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

Abstract

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.

Keywords:

• Anal sphincter rupture
• bio-feedback
• electrical stimulation
• pelvic floor exercises
• physical therapy

Disclosure statement

The authors declare that there is no conflict of interest.

Funding

The trial was undertaken with financial support from the Swedish Physical Therapy Association.