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Torell K.1, Arkel E.2, Rydhög S.3, Rikner Å.4, Neymark Bachmeier H.5, Gutke A.6, Fagevik Olsén M.6
1Sahlgrenska University Hospital, Physiotherapy Department, Gothenburg, Sweden, 2Norra Älvsborgs Länssjukhus, Physiotherapy Department, Trollhättan, Sweden, 3Skåne University Hospital, Physiotherapy Department, Malmö, Sweden, 4Akademiska Sjukhuset, Physiotherapy Department, Uppsala, Sweden, 5Centralsjukhuset, Physiotherapy Department, Karlstad, Sweden, 6Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden
Background: Vaginal delivery often causes minor or major ruptures in the pelvic floor region. In the majority there are no adverse effects, while some cause life-long problems or problems that arise many years after child-birth (1). A specific group of ruptures are those involving the anal sphincter (Obstetric Anal Sphincter InjurieS -OASIS). Even though such ruptures affect many women worldwide each year there has been limited focus on rehabilitation after the injury and international guidelines are missing.
Purpose: To evaluate the level of evidence for treatments included in physical therapy practice for patients with obstetric anal sphincter injury and provide treatment recommendations.
Methods: A literature search was done in relevant databases. The randomized controlled trials were evaluated for internal validity and degree of evidence for the interventions was set.
Results: Seven articles were identified evaluating pelvic floor exercises, biofeedback and electrical stimulation.
There is a very low degree of evidence that augmented biofeedback with electro stimulation has better effects compared to sensory feed-back for women with faecal incontinence and that adjuvant biofeedback has effect on anal incontinence and decreases embarrassment following anal sphincter repair.
The studies evaluating pelvic floor exercises or electrical stimulation were contradictory or show no significant effects compared with controls.
Conclusion(s): There are a limited number of trials evaluating the effect of physical therapy interventions to prevent or treat anal incontinence after obstetric anal sphincter injury. 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.
Implications: The limited degree of evidence does not necessarily mean that the method is ineffective. It is important to start evaluating different treatments in well-designed settings so that there is enough knowledge to tailor the optimal treatment for each woman in the future. In the meantime, we have to rely on clinical experience and results of studies evaluating the treatments in other groups of patients.
Funding acknowledgements: The trial was undertaken with financial support from the Swedish Physical Therapy Association.
Topic: Women's & mens pelvic health
Ethics approval: The authors declare that there is no conflict of interest
All authors, affiliations and abstracts have been published as submitted.
