Pelvic Health Physical Therapy Improves Pelvic Floor Symptoms in Women With Obstetric Anal Sphincter Injury

Lisa Kim, Karen Weeks, J. Geynisman-Tan
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Abstract

Background: Following obstetric anal sphincter injuries (OASISs), women commonly report symptoms of pelvic floor dysfunction such as fecal incontinence. Few studies have looked at pelvic health physical therapy (PHPT) as a treatment for women with OASIS and its associated symptoms. Objectives: To assess the outcomes of early PHPT on the presence and severity of symptoms in women with OASIS. Study Design: Retrospective cohort study. Methods: We assessed the records of 70 subjects with third- or fourth-degree OASIS who had undergone clinical evaluation and PHPT in the institution's pelvic health clinic between 2017 and 2019. PHPT assessment focused on pelvic and abdominal muscle strength, neuromuscular control, soft and connective tissue/scar mobility, and functional movement. Outcome measures assessed changes in the Pelvic Floor Distress Inventory-20 (PFDI-20), subjective symptom reports of pelvic floor dysfunction, and manual muscle testing of pelvic floor muscle strength. These changes were calculated using the t test, McNemar's test, and Wilcoxon rank sum test, respectively. Results: PHPT started within an average of 6.2 weeks resulted in a reduction across all subjective complaints. Pelvic floor muscle strength improved from an initial Modified Oxford Grading system (MOS) score of 1 (1-2) to 2 (1-3), (P < .01). Subjects who received PHPT within 2 months postpartum had a greater reduction in subjective symptoms than those who started after 2 months (2.4 ±1.7 vs 1.1 ± 1.3, P = .02). Conclusion: PHPT intervention is associated with a reduction in subjective complaints reported by women who experienced OASIS in a single tertiary center. Earlier initiation of PHPT may lead to a greater improvement in symptoms.
盆腔健康物理治疗改善产科肛门括约肌损伤妇女盆底症状
背景:产科肛门括约肌损伤(OASISs)后,女性通常报告盆底功能障碍症状,如大便失禁。很少有研究将盆腔健康物理疗法(PHPT)作为女性OASIS及其相关症状的治疗方法。目的:评估早期PHPT对女性OASIS患者症状存在和严重程度的影响。研究设计:回顾性队列研究。方法:我们评估了2017年至2019年在该机构盆腔健康诊所接受临床评估和PHPT的70名三度或四度OASIS患者的记录。PHPT评估侧重于骨盆和腹部肌肉力量、神经肌肉控制、软性和结缔组织/疤痕活动以及功能性运动。结果测量评估了盆底窘迫量表-20 (PFDI-20)的变化、盆底功能障碍的主观症状报告和盆底肌肉力量的手动肌肉测试。这些变化分别采用t检验、McNemar检验和Wilcoxon秩和检验计算。结果:PHPT在平均6.2周内开始导致所有主观抱怨的减少。盆底肌力从最初的改良牛津评分系统(MOS)评分1(1-2)提高到2 (1-3),(P < 0.01)。产后2个月内接受PHPT治疗的患者比产后2个月后接受PHPT治疗的患者主观症状明显减轻(2.4±1.7 vs 1.1±1.3,P = 0.02)。结论:PHPT干预与在单一三级中心经历OASIS的妇女主观抱怨的减少有关。早期开始PHPT可能会导致症状的更大改善。
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