A new study claims that a combination of therapies for fecal incontinence is more effective than the current standard treatment.

Researchers at Justus-Liebig-University (JLU; Giessen, Germany), Lübeck University (Germany), and other institutions conducted a multicenter randomized trial involving 80 patients with anal incontinence, comparing a combination of electromyography biofeedback (EMG-BF) and amplitude-modulated medium-frequency stimulation--known as triple-target treatment (3T)--with the standard treatment, low-frequency stimulation (LFS). Thirty-nine patients were randomized to 3T, and 41 to LFS. The primary endpoint was Cleveland Clinic Score (CCS) after self-training at home with either 3T or LFS, in two 20-minute sessions per day for six months. The secondary endpoints included the proportion of patients regaining continence, and the patients´ quality of life (QoL).

The results showed that after six months of treatment, the CCS mean score was 3.1 in the 3T group, compared to 9.6 in the LFS group; the median improvement in the CCS at six months compared to baseline was 7 points greater in the 3T group than in the LFS group. Anal continence was regained by 54% of the 3T patients, versus none of the LFS patients, and QoL scores were higher in all dimensions in the 3T group than in the LFS group. No major adverse effects occurred in either group. The study was published in the October 2011 issue of Deutsches Ärzteblatt International.

“3T is superior to LFS in the treatment of anal incontinence,” concluded lead author Thilo Schwandner, MD, of JLU, and colleagues. “The available evidence suggests that the success of 3T is based on the combined effect of biofeedback and medium-frequency stimulation. LFS of the type applied in this trial has no effect; 3T should be used in routine clinical practice instead of LFS.”

Combination therapy involves targeted training, biofeedback, and electrical stimulation. First, the phasic voluntary musculature is trained using EMG-biofeedback, so that patients can learn to activate the correct muscle groups to achieve continence. In a separate component, the smooth muscle (which cannot be voluntarily contracted) is treated with medium-frequency stimulation, which is less painful than low-frequency stimulation.

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