Faecal Incontinence (FI) is an involuntary discharge of solid or liquid faecal, caused by a lack of controlling or delaying evacuation. FI can have various causes, but all of them can be traced back to a loss in elasticity of the rectum muscles.
In adults, FI is a mostly embarrassing disorder, which can negatively affect their quality of life.
The incidence of FI among the female population is estimated at 7-10%.
Diagnosing and treating of faecal incontinence is done in accordance with 2022 guidelines, compiled in a multidisciplinary framework among several scientific societies: United European Gastroenterology UEG - European Society of Coloproctology  ESCP -Neurogastroenterology - European Society of neurogastroenterology and Motility ESNM – European Society for Primary care Gastroenterology ESPCG.
In our retrospective study we analysed the efficacy of Pulsed Radiofrequency Neuromodulation of the ischiadic nerve (retrograde stimulation of the posterior tibial nerve) in cases of FI due to painful pathology of the pelvic floor.
The Posterior Tibial Nerve (PTN) is a mixed sensory and motor nerve, stemming from L4-S3 roots, which modulates the nerve activity of pelvic organs. The mechanism of action behind repetitive PTN stimulation is based on the attempt of inhibiting the nociceptors along the spinothalamic tract.

STUDY DESIGN: we present an observational retrospective study with a 36-month follow-up on 18 patients (all female) where FI is treated according to the retrograde neuromodulation to the ischiadic nerve.
All of the patients have been treated by ultrasound locating of the left ischiadic nerve, the duration of Pulsed Radiofrequency has lasted 8 minutes, at 90 V on average (ranging from 65 to 100 V) at a temperature never exceeding 42°C. The treatment has been preceded by a motor stimulation of the ischiadic nerve with an abduction movement of the foot, and by a paresthesic sensory stimulation along the nerve’s development.
The procedure has been performed with timings set at Time 0, repeating the procedure after 3 months and with a further repetition after 9 months (always referred to T0).
The patients who had been selected for the study had been affected by FI for > 4 years.
Inclusion criteria are as follows: eligible patients must be al last 18 years old, patients need  to fill out a medical informed-consent form, patients need to participate in all of the scheduled follow-ups.
Exclusion criteria are damage to the tibial nerve, coagulation disorder, ongoing systemic infection on the neddle position, major psychiatric disorder.

RESULT: at the end of the follow-up period, the collected data reports the following:
- for patients enrolled in the study, the quality of life was assessed by the SF 36 questionnaire, which showed 16 patients out of 18 as “very satisfied” and 2 patients as “satisfied” after the procedures;
- the decrease in number of adjuvant drugs was between 60-70%.

Pulsed Radiofrequency Neuromodulation of the ischiadic nerve is an effective and minimilly invasive therapy for FI.

The  Pulsed Radiofrequency of the ischiadic nerve (retrograde stimulation of the posterior tibial nerve) is a valid opportunity for the patients who are not candidates  Tibial nerve neuromodulation or Sacral neuromodulation

Faecal incontinence in adults. Bharucha Ae et all. Nat Rev Dis Primers 2022
Guideline for the diagnosis and treatment of faecal incontinence -A- UEG-ESCP-ESNM-ESPCG collabration. Sadè L assmann et al. United European  gastroenterology J.  Apri