertiary care center, included 15 children (6 girls, 9 boys) aged 8 to 15 years (mean 11,4 years), with chronic treatment-resistant pelvic floor dyssynergia-type constipation. After one year of follow-up we observed a trend towards increased defecation frequency (mean 6,1/week to mean 8,3/week, p = 0,17), a significant improvement in stool consistency (75% of patients to 100% of patients achieving normal consistency in at least 50% of bowel movements, p = 0,01) and a trend towards reduced soiling episodes (mean 2,4/week to mean 0,7/week, p=0,08). There was  a significant reduction in laxative use (from 75% to 41% of patients using laxatives, p = 0,02) with 54% of patients no longer requiring any therapy at the one-year follow-up. QoL scores demonstrated significant improvements: gastrointestinal QoL scores increased from a mean of 69/100 to 82/100 for patients (p = 0,01) and from a mean of 65/100 to 83/100 for parents (p = 0,01). General QoL scores rose from 64/100 to 78/100 for patients (p = 0,00) and from a mean of 58/100 to 77/100 for parents (p = 0,00). Additionally, there was a significant improvement in rectal sensation and the urge to defecate as assessed by anal manometry. No adverse events were reported during the study.

IFT improves stool consistency in children with pelvic floor dyssynergia-type constipation. We observed a significant reduction in the use of laxatives and water enemas and a significant improvement in patient and parental QoL scores. We observed a significant improvement in rectal sensation and urge to defecate. IFT is a safe therapy and no adverse events were reported. Adding IFT to the standard medical treatment for patients with dyssynergia-type constipation could possibly prevent the need for water enemas and could significantly improve the QoL of patients and their families.

The intervention led to significant improvements in bowel function, stool consistency, and QoL, with reduced reliance on laxatives. These findings support the potential effectiveness of this approach for managing chronic treatment-resistant constipation in children, warranting further research in larger studies.

B. R. Southwell, S. K. King, and J. M. Hu tson, “Chronic constipation in children: Organic disorders are a major cause,” Journal of Paediatrics and Child Health , vol. 41, no. 1 2. pp. 1 15, Jan. 2005. doi: 10.1111/j.1440 1754.2005.00527.x.
Chase, V. J. Robertson, B. Southwell, J. Hutson, † And, and S. Gibb, “Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment resistant constipation and s oiling in children,” J Gastroenterol Hepatol , vol. 20, pp. 1054 1061, 2005, doi: 10.1111/j.1400 17 46.2005.03863.x.