Tibial Nerve Stimulation for Fecal Incontinence: The Importance of Sham

Sacral neuromodulation has become an established treatment for fecal incontinence unresponsive to conservative measures. However, it requires surgical implantation and is expensive. Percutaneous tibial nerve stimulation (PTNS) has been suggested as a minimally invasive and less expensive alternative on the basis of uncontrolled studies. The study by Zyczynski et al. compared active PTNS with a sham control group of women with fecal incontinence. Similar to previous studies, active PTNS provided benefits to treated patients but were not different from the sham group. This study highlights the need for rigorously performed controlled studies of neuromodulation for anorectal disorders.