Dutch evidence statement for pelvic physical therapy in patients with anal incontinence.
OBJECTIVE
To promote agreement among and support the quality of pelvic physiotherapists' skills and clinical reasoning in The Netherlands, an Evidence Statement Anal Incontinence (AI) was developed based on the practice-driven problem definitions outlined. We present a summary of the current state of knowledge and formulate recommendations for a methodical assessment and treatment for patients with AI, and place the evidence in a broader perspective of current developments.


METHODS
Electronic literature searches were conducted in relevant databases with regard to prevalence, incidence, costs, etiological and prognostic factors, predictors of response to therapy, prevention, assessment, and treatment. The recommendations have been formulated on the basis of scientific evidence and where no evidence was available, recommendations were consensus-based.


RESULTS
The evidence statement incorporates a practice statement with corresponding notes that clarify the recommendations, and accompanying flowcharts, describing the steps and recommendations with regard to the diagnostic and therapeutic process. The diagnostic process consists of history-taking and physical examination supported by measurement instruments. For each problem category for patients with AI, a certain treatment plan can be distinguished dependent on the presence of pelvic floor dysfunction, awareness of loss of stools, comorbidity, neurological problems, adequate anorectal sensation, and (in)voluntary control. Available evidence and expert opinion support the use of education, pelvic floor muscle training, biofeedback, and electrostimulation in selected patients.


CONCLUSIONS
The evidence statement reflects the current state of knowledge for a methodical and systematic physical therapeutic assessment and treatment for patients with AI.
Pelvic Care Center Maastricht, Maastricht University Medical Centre (MUMC), P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands, bary.berghmans@maastrichtuniversity.nl.
L C M
LC
Berghmans
J A M
JA
Groot
I C
IC
van Heeswijk-Faase
E M J
EM
Bols
D001676:Biofeedback, Psychology; D004599:Electric Stimulation Therapy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D010353:Patient Education as Topic; D017773:Pelvic Floor / Q000503:physiopathology*; D059952:Pelvic Floor Disorders / Q000150:complications / Q000628:therapy*