Faecal incontinence is an embarrassing and socially isolating condition, which can have a profound effect on quality of life.
Since 2008 the Functional Bowel Nurses based at the Royal London Hospital have been treating patients in an Outpatient setting with Percutaneous Tibial Nerve Stimulation (PTNS). This is a form of neuromodulation which involves inserting a small needle electrode into the tibial nerve at the ankle and using a low electric current to stimulate the nerve and is very safe, with almost no side efffects.
Patients attend for 12 initial weekly sessions, followed by maintenance top up treatments at about 6 monthly intervals. This treatment has been a great success, with 57% of people who have it reporting an improvement in their symptoms and being able to resume more normal lives again. We have now treated over 400 patients with PTNS, run two designated PTNS clinics a week and treat patients at other times as well.
An initial course of 12 weekly treatments requires a considerable time commitment from patients and they can incur multiple travel costs. The PTNS service also uses substantial clinic and nursing time. We decided to see if this treatment could be safely administered by patients or their relatives in their own homes.
This option is initially discussed with potential patients, usually by telephone, after they have read the information about the treatment. If they express an interest in home PTNS, at their initial appointment for treatment the procedure is demonstrated by the specialist nurse and they are given an illustrated step by step guide to take home, as well as needles with which to practice positioning and insertion. They return a week later to carry out the procedure under supervision. Some will be confident and competent at that time. Others may require a further session a week later.
Fourty one patients have now completed their initial PTNS course at home. We have found that the outcomes of their home administered treatment are very similar to those obtained when the treatment is given in hospital, with 58% reporting being able to defer defaecation for longer, less accidents, improvements in lifestyle and coping and less embarrassment and depression. Both patients and nursing staff are very positive about home PTNS. We shall publish our findings very soon and hope that other centres will consider a similar service for their PTNS patients in future.
Dr Marion Allison, Ann Curry and Tatenda Marunda (Functional Bowel Specialist Nursing Team)