Purpose: To evaluate the clinical outcomes of pelvic floor rehabilitation (PFR) and/or transcutaneous electrical nerve stimulation (TENS) in children with refractory functional constipation (FC).
Method: This prospective, randomized, controlled trial included 46 children aged 5–18 years diagnosed with refractory FC. All participants continued medical treatment and were randomly assigned to four groups: PFR (n=10), TENS (n=14), combined PFR+TENS (n=10), and control (n=12). PFR and TENS were administered for six weeks. Assessments were done before treatment, at 6th week, 3rd and 6th months post-treatment. Outcome measures included number of symptoms meeting the Rome IV criteria, Constipation Severity Instrument (CSI), Constipation Quality of Life Questionnaire (CQLQ) and Leech score. Data were analyzed using SPSS 27.0, with p<0.05 considered statistically significant.
Results: Of the patients, 56.5% were female (n=26) and 43.5% male (n=20). The mean age was 10.9 ± 3.3 years. Comparisons were made with pre-treatment values. In the PFR group, symptoms decreased at 6th week and 6th month, while CQLQ scores improved at 6th week and 3rd month (p<0.05). In the TENS group, symptoms and CQLQ scores improved at all follow-ups (p<0.05). In PTR+TENS group, symptoms and CSI scores were reduced at all assessments and CQLQ scores at 6th week and 6th month (p<0.05). In the control group, only symptoms improved. No significant changes were observed in Leech scores in any group.
Conclusion: PFR and TENS both reduce symptoms and improve quality of life in children with FC. Combined therapy is superior to monotherapy because it improves symptoms, reduces constipation severity, and provides a long-lasting therapeutic effect. Both PFR and TENS can be regarded as safe and effective alternative treatment options for selected patients.
Keywords: Functional constipation, children, transcutaneous electrical nerve stimulation, TENS, neuromodulation, pelvic floor rehabilitation
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