Combination therapy more effective for fecal incontinence

Combination therapy for fecal incontinence is more effective than the current standard treatment. This is the conclusion of a randomized trial comparing the different treatments, described by Thilo Schwandner and colleagues in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108[39]: 653-60).

In Germany, 1-2% of the population suffers from anal incontinence. The problem is often caused by weakness of the pelvic floor muscles. Targeted training, biofeedback, and electrical stimulation are used to restore coordination to the muscles responsible for continence. For anatomical reasons, physical exercises alone do not suffice to train all of the relevant muscles; thus, stimulation with an electric current plays an important role as well.

The standard treatment to date, low-frequency electric stimulation, is painful for patients and is shown in the present study to yield no demonstrable therapeutic benefit. In contrast, the combination therapy devised by the authors, which they call "triple-target treatment" (3T), restored continence in 50% of the patients who received it. In one component of 3T, the phasic voluntary musculature is trained with 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.

Source Deutsches Ärzteblatt International