Alternative approaches to the treatment of fecal incontinence.

This editorial accompanies the article “Triple-Target Treatment vs. LowFrequency Electrostimulation for Anal Incontinence: A Randomized, Controlled Trial,” by Thilo Schwandner, Claudia Hemmelmann, et al., which appears on the following pages of the 158 patients (39%) actually received treatment as planned for the full nine months—43 in the 3T group and 19 in the EMG-BF group. The trial was thus much less informative than it otherwise might have been; the main thing that it demonstrated was the practical difficulty of carrying out highly demanding investigations of competing treatments for anal incontinence. The three goals (targets) to which the term 3T refers are: ● coordination training with EMG-BF to normalize “corrupt” motor activity in the central nervous system, ● conditioning of the puborectalis muscle, and ● stimulation of the slow fibers of the internal anal sphincter. Medium-frequency electrostimulation (AM-MF) exerts its effect through summation of action potentials. It is less painful than low-frequency stimulation (LFS), because it requires a less intense current. In LFS, the current must be intense enough to stimulate slow muscle fibers as well; many patients find such high currents unpleasant or painful.