title: [3T-AI: a new treatment algorithm for anal incontinence with a higher evidence level].
abstract: BACKGROUND
  The evidence for conservative treatment of anal incontinence is poor. In our first publication [Schwandner et al. Dis Colon Rectum 2010; 53: 1007-1016] we demonstrated that a novel therapeutic concept, termed triple target treatment (3T), combining amplitude-modulated medium frequency stimulation and electromyography biofeedback (EMG-BF) was superior to EMG-BF alone. Questions about the required treatment duration and the relevant subgroups of patients with sphincter damage and damaged anal sensibility were not addressed.
  
  
  METHODS
  We enrolled 158 patients with anal incontinence in this randomized study. Here, we -report on the important subgroup analyses of patients with and without sphincter damage and damaged anal sensibility for the endpoints Cleveland Clinic Score (CCS) and success record. Using the results of this study we propose a novel treatment algorithm which is open for discussion.
  
  
  RESULTS
  In patients with sphincter damage, the median difference on the CCS from baseline to 9 months was 5 points higher for 3T than for EMG-BF (95 % confidence interval 0-8; p = 0.0168). While 47 % of the patients with sphincter damage became continent with 3T, only 18 % did with EMG-BF (p = 0.0036). Ten of 17 patients in the 3T group regained anal sensibility after 3 months stimulation. There was tendency towards improved continence in patients with neuropathy upon 3T treatment (p = 0.1219).
  
  
  CONCLUSIONS
  3T is superior to EMG-BF alone for patients with sphincter damage and neuropathic anal incontinence. It is a successful key element within our treatment algorithm, even in patients with sphincter damage and neuropathic anal incontinence.
authors.affiliation: Justus-Liebig-Universität Gießen, Klinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Gießen, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Schwandner
authors.forename: T
authors.initials: T
authors.lastname: Heimerl
authors.forename: I R
authors.initials: IR
authors.lastname: König
authors.forename: W
authors.initials: W
authors.lastname: Kierer
authors.forename: M
authors.initials: M
authors.lastname: Roblick
authors.forename: R
authors.initials: R
authors.lastname: Bouchard
authors.forename: T
authors.initials: T
authors.lastname: Unglaube
authors.forename: P
authors.initials: P
authors.lastname: Holch
authors.forename: G
authors.initials: G
authors.lastname: Kolbert
authors.forename: W
authors.initials: W
authors.lastname: Padberg
authors.forename: A
authors.initials: A
authors.lastname: Ziegler
mesh_terms: D000465:Algorithms; D001676:Biofeedback, Psychology / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D016896:Treatment Outcome