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Effects of physiotherapy treatment for patients with obstetric anal sphincter rupture: a systematic review

Review article
Authors Elisabeth Arkel
Karin Torell
Sofia Rydhög
Åsa Rikner
Helena Neymark Bachmeier
Annelie Gutke
Monika Fagevik Olsén
Published in European Journal of Physiotherapy
Volume 19
Issue 2
Pages 90-96
ISSN 2167-9169
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Pages 90-96
Language en
Links doi.org/10.1080/21679169.2016.12638...
Keywords Anal sphincter rupture, bio-feedback, electrical stimulation, pelvic floor exercises, physical therapy
Subject categories Obstetrics and gynaecology

Abstract

© 2017 Informa UK Limited, trading as Taylor & Francis Group.Objectives: To evaluate the level of evidence for treatments included in physical therapy practice for patients with Obstetric Anal Sphincter InjurieS (OASIS) and provide treatment recommendations. Methods: Literature search was done in relevant databases of which the last one was performed on 1 November 2016. The randomized controlled trials were evaluated for internal validity and level of evidence for the interventions was set. Results: Eight articles were identified evaluating pelvic floor exercises, biofeedback and electrical stimulation of which six were randomized and controlled. There is a very low level of evidence that pelvic floor exercises with augmented biofeedback (audio-visual feedback and electro stimulation) has better effects compared to sensory biofeedback for women with impaired faecal continence after OASIS and that adjuvant biofeedback has effect on anal incontinence and decreases embarrassment following anal sphincter repair years after OASIS. The studies evaluating solely pelvic floor exercises or electrical stimulation were contradictory or showed no significant effects. Conclusions: There are a limited number of trials evaluating the effect of physical therapy interventions to prevent or treat anal incontinence after OASIS. The studies are diverse and the level of evidence is consequently very low or missing. Until there are enough studies to write evidence-based guidelines, it is still of importance to treat women with leakage and pain in the attempt to increase function and quality of life.

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