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