The role of Sacral TENS in Improving Continence and Quality of Life in Children with Anorectal Malformations: A six-year Follow-up

Abstract PURPOSE Anorectal malformations are congenital defects of the posterior intestinal development, leading to structural and functional abnormalities of the rectum and/or anal canal. Typically, these patients develop long-term constipation or fecal incontinence, which can be challenging to manage. Sacral transcutaneous electrical nerve stimulation (TENS) is a non-invasive technical alternative initially studied for bladder elimination disorders and has been increasingly established as a tool for treating intestinal dysfunctions. This study aims to observe outcomes in patients who underwent surgery for anorectal malformations and received TENS therapy. METHODS: A longitudinal and retrospective observational study (2018 to 2024). Included children with corrected anorectal malformation, aged 4 to 15 years who underwent TENS therapy. The analysis considered medication use, quality of life through the Paulista Continence Score, and anorectal manometry at three time points: before TENS application, four weeks and six years post TENS. RESULTS: Eleven children were included, 6 had low anorectal malformations and 5 had high anorectal malformations. Among these patients, 81.81% used some type of laxative or bowel management before application, and six years after the treatment, the immediate post-results remained, only 27.27% of patients used some type of laxative or bowel management. Applying São Paulo Continence Score 36.36% were classified as a continent before TENS, increasing to 75% continence six years after TENS. The number of Paulista score had shown improvement through time (χ² (2) = 29.7, p < 0.001). Post-TENS and late follow-up scores were significantly lower than pre-TENS scores (post vs. pre: p = 0.005; late vs. pre: p < 0.001), and late follow-up scores were also significantly lower than post-TENS scores (late vs. post: p = 0.012). Manometric evaluation did not show statistical significance when analyzing resting pressure and average contraction pressure, neither intra-rectal volumes across the three time points. CONCLUSION: patients with anorectal malformation improved clinical outcomes with TENS therapy and can be used for treating elimination disorders.