Pelvic floor physical therapy in patients with chronic anal fissure: a randomized controlled trial.
Anal pain
Biofeedback
Chronic anal fissure
Pelvic floor physical therapy
Treatment
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
15
01
2022
accepted:
16
03
2022
pubmed:
6
5
2022
medline:
10
6
2022
entrez:
5
5
2022
Statut:
ppublish
Résumé
A chronic anal fissure is a common, painful condition with great impact on daily life. The exact pathogenesis has not been fully elucidated and treatment varies. A large percentage of patients experience pelvic floor dysfunction (dyssynergia and increased pelvic floor muscle tone). The aim of our study was to investigate the effect of pelvic floor physical therapy in patients with chronic anal fissure. Between December 2018 and July 2021, at the Proctos Clinic in the Netherlands, patients with chronic anal fissure and pelvic floor dysfunction were randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy including electromyographic biofeedback or assigned to a control group receiving postponed pelvic floor physical therapy. The primary outcome was muscle tone at rest during electromyographic registration of the pelvic floor before and after pelvic floor physical therapy. Secondary outcomes contained healing of the fissure, pain ratings, improvement of pelvic floor function, and complaint reduction measured with a proctology-specific patient-reported outcome measurement. Endpoints were measured at 8- and 20-week follow-up. One hundred forty patients were included in the study, 68 men (48.6%) and 72 women (51.4%) with a mean age of 44.5 ± 11.1 (range 19-79) years. Mean resting electromyographic values of the pelvic floor in the intervention group significantly improved from pre- to post-treatment (p < 0.001) and relative to controls (mean estimated difference between groups - 1.88 µV; 95% CI, - 2.49 to - 1.27 (p < 0.001) at first follow-up and remained significant from baseline at 20-week follow-up (p < 0.001). The intervention group performed better compared to the control group on all secondary outcomes, i.e., healing of the fissure (55.7% of the patients vs 21.4% in control, pain ratings (p < 0.001), diminished dyssynergia (p < 0.001), complaint reduction (p < 0.001), and decrease of pelvic floor muscle tone (p < 0.05) at first follow-up. The findings of this study provide strong evidence that pelvic floor physical therapy is effective in patients with chronic anal fissure and pelvic floor dysfunction and supports its recommendation as adjuvant treatment besides regular conservative treatment.
Sections du résumé
BACKGROUND
A chronic anal fissure is a common, painful condition with great impact on daily life. The exact pathogenesis has not been fully elucidated and treatment varies. A large percentage of patients experience pelvic floor dysfunction (dyssynergia and increased pelvic floor muscle tone). The aim of our study was to investigate the effect of pelvic floor physical therapy in patients with chronic anal fissure.
METHODS
Between December 2018 and July 2021, at the Proctos Clinic in the Netherlands, patients with chronic anal fissure and pelvic floor dysfunction were randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy including electromyographic biofeedback or assigned to a control group receiving postponed pelvic floor physical therapy. The primary outcome was muscle tone at rest during electromyographic registration of the pelvic floor before and after pelvic floor physical therapy. Secondary outcomes contained healing of the fissure, pain ratings, improvement of pelvic floor function, and complaint reduction measured with a proctology-specific patient-reported outcome measurement. Endpoints were measured at 8- and 20-week follow-up.
RESULTS
One hundred forty patients were included in the study, 68 men (48.6%) and 72 women (51.4%) with a mean age of 44.5 ± 11.1 (range 19-79) years. Mean resting electromyographic values of the pelvic floor in the intervention group significantly improved from pre- to post-treatment (p < 0.001) and relative to controls (mean estimated difference between groups - 1.88 µV; 95% CI, - 2.49 to - 1.27 (p < 0.001) at first follow-up and remained significant from baseline at 20-week follow-up (p < 0.001). The intervention group performed better compared to the control group on all secondary outcomes, i.e., healing of the fissure (55.7% of the patients vs 21.4% in control, pain ratings (p < 0.001), diminished dyssynergia (p < 0.001), complaint reduction (p < 0.001), and decrease of pelvic floor muscle tone (p < 0.05) at first follow-up.
CONCLUSIONS
The findings of this study provide strong evidence that pelvic floor physical therapy is effective in patients with chronic anal fissure and pelvic floor dysfunction and supports its recommendation as adjuvant treatment besides regular conservative treatment.
Identifiants
pubmed: 35511322
doi: 10.1007/s10151-022-02618-9
pii: 10.1007/s10151-022-02618-9
pmc: PMC9069957
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
571-582Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022. The Author(s).
Références
Contemp Clin Trials Commun. 2021 Nov 16;24:100874
pubmed: 34841124
Int J Colorectal Dis. 2007 Jul;22(7):783-90
pubmed: 17096089
Colorectal Dis. 2008 Mar;10(3):280-5
pubmed: 17655720
Arq Gastroenterol. 2020 Apr-Jun;5757(2):198-202
pubmed: 32401951
Dis Colon Rectum. 1990 Jun;33(6):479-85; discussion 485-6
pubmed: 2351000
Neurogastroenterol Motil. 2015 May;27(5):594-609
pubmed: 25828100
Gut Liver. 2018 Jul 15;12(4):375-384
pubmed: 29050194
Am J Surg. 2005 Apr;189(4):429-34
pubmed: 15820455
Int J Colorectal Dis. 2017 Jun;32(6):921-924
pubmed: 28039531
Int J Colorectal Dis. 2020 Oct;35(10):1807-1815
pubmed: 32712929
Tech Coloproctol. 2019 Feb;23(2):101-115
pubmed: 30631977
Am J Gastroenterol. 2021 Oct 1;116(10):1987-2008
pubmed: 34618700
Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):9-14
pubmed: 11294536
Neurourol Urodyn. 2013 Apr;32(4):341-8
pubmed: 22972554
Clin Gastroenterol Hepatol. 2014 Dec;12(12):2049-54
pubmed: 24674941
Dis Colon Rectum. 1994 May;37(5):424-9
pubmed: 8181401
Colorectal Dis. 2013 Mar;15(3):e104-17
pubmed: 23320551
Colorectal Dis. 2004 Jan;6(1):39-44
pubmed: 14692952
Colorectal Dis. 2018 Jan;20(1):6-15
pubmed: 29166553
Clin Gastroenterol Hepatol. 2010 Nov;8(11):955-60
pubmed: 20656061
Dis Colon Rectum. 2007 Apr;50(4):428-41
pubmed: 17294322
Med Hypotheses. 2016 Sep;94:25-9
pubmed: 27515194
Gastroenterology. 2020 Apr;158(5):1232-1249.e3
pubmed: 31945360
J Pain. 2008 Feb;9(2):105-21
pubmed: 18055266
World J Gastroenterol. 2006 Nov 28;12(44):7069-74
pubmed: 17131466
Sex Med Rev. 2017 Jul;5(3):282-294
pubmed: 28330675
Am J Gastroenterol. 1998 Jul;93(7):1042-50
pubmed: 9672327
Am J Gastroenterol. 2018 May;113(5):635-638
pubmed: 29453382
Br J Surg. 1996 Oct;83(10):1335-44
pubmed: 8944447
Int J Colorectal Dis. 1993 Jul;8(2):95-7
pubmed: 8409694
Cochrane Database Syst Rev. 2012 Feb 15;(2):CD003431
pubmed: 22336789
Clin Colon Rectal Surg. 2016 Mar;29(1):30-7
pubmed: 26929749
Dis Colon Rectum. 1991 Aug;34(8):690-5
pubmed: 1855425
Tech Coloproctol. 2020 Apr;24(4):291-300
pubmed: 32112248
Tech Coloproctol. 2020 Apr;24(4):393-394
pubmed: 32112246
Neurogastroenterol Motil. 2015 Jun;27(6):787-95
pubmed: 25807997
Neurourol Urodyn. 2021 Jun;40(5):1217-1260
pubmed: 33844342
Asian J Surg. 2021 Jul;44(7):1021-1022
pubmed: 34052084
Dis Colon Rectum. 1986 Apr;29(4):248-51
pubmed: 3948615
Sex Med Rev. 2022 Apr;10(2):209-230
pubmed: 34127429
Dis Colon Rectum. 1994 Jul;37(7):664-9
pubmed: 8026232
Tech Coloproctol. 2019 Mar;23(3):239-244
pubmed: 30778784
Dig Dis Sci. 2012 Jun;57(6):1445-64
pubmed: 22367113
Tech Coloproctol. 2017 Aug;21(8):605-625
pubmed: 28795245
Am J Gastroenterol. 2015 Aug;110(8):1197-204
pubmed: 26032152
Aliment Pharmacol Ther. 2006 Jul 15;24(2):247-57
pubmed: 16842451
Can J Gastroenterol. 2011 Oct;25 Suppl B:16B-21B
pubmed: 22114753
Gastroenterology. 2010 Apr;138(4):1321-9
pubmed: 20044997
Indian J Gastroenterol. 2019 Apr;38(2):173-177
pubmed: 30707420
Mayo Clin Proc. 2016 Oct;91(10):1471-1486
pubmed: 27712641