Physical Therapy After OASIs

Obstetric anal sphincter injuries (OASIS) increase the risk of anal incontinence (AI), thus potentially affecting a woman’s quality of life. Recent systematic reviews show limited effects of pelvic floor muscle training (PFMT) in treating postpartum AI. However, few studies are actually designed to detect changes in AI. Similarly, quantitative assessment of pelvic floor muscle function and activity tend to be lacking in previous studies, and many interventions include only verbal instruction of PFMT. There is little or no focus on dose-responses and progression in the PFMT protocols. However, studies of postpartum women that identify AI as the main outcome measure and focus on the principles of strength training show promising clinical results: reduced AI symptoms and improved pelvic floor muscle strength are reported. Not surprisingly, women with reduced function or large defects of the pelvic floor muscles and anal sphincter complex have worse outcomes than women with no or minimal defects and confirmed ability to contract their pelvic floor muscles. Furthermore, AI involves a complex interplay of muscular function, stool consistency and bowel function, and women with co-existing symptoms such as constipation, soiling or bowel evacuation problems may improve their symptoms and quality of life if treated using a combination of treatment modalities such as PFMT, laxatives and bulking agents.