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

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

To promote agreement among and support the quality of pelvic physiotherapists’ skills and clinical reasoning in The Netherlands, an Evidence Statement Anal Incontinence (AI) was developed based on the practice-driven problem definitions outlined. We present a summary of the current state of knowledge and formulate recommendations for a methodical assessment and treatment for patients with AI, and place the evidence in a broader perspective of current developments.

Methods

Electronic literature searches were conducted in relevant databases with regard to prevalence, incidence, costs, etiological and prognostic factors, predictors of response to therapy, prevention, assessment, and treatment. The recommendations have been formulated on the basis of scientific evidence and where no evidence was available, recommendations were consensus-based.

Results

The evidence statement incorporates a practice statement with corresponding notes that clarify the recommendations, and accompanying flowcharts, describing the steps and recommendations with regard to the diagnostic and therapeutic process. The diagnostic process consists of history-taking and physical examination supported by measurement instruments. For each problem category for patients with AI, a certain treatment plan can be distinguished dependent on the presence of pelvic floor dysfunction, awareness of loss of stools, comorbidity, neurological problems, adequate anorectal sensation, and (in)voluntary control. Available evidence and expert opinion support the use of education, pelvic floor muscle training, biofeedback, and electrostimulation in selected patients.

Conclusions

The evidence statement reflects the current state of knowledge for a methodical and systematic physical therapeutic assessment and treatment for patients with AI.

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Abbreviations

AI:

Anal incontinence

BF:

Biofeedback

BSS:

Bristol Stool Scale

EMG:

Electromyography

ES:

Electrostimulation

FI:

Fecal incontinence

FIQL:

Fecal Incontinence Quality of Life Scale

GPE:

Global Perceived Effect

ICF:

International Classification of Functioning, Disability, and Health

ICS:

International Continence Society

ICIQ-B:

The International Consultation on Incontinence Questionnaire—Bowels

IUGA:

International Urogynecological Association

KNGF:

Royal Dutch Society for Physical Therapy

PFMT:

Pelvic floor muscle training

RAIR:

Rectoanal inhibitory reflex

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Funding

The project was subsidized by the Royal Dutch Society for Physical Therapy (KNGF).

Conflicts of interest

None.

Authors’ contributions

L.C.M. Berghmans: protocol/project, literature search, grading literature, expert opinion, manuscript writing/editing; J.A.M. Groot: protocol/project, grading literature, expert opinion, manuscript writing/editing; I.C. van Heeswijk-Faase: protocol/project, grading literature, expert opinion, manuscript writing/editing; E.M.J. Bols: protocol/project, literature search, grading literature, expert opinion, manuscript writing/editing.

Author information

Authors and Affiliations

  1. Pelvic Care Center Maastricht, Maastricht University Medical Centre (MUMC), P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    L. C. M. Berghmans

  2. Primary Care Physical Therapy Practice, Heemstede and Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

    J. A. M. Groot

  3. Primary Care Physical Therapy Practice, Zoetermeer, The Netherlands

    I. C. van Heeswijk-Faase

  4. Department of Epidemiology, Center for Evidence Based Physiotherapy (CEBP), Maastricht University, Maastricht, The Netherlands

    E. M. J. Bols

Authors
  1. L. C. M. Berghmans
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  2. J. A. M. Groot
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  3. I. C. van Heeswijk-Faase
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  4. E. M. J. Bols
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Corresponding author

Correspondence to L. C. M. Berghmans.

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Berghmans, L.C.M., Groot, J.A.M., van Heeswijk-Faase, I.C. et al. Dutch evidence statement for pelvic physical therapy in patients with anal incontinence. Int Urogynecol J 26, 487–496 (2015). https://doi.org/10.1007/s00192-014-2555-y

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  • DOI: https://doi.org/10.1007/s00192-014-2555-y

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