I’ve written so often about how complicated functional constipation can be. It takes work and consistency and focus. And you will spend years of a child’s life treating it.
How lovely, then, to come upon a promising intervention that is, dare I say it, fairly easy to implement - under the guidance of a physical therapist 😀.
Enter the TENS unit. Transcutaneous Electric Nerve Stimulation. If you’ve heard of it, you’re probably aware it’s used to treat pain, often in the low back or a hip. It uses low-voltage electrical stimulation to change your perception of pain. Slap the stickers (electrodes) on your skin, crank up the amplitude to a tolerable buzz, and relax for twenty minutes or so.
TENS has been around a long time. It’s safe (as long as you don’t have any contraindications like a pacemaker or VNS, epilepsy, cancer, heart disease), and it’s relatively inexpensive (units are available on the internet for less than $50). What I didn’t learn in PT school, though, is that it has more uses than just treating pain.
I first learned of TENS for bladder dysfunction from a friend whose child was prescribed TENS for bedwetting. The treatment was effective, and the literature supports using TENS to treat an overactive bladder (see this meta-analysis published in 2020).
Since I treat all kinds of bowel and bladder dysfunction in our clinic, I obviously wanted to use TENS for my kids with overactive bladder. Once I learned more about how to do that, my next thought was “what about constipation”? Sadly, the research was very limited. Until recently, there were only a few small studies on whether TENS could help kids with functional constipation, and they were promising but inconclusive.
That is, until this winter when the Journal of Immunology Research published “Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) in Pediatric Functional Constipation: Impact on Immunological Indicators and Gut Microbiota.”
The researchers took sixty children with functional constipation and divided them into two groups: one group received TENS therapy three times per week for thirty minutes. The other group, called the control group, just took a daily lactulose dose. After four weeks, the researchers found that the TENS group had shown a statistically significant improvement in the frequency of BMs as well as a reduction in painful BMs and large-diameter poops. What’s more, most TENS kids were still using their TENS units four weeks after the study was over, whereas most lactulose kids had stopped taking lactulose.
So, do we have an intervention here? Possibly. Reading research can be tough, and this study is in an open-access journal, which might have less stringent review policies. I’m not a statistician, so I don’t have the skills to independently validate their data. The control group didn't use a sham TENS unit, which would have helped rule out the placebo effect.
All of that said, TENS is a low-cost intervention with very little risk. As long as my patients aren’t using TENS and neglecting all of their other interventions (the ones laid out in The Constipation Game Plan), I will gladly help them get started with a TENS program to do at home. It will be a treat to give them some easy homework for once 😂. If you think TENS might help your little one, bring this study to your PT. They can determine if it's appropriate and help you set it up. I'd love to hear how it goes!
P.S. Because I am writing for the general public and NOT as your physical therapist, I chose not to include the parameters of the TENS protocol in this post. Please consult your medical provider before changing your health care routine.