Int J Colorectal Dis (2006) 21: 802–806 DOI 10.1007/s00384-006-0102-0 ORIGINAL ARTICLE Ciaran F. Healy Ann E. Brannigan Elizabeth M. Connolly Molly Eng Martin J. O’Sullivan Deborah A. McNamara Cinny Cusack Joseph M. Deasy Accepted: 12 January 2006 Published online: 17 March 2006 # Springer-Verlag 2006 The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study Abstract Background and aims: Faecal incontinence is a distressing problem that is often not amenable to surgical correction. Chronic low- frequency electrical stimulation of damaged axons is thought to reduce synaptic resistance, increase the size of motor units by axonal sprouting and increase the rate of conduction of the pudendal nerve. The aim of this study was to prospectively evaluate the effect of chronic low-frequency endo-anal electrical stimulation on faecal incontinence using a home- based unit and hospital-supervised therapy. Materials and methods: Forty-eight patients with faecal in- continence completed a prospective randomised trial. Patients were allo- cated randomly to one of two groups; group 1 was exposed to endo-anal pudendal nerve stimulation daily at home with a portable home unit, group 2 attended the physiotherapy department for endo-anal electrical stimulation under supervision. Results: Continence scores improved significantly after treatment in both groups (p<0.001). Both groups showed improved manometric scores, although only group 1 showed sig- nificant improvement in both resting and squeeze pressures (mean total resting pressure 184–224 mmHg, p<0.001; mean total squeeze pressure 253–337 mmHg, p<0.001). This was also reflected by an improvement in quality of life in both groups. Conclusions: Low-frequency endo- anal electrical stimulation signifi- cantly improves continence scores and quality of life in patients with faecal incontinence not amenable to surgical correction. It leads to im- proved manometric values when car- ried out on a daily basis with a portable home unit. Keywords Faecal incontinence . Endo-anal electrical stimulation . Biofeedback Introduction Faecal incontinence is a devastating social handicap and affects approximately 2% of the general population [1]. It is eight times more common in women largely due to the adverse effects of obstetric trauma on the pelvic floor and anal sphincter, coupled with the effects of post-menopausal neuromuscular degeneration. Direct injury to the anal sphincter can be treated by overlapping sphincteroplasty but is associated with mixed long-term results [2]. For surgically incorrectable faecal incontinence, the therapeutic armamentarium is limited. Biofeedback therapy has emerged as the mainstay of treatment for mild to moderate faecal incontinence [3, 4]. Biofeedback from anal sphincter muscle contraction is used to encourage patients to increase the power and endurance of external anal sphincter contraction. Symptomatic im- provement can be expected in up to 90% of patients, but the C. F. Healy . A. E. Brannigan . E. M. Connolly . M. Eng . M. J. O’Sullivan . D. A. McNamara . J. M. Deasy (*) Department of Colorectal Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland e-mail: healyciaran@eircom.net Tel.: +353-1-8093000 Fax: +353-1-8227108 C. Cusack Department of Physiotherapy, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland