Posterior tibial neurostimulation for faecal incontinence in community-dwelling older adults: long-term outcomes and predictors of response.

BACKGROUND

Faecal incontinence (FI) increases up to 50% with age in institutionalized older individuals, and treatment options have been scarcely studied for older people. Posterior tibial nerve stimulation (PTNS) is a minimally invasive second-line treatment available. This research aims to assess long-term clinical outcomes of PTNS using the Wexner score in community-dwelling patients aged > 65 years, and its impact on quality of life (QoL).

METHODS

A prospective cohort study with 61 patients (median age 71 years; 79% women) was conducted. PTNS was administered in three phases over 12 months, with follow-ups (FUs) at 3, 6, 12 and 36 months. Optimal responders (ORs) were defined as achieving a > 50% reduction in Wexner score compared with baseline. Partial responders that presented a 25-50% reduction in Wexner score were also considered as potential long-term ORs.

RESULTS

At the end of treatment, 64% of patients were OR, with sustained improvement in 77% of them at 36 months. Wexner score significantly decreased throughout FUs, from median ten to four (p < 0.001). Faecal incontinence quality of life questionnaires (FIQLs) showed limited improvement in depression domain at 6- and 36-month FUs. Faecal urgency improved in a logistic regression analysis (p < 0.01). Multivariable logistic regression identified increasing age as independently associated with clinical response (p = 0.04).

CONCLUSIONS

PTNS was associated with improvement in incontinence severity scores and faecal urgency in selected community-dwelling older adults, although reductions in FI episode frequency and quality of life measures were limited. These findings suggest that PTNS may have a selective role within individualized management strategies, particularly in urgency-predominant symptoms.

TRIAL REGISTRATION NUMBER: NCT05016453, retrospectively registered in 2021.