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Impact of Pelvic Floor Physical Therapy on Quality of Life and Function After Obstetric Anal Sphincter Injury: A Randomized Controlled Trial

Oakley, Susan H. MD; Ghodsi, Vivian C. RN; Crisp, Catrina C. MD, MSc; Estanol, Maria Victoria MD; Westermann, Lauren B. DO; Novicki, Kathleen M. CPT; Kleeman, Steven D. MD; Pauls, Rachel N. MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2016 - Volume 22 - Issue 4 - p 205–213
doi: 10.1097/SPV.0000000000000255
Original Articles

Objectives There is no standard of care for women sustaining an obstetric anal sphincter injury (OASIS). We sought to determine whether pelvic floor physical therapy (PFPT) would improve the quality of life and function in women 12 weeks after OASIS.

Methods This institutional review board–approved randomized trial enrolled primiparous women 2 weeks after delivery complicated by OASIS. After informed consent, all subjects underwent vaginal electromyography and anorectal manometry and completed validated questionnaires; measures were repeated for all subjects at 12 weeks after delivery. The intervention arm completed 4 PFPT sessions. The primary outcome was a change in the Fecal Incontinence Quality of Life.

Results Three hundred four women were screened; 250 were excluded, and 54 were randomized. After four were lost to follow-up, analysis included 27 in the intervention arm and 23 in the control arm. Overall, mean age was 29.8 ± 4.7 years, and there were no demographic differences between groups.

Fecal Incontinence Quality of Life domain scores showed improvement for both groups from baseline to 12 weeks for coping (P = 0.006) and depression (P = 0.009); however, there was no difference in domain scores between groups. For the secondary outcome of anorectal manometry, squeezing pressure improved for all subjects (P = 0.035) from baseline to 12 weeks. Vaginal EMG strength (microvolts) increased for all subjects in measures of rest average (P < 0.000), rapid peak (P = 0.006), and work average (P < 0.000), with no difference based on therapeutic arm.

Conclusions All women showed improvements in quality of life and function at 12 weeks after delivery, regardless of treatment allocation. Further study is needed to determine whether PFPT provides a significant benefit to women having OASIS.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Physicians, Fort Thomas, KY.

Reprints: Susan H. Oakley, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Physicians, 1400 N Grand Ave, Fort Thomas, KY 41017. E-mail: susan.oakley@stelizabeth.com.

Conflicts of interest and source of funding: Supported by an educational grant from the TriHealth Medical Education Research Fund. The authors have declared they have no conflicts of interest.

Presented at the 36th Annual Scientific Meeting of the American Urogynecologic Society PFDWeek 2015 in Seattle, Washington, October 2015.

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