Efficacy of pelvic floor muscle training, biofeedback and electrical stimulation as physiotherapy treatment modalities for women with postpartum anal incontinence

Author(s): B. Hallier - Pages: 9-18

Abstract

Symptoms of anal incontinence (AI) during the postpartum period can reduce an individual’s quality of life and social interaction. Although there are published guidelines for the management of AI in adults, these do not specifically focus on the challenges faced by women in the postpartum period. While the aetiology of AI is often multifactorial, physiotherapists are well placed to treat women who present with AI. This is because weakness in or damage to the pelvic floor and/or anal sphincter muscles is likely to be a major contributing factor in this population as a result of pregnancy and childbirth. Despite this, there are only a limited number of studies of this specific population, which means that the effects of the existing treatment modalities remain uncertain. The aim of this literature review is to evaluate the available evidence for the efficacy of three physiotherapy treatment modalities on symptoms of postpartum AI: pelvic floor muscle training, biofeedback and electrical stimulation. A literature search from 2002 to 2022 was performed, and five relevant randomized controlled trials were identified and selected for analysis. The results suggest that pelvic floor muscle training and biofeedback are effective treatment modalities for postpartum women with symptoms of AI. However, the evidence did not support the early use of electrical stimulation in this population. More high-quality research is required to further assess the efficacy of these treatment modalities, and to consider the impact of treatment length and intensity, the time to start treatment postpartum, and the subdivision of symptoms or delivery types.