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Fecal IncontinenceNOTABLeNCT03278613

Neuromodulation for Accidental Bowel Leakage

A study testing ES-130 in people with Fecal Incontinence and Bowel Incontinence, run by NICHD Pelvic Floor Disorders Network at 9 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is a multi-center, randomized clinical trial of women with refractory accidental bowel leakage (ABL) symptoms who have failed to achieve satisfactory symptom control from 2 first-line treatments for ABL: supervised pelvic muscle training (PMT) and constipating medication. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Fecal Incontinence, Bowel Incontinence
What is being tested?
ES-130
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
166 participants
Where
9 sitesUnited States
Study dates
9 Feb 2018to 9 Mar 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women ≥ 18 years of age
  • FI symptoms ≥ 3 months
  • Baseline St. Mark's score of ≥ 12
  • Attended ≥ 2 supervised PMT for ABL
  • Intolerance, unwillingness, or inadequate response to constipating medications
  • Current negative colon cancer screening based on the USPSTF's recommendation for colorectal cancer screening (2016)

Who cannot join

  • Previous PTNS treatment
  • History of uncontrolled diarrhea in the past 3 months (usual or most common stool type over the preceding 3 months of 7 on the Bristol Stool Form Scale)
  • History of severe constipation in the past 3 months (usual or most common stool type over the preceding 3 months of 1 on the Bristol Stool Form Scale)
  • History of inflammatory bowel disease (includes Crohn's disease and ulcerative colitis, but does not include irritable bowel disease)
  • Unrepaired rectovaginal fistula/chronic 4th degree laceration
  • Full thickness rectal prolapse
Show all 29Show fewer
  • History of congenital anorectal malformation
  • History of bowel resection surgery for any indication
  • Minor anal procedures within 6 months for treatment of ABL (injection of bulking agent or radiofrequency energy) or ligation of hemorrhoids
  • Prior pelvic or abdominal radiation
  • Diagnosis of cancer of the descending colon or anus
  • Diagnosis of cancer in the region where the PTNS or sham needles or surface electrodes would be placed
  • Pacemaker, implantable defibrillator
  • Current use of Interstim sacral nerve stimulator or TENS in the pelvic region, back, or legs
  • Clinically significant neurological disorders known to affect anal continence
  • Coagulopathy
  • Severe peripheral edema preventing accurate placement of PTNS needles
  • Chronic swollen, infected, inflamed skin or skin eruptions (e.g., phlebitis, thrombophlebitis, varicose veins) in the region where the PTNS or sham needles or surface electrodes would be placed
  • Metal implant in foot/toes near TENS electrode location
  • Marked sensory deficit (numbness) of feet or ankles in the region where the PTNS or sham needles or surface electrodes would be placed
  • Childbirth within the last 3 months
  • Pregnant or planning to become pregnant during the study duration 1 year; a urine pregnancy test will be performed and must be negative by the first intervention visit if the participant is of childbearing potential
  • Unwilling to use acceptable form of contraceptive if the participant is of childbearing potential
  • Participation in another intervention trial impacting bowel function
  • Inability to provide informed consent, complete questionnaires independently, or to attend intervention sessions
  • Unable or unwilling to complete the bowel diary in Run-In Phase (valid diary defined as data from ≥ 10 of 14 days with minimum of 3 consecutive days per week)
  • Unwilling to download bowel diary app onto smartphone if the participant owns a smartphone
  • Visual impairment prohibiting reading the paper diary, the smart phone screen
  • Unable to speak, read, or write in English or Spanish at a basic level

Trial locations and contacts

9 sites in 1 country.

9 sites in 1 country

United States9 sites
  • University of Alabama at Birmingham

    Birmingham, Alabama, 35233-7333

  • University of Texas Southwestern Medical Center

    Dallas, Texas, 75390

  • Kaiser Permanente -- Downey

    Downey, California, 90242

  • Duke University, Duke Division of Urogynecology and Reconstructive Pelvic Surgery

    Durham, North Carolina, 27707

  • University of California at San Diego, UCSD Women's Pelvic Medicine Center

    La Jolla, California, 92037-0974

  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

  • Magee-Women's Hospital, Department of Obstetrics and Gynecology

    Pittsburgh, Pennsylvania, 15213

  • Brown/ Women and Infants Hospital of Rhode Island, Center for Women's Pelvic Medicine and Reconstructive Surgery

    Providence, Rhode Island, 02903

  • Kaiser Permanente -- San Diego

    San Diego, California, 92110

Other trials in United States

About this study

This study is a multi-center, randomized clinical trial of women with refractory accidental bowel leakage (ABL) symptoms who have failed to achieve satisfactory symptom control from 2 first-line treatments for ABL: supervised pelvic muscle training (PMT) and constipating medication. The purpose of this study is to compare percutaneous tibial nerve stimulation (PTNS) to a validated sham to determine if PTNS is effective for the treatment of fecal incontinence (FI) in women.

The investigators will test the null hypothesis that change from baseline in St. Mark's (Vaizey) score after 12 weeks of stimulation is not significantly different in women with symptomatic ABL receiving PTNS treatments compared to women receiving sham PTNS treatments.

Read the detailed description

The overarching goal of this randomized clinical trial is to determine if PTNS is more effective than sham PTNS for the treatment of FI in women after 12 weeks of treatment and 1 year after initiating treatment. This is a two-part trial with a Run-In Phase prior to randomization. The trial has the following primary aim:

To determine whether the change from baseline in St. Mark's (Vaizey) score in women with symptomatic ABL undergoing PTNS differs from sham after 12 weeks of stimulation.

Additional secondary aims include:

  1. To compare changes from baseline in self-reported functional outcomes after 12 weekly stimulation sessions in both PTNS and sham groups in Part 1.
  2. To determine whether symptom relief amongst study "responders" can be sustained for one year with maintenance treatments in Part II.
  3. To determine the impact of completing a bowel diary and receiving education on FI on symptom severity.
  4. To determine the ability of the PFDN ABL phone app bowel diary to detect changes from baseline in fecal incontinence episodes recorded to after 12 weeks of stimulation sessions.
  5. To determine the association between St. Mark's score and both fat and fiber intake alone and in combination.
Being tested
ES-130
Medical subject headings
Fecal Incontinence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ES-130Device

    The ES-130 device will be used for the indication of "Posterior Tibial Nerve Stimulation for the treatment of fecal incontinence" using the FDA-approved protocol for treatment of urge urinary incontinence (UUI) in the PFDN NOTABLe study. There is no PTNS device cleared by the FDA for the indication of FI treatment; therefore, this is considered an investigational device.

Study groups in NCT03278613
Study groupRoleWhat they receive
Percutaneous Tibial Nerve Stimulation (PTNS)ExperimentalPTNS treatment entails insertion of a 36 gauge needle electrode at a 60 degree angle 3-4 cm deep towards the tibial nerve, approximately 5 cm or 3 finger breadths cephalad to the medial malleolus and posterior to the tibia. The PTNS grounding electrode, placed near the calcaneus and the needle electrode will be connected to the ES-130 device pulse generator.
Receives: Device: ES-130
Validated ShamSham comparatorSham treatment will use the Streitberger acupuncture placebo needle in the same location as the needle electrode for PTNS. The sham uses an active gel surface electrode pad placed on the bottom of the foot just below the fifth (smallest) toe. This location is not part of the acupuncture nerve pathway connected to the bladder, pelvis or any major organs. Electrical current is delivered to this pad via a TENS unit resulting in sensory stimulation.
Receives: Device: ES-130

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change From Baseline St. Mark's (Vaizey) Score

    The primary outcome measure is the change from baseline in St. Mark's (Vaizey) Score 12 weeks after treatment initiation to compare the outcomes of post-tibial nerve stimulation (PTNS) versus sham stimulation. The St. Mark's (Vaizey) score, published in 1999, is commonly used in clinical studies and reports and was based on the Jorge-Wexner score but added two further items for assessment: the use of constipating medication and the presence of fecal urgency. Minimum score is 0 = perfect continence; maximum score is 24 = totally incontinent. Change from baseline is calculated as Week [4, 8, or 12] Score minus the score at baseline.

    Measured: 4, 8, and 12 Weeks

Secondary outcomes (9)
  1. Responder to Treatment

    Responder status is based on the primary chnage from St. Mark's Score. A responder is defined as any particpant with at least a 4 point reduction in score compared to their baseline score

    Measured: 4, 8, and 12 Weeks

  2. Change From Baseline Number of Fecal Incontinence Events Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome variable is computed as the difference in number of fecal incontinence episodes per week at 8 and 12 weeks and the number of fecal incontinence episodes at baseline.

    Measured: 8 and 12 Weeks

  3. Change From Baseline Number of Urge Fecal Incontinence Events Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome variable is computed as the difference in number of urge fecal incontinence episodes per week at 8 and 12 weeks and the number of urge fecal incontinence episodes at baseline.

    Measured: 8 and 12 Weeks

  4. Change From Baseline Number of Bowel Movements Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome variable is computed as the difference in number of bowel movements per week at 8 and 12 weeks and the number of bowel movements at baseline.

    Measured: 8 and 12 Weeks

  5. Change From Baseline Number of Urge Bowel Movements Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome variable is computed as the difference in number of urge bowel movements per week at 8 and 12 weeks and the number of urge bowel movements at baseline.

    Measured: 8 and 12 Weeks

  6. Change From Baseline Number of Days Without Fecal Incontinence Episodes Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome variable is computed as the difference in number of days without fecal incontinence episodes per week at 8 and 12 weeks and the number of days without fecal incontinence episodes at baseline.

    Measured: 8 and 12 Weeks

  7. 50% Improvement in Fecal Incontinence Episodes Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome is calculated as any participant with a 50% reduction in fecal incontinence episodes per week at 8 and 12 weeks compared to the fecal incontinence episodes at baseline

    Measured: 8 and 12 Weeks

  8. 75% Improvement in Fecal Incontinence Episodes Per Week

    Based on data collected from participant-completed diaries at baseline, 8, and 12 weeks, the outcome is calculated as any participant with a 75% reduction in fecal incontinence episodes per week at 8, and 12 weeks compared to the fecal incontinence episodes at baseline.

    Measured: 8 and 12 Weeks

  9. Patient Global Impression-Improvement

    The Patient Global Impression of Improvement (PGI-I) is a patient-reported measure of perceived improvement with treatment, as assessed on a scale of 1 (very much better) to 7 (very much worse). Included here are participants who had improvement as indicated by a rating of 1 (very much better) or 2 (much better)

    Measured: 4, 8, and 12 Weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Sep 2017
  2. Study start9 Feb 2018
  3. Primary completion9 Mar 2020
  4. Study completion9 Mar 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
166 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03278613
Sponsor's protocol ID
12865-29
Other IDs
2U24HD069031-06, 2UG1HD069013-06, 5UG1HD041267-18, 5UG1HD069010-07, 5UG1HD069006-07, 5UG1HD041261-17, 5UG1HD054214-12, 5UG1HD054241-12
Acronym
NOTABLe
Status last verified
May 2025
First submitted
6 Sep 2017
Last updated
3 Jun 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Zyczynski HM, Richter HE, Sung VW, Lukacz ES, Arya LA, Rahn DD, Visco AG, Mazloomdoost D, Carper B, Gantz MG; NICHD Pelvic Floor Disorders Network. Percutaneous Tibial Nerve Stimulation vs Sham Stimulation for Fecal Incontinence in Women: NeurOmodulaTion for Accidental Bowel Leakage Randomized Clinical Trial. Am J Gastroenterol. 2022 Apr 1;117(4):654-667. doi: 10.14309/ajg.0000000000001605.

    PubMed 35354778
  • Zyczynski HM, Arya LA, Lukacz ES, Richter HE, Rahn DD, Sung VW, Visco AG, Shaffer A, Jelovsek JE, Rogers R, Mazloomdoost D, Gantz MG; Eunice Kennedy Shriver NICHD Pelvic Floor Disorders Network (PFDN). Design of a Randomized Controlled Trial of Percutaneous Posterior Tibial Nerve Stimulation for the Treatment of Refractory Fecal Incontinence in Women: The NeurOmodulaTion for Accidental Bowel Leakage Study. Female Pelvic Med Reconstr Surg. 2021 Dec 1;27(12):726-734. doi: 10.1097/SPV.0000000000001050.

    PubMed 33950027

Questions about this trial

What is this clinical trial studying?

A study testing ES-130 in people with Fecal Incontinence and Bowel Incontinence, run by NICHD Pelvic Floor Disorders Network at 9 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 29 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 May 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change From Baseline St. Mark's (Vaizey) Score (time frame: 4, 8, and 12 Weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03278613, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jun 2025.

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