Pelvic floor physical therapy in patients with chronic anal fissure: long-term follow-up of a randomized controlled trial.

Abstract

BACKGROUND:

Chronic anal fissure is a common benign anorectal disease with a high recurrence rate. Pelvic floor physical therapy has been proven effective in the short-term management in patients with chronic anal fissure and pelvic floor dysfunction (PAF-trial). The aim of this study was to determine the outcomes of the PAF-trial and fissure recurrence in patients who completed the 2 months of pelvic floor physical therapy at 1-year follow-up.

METHODS:

Electromyographic registration of the pelvic floor, digital rectal examination, visual analog scales, patient-related outcome measurements, and quality of life were assessed at baseline and at 1-year after inclusion. The primary outcome was muscle tone at rest during electromyographic registration of the pelvic floor at baseline and at 1-year follow-up. Secondary outcomes contained fissure recurrence, pain ratings, pelvic floor dysfunction, complaint reduction measured with a proctology specific patient-reported outcome measurement, and quality of life.

RESULTS:

The treatment protocol was followed by 137 patients. Ninety-seven patients (71%) completed the 1-year follow-up, 48 women (49.5%) and 49 men (50.5%) with a mean age of 44.4 ± 11.6 years (range 19-68). In the total group of patients, mean resting electromyographic values of the pelvic floor significantly improved from baseline to follow-up at 1 year (mean estimated difference 2.20 μV; 95% CI, 1.79 to 2.61; p < 0.001). After 1 year, the fissure recurred in 15 patients (15.5%). VAS-pain significantly decreased from baseline to follow-up (mean estimated difference 4.16; 95% CI, 3.75 to 4.58; p < 0.001). Dyssynergia was found in 72.9% at baseline and decreased to 14.4% at 1-year follow-up (p < 0.001). Complaint reduction measured with the Proctoprom significantly improved from baseline to 1-year follow-up (p < 0.001). Quality of life (RAND-36) significantly improved in eight of nine domains at 1-year follow-up. No significant improvement was found in the domain vitality.

CONCLUSIONS:

In the PAF-trial, we demonstrated that pelvic floor physical therapy yields a significant and clinical benefit in the time course and therefore should be advocated as adjuvant conservative treatment in patients with chronic anal fissure.

TRIAL REGISTRATION:

The trial is registered at the Dutch Trial registry (NTR7581)  https://trialsearch.who.int.

• Authors: Daniëlle A van Reijn-Baggen, Henk W Elzevier, H Putter, Rob C M Pelger, Ingrid J M Han-Geurts
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 38 Issue 1 Pg. 3 (Jan 05 2023) ISSN: 1432-1262 [Electronic] Germany
• PMID: 36602613 (Publication Type: Randomized Controlled Trial, Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Male
• Humans
• Female
• Young Adult
• Adult
• Middle Aged
• Aged
• Fissure in Ano (drug therapy)
• Follow-Up Studies
• Treatment Outcome
• Pelvic Floor
• Quality of Life
• Pain
• Physical Therapy Modalities