Division of Gastroenterology, University of Verona at Verona, Italy.
Gastroenterology. 2010 Apr;138(4):1321-9. doi: 10.1053/j.gastro.2009.12.040. Epub 2010 Jan 4.
BACKGROUND & AIMS: Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiologic mechanisms for treatment.
Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as "highly likely" to have LAS if they reported tenderness with traction on the levator muscles or as "possible" LAS if they did not. All 157 patients received 9 sessions including psychologic counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months.
Among patients with "highly likely" LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0-10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a "possible" diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon and by reducing the urge and pain thresholds.
Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation.
提肛肌综合征（LAS）可能可以通过生物反馈来治疗，以教授盆底放松、电刺激（EGS）或按摩提肛肌。我们进行了一项前瞻性、随机对照试验，比较这些技术的有效性，并评估治疗的生理机制。
纳入标准为罗马 II 症状加每周疼痛。如果患者报告在牵引提肛肌时出现压痛，则将其归类为“高度可能”患有 LAS；如果没有，则归类为“可能”LAS。所有 157 名患者均接受了 9 次治疗，包括心理辅导加上生物反馈、EGS 或按摩。结果在 1、3、6 和 12 个月时重新评估。
在“高度可能”LAS 的患者中，生物反馈的缓解率为 87%，EGS 为 45%，按摩为 22%。疼痛天数从基线时的 14.7 天减少到生物反馈后的 3.3 天、EGS 后的 8.9 天和按摩后的 13.3 天。疼痛强度从基线时的 6.8（0-10 级）降低到生物反馈后的 1.8 级、EGS 后的 4.7 级和按摩后的 6.0 级。改善持续 12 个月。只有“可能”LAS 诊断的患者没有从任何治疗中受益。生物反馈和 EGS 通过增加放松盆底肌肉和排空充满水的气球的能力以及降低排便冲动和疼痛阈值来改善 LAS。
生物反馈是这些治疗中最有效的方法，EGS 也有一定效果。只有直肠检查有压痛的患者受益。LAS 的病理生理学与协同性排便障碍相似。
