[Levator ani syndrome, functional intestinal disorders and articular abnormalities of the pelvis, the place of osteopathic treatment].
OBJECTIVE
Various treatments of the Levator ani syndrome (LVAS) have been proposed. None of them alleviate symptoms in more than 20% of the cases. A new approach combining massages of the coccygeus muscle with physical treatment of frequently associated pelvic joint disorders was assessed. The outcome of the Irritable Bowel Syndrome (IBS) that is frequently associated was also studied.


METHODS
One hundred and one patients (76 females and 25 males, mean age: 54 years) with a diagnosis of LVAS were studied prospectively over one year. Massages were given with a patient lying on the left side. Physical treatment of the pelvic joint disorders was given at the end of each massage session.


RESULTS
Forty-seven patients (46.5%) suffered both from LVAS and IBS. A mean of less than 2 sessions of treatment was necessary. Sixty-nine per cent of the patients were LVAS-free at 6 months (p<0.0001) and 10% were improved. At 12 months, 62% were still free of symptoms and 10% improved (p=0.37). A comparable trend according to the Rome II criteria was found in the IBS-patient group (53% IBS free initially, 78% at 6 months [p=0.00001], 72% at 12 months [p=1]). There was a significant correlation between the favorable outcome of IBS and the LVAS at 6 and 12 months. All IBS-free patients were LVAS-free at 6 months.


CONCLUSIONS
The LVAS may be cured or alleviated in 72% of the cases at 12 months with one to 2 sessions. This new comprehensive treatment suggests the role of a muscular and osteoligamentary etiology in the LVAS. Since most of IBS benefitted from such treament, it is logical to suspect a mutual pathogeny and to screen for LVAS in all such patients.
Riot
François-Marie
FM
Cabinet d'hépatogastroentérologie et proctologie, Dijon. f.riot@caramail.com
Goudet
Pierre
P
Mouraux
Jean-Pierre
JP
Cougard
Patrick
P
D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000628:therapy*; D003109:Colonic Diseases, Functional / Q000628:therapy*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000628:therapy*; D008297:Male; D008405:Massage; D008875:Middle Aged; D010021:Osteopathic Medicine / Q000379:methods*; D010388:Pelvis; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013577:Syndrome; D016896:Treatment Outcome
Syndrome des releveurs de l'anus, troubles fonctionnels intestinaux et anomalies articulaires du petit bassin, place du traitement ostéopathique.