Biofeedback Is Superior to Electrogalvanic Stimulation and Massage for Treatment of Levator Ani Syndrome
Biofeedback Is Superior to Electrogalvanic Stimulation and Massage for Treatment of Levator Ani Syndrome
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DOI：
10.1053/j.gastro.2009.12.040
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发表时间：
2010-04-01
期刊：
影响因子：
29.4
通讯作者：
Whitehead, William E.
中科院分区：
文献类型：
--
作者：
Chiarioni, Giuseppe;Nardo, Adriana;Whitehead, William E.
背景与目的：肛提肌综合征（LAS）的治疗可以使用生物反馈，教盆底放松，电刺激（EGS），或提肛肌按摩。我们进行了一项前瞻性随机对照试验，比较这些技术的有效性，并评估治疗的生理机制。方法：纳入标准为罗马II症状加每周疼痛。如果患者报告上睑提肌牵拉时有压痛，则将其归类为“极有可能”发生LAS，如果没有，则归类为“可能”发生LAS。所有157例患者接受了9次治疗，包括心理咨询加生物反馈，EGS或按摩。在1、3、6和12个月时重新评估结局。结果：在“高度可能”LAS的患者中，87%的患者报告了生物反馈的充分缓解，45%的患者报告了EGS的充分缓解，22%的患者报告了按摩的充分缓解。每月疼痛天数从基线时的14.7天减少到生物反馈后的3.3天，EGS后的8.9天和按摩后的13.3天。疼痛强度从基线时的6.8（0-10量表）降至生物反馈后的1.8，EGS后的4.7和按摩后的6.0。改进持续了12个月。仅诊断为LAS“可能”的患者未从任何治疗中获益。生物反馈和EGS通过增加放松骨盆底肌肉和排空充满水的球囊的能力以及通过降低冲动和疼痛阈值来改善LAS。结论：生物反馈是这些治疗中最有效的，EGS也有一定的效果。只有直肠检查有压痛的患者才能受益。LAS的病理生理学与排便协同失调相似。
BACKGROUND & AIMS: Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiologic mechanisms for treatment. METHODS: Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as "highly likely" to have LAS if they reported tenderness with traction on the levator muscles or as "possible" LAS if they did not. All 157 patients received 9 sessions including psychologic counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months. RESULTS: Among patients with "highly likely" LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0-10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a "possible" diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon and by reducing the urge and pain thresholds. CONCLUSIONS: Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation.