Dutch evidence statement for pelvic physical therapy in patients with anal incontinence

Telehealth is effective for pelvic health physical therapy

BACKGROUND

Telehealth utilization, largely spurred by the COVID-19 pandemic, has become popular due to convenience and access. We assessed the effectiveness of telehealth for delivering pelvic health physical therapy (PHPT) in patients with pelvic floor disorders (PFD).

METHODS

In this IRB approved, cross-sectional study, 812 patients who underwent PHPT treatment by telehealth or in combination with in-person visits were surveyed. Post intervention effectiveness was analyzed using Patient Global Impression of Change (PGIC) and short form Pelvic Floor Impact Questionnaire (PFIQ-7).

RESULTS

One hundred and forty-one patients, 80% female, mean (SD) age of 52 (17) completed the study. The mean number of encounters was 4.55 (4.25) with 2.81 (2.08) telehealth visits. A total of 42 (30%) patients reported no change/worse, 27 (19%) minimal, and 72 (51%) moderate/much improvement of symptoms consistent with a lower PFIQ-7 scores. Patients who reported improvement were significantly younger (p < 0.002). Age was the only independent factor that could predict response to PHPT. Patients <50 years old reported significantly more symptom improvement (p < 0.02), symptom resolution (p < 0.002), meeting personal goals (p < 0.0001), improved muscle strength, coordination, and relaxation (p < 0.05), greater satisfaction with bowel movements, and less negative impact of bowel on quality of life (p < 0.005) than older patients. Regardless of age, 89 (64%) patients preferred hybrid telehealth visits.

CONCLUSION & INFERENCES

Utilizing telehealth alone or in a hybrid format combined with in-person visits for PHPT appears to be preferred by patients and associated with subjective report of improvement of symptoms. However, efficacy of telehealth interventions in older adults warrants further studies.

Fecal Incontinence: The Importance of a Structured Pathophysiological Model

Fecal incontinence has an enormous social and economic impact and may significantly impair quality of life. Even though fecal incontinence is a common complaint in (aging) adults, a structured pathophysiological model of the clinical presentations of fecal incontinence is missing in current literature. The most frequent manifestations of fecal incontinence are passive fecal loss, urge incontinence, or mixed fecal incontinence. At our institution, we treat 400 patients per year with defecation disorders, including a significant number of patients with fecal incontinence. On the basis of this experience, we have tried to create a concept that merges current insight in causes and treatment options in a clinically useful algorithm. By applying the system of anamnesis and physical examination described in this article and expanding it with simple additional anorectal examination, in most patients, one can determine the type of fecal incontinence and choose a targeted therapy.

Percutaneous electrical stimulation of the posterior tibial nerve for the treatment of fecal incontinence: manometric results after 6 months of treatment

BACKGROUND

Posterior tibial nerve stimulation (PTNS) is a minimally invasive approach with little adverse effects, but obtaining good results as shown in the different scales for the evaluation of the severity of incontinence. The aim of this study was to determine the effects of PTNS based on manometric determinations of the anal sphincter and severity during a period of treatment of 6 months (18 sessions).

PATIENTS AND METHODS

A prospective interventional study of patients with fecal incontinence was performed. Subjects underwent one 30-min session every week for 12 weeks, followed by 6 sessions every 2 weeks. The effect on incontinence was evaluated by means of St. Marks and defecatory urgency scales, and manometry.

RESULTS

Seventy-three patients were included. At baseline, 28.8% of the patients had a retention time of less than 1 min. At 12 weeks, 39.7% of the patients presented a retention time to 5-10 min and at 18 weeks 37% presented it over 10 min. At baseline, mean St Marks score was 15.1 + 5.1, improving after 12 weeks of treatment to 8.9 + 5 (p < 0.001). After 18 sessions, a greater improvement was observed up to 4 + 4.8 (p < 0.001). Maximum resting pressure showed a significant increase after treatment (mean increase 9.8 mmHg; p = 0.006). Similarly, maximum squeeze pressure also presented a significant augmentation (mean increase 25.3 mmHg; p = 0.002).

CONCLUSION

Eighteen sessions of PTNS, divided in 12 weekly sessions and 6 sessions every 2 weeks, have shown to obtain benefits, reducing the St. Marks and the defecatory urgency scores, and increasing the manometric values.

Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior?

PURPOSE OF REVIEW

Pelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction.

RECENT FINDINGS

Today, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training component, is not an effective treatment. Biofeedback is an adjunct to the pelvic floor training. In the current review, we develop the role of pelvic floor physical therapy in management of children with non-neuropathic voiding dysfunction and compare it with biofeedback therapy alone.