Khera Angela J, Chase Janet W, Salzberg Michael, Thompson Alexander J V, Kamm Michael A
Department of Gastroenterology St Vincent's Hospital Australia.
Department of Medicine, University of Melbourne Melbourne Victoria Australia.
JGH Open. 2019 Jun 24;3(6):494-507. doi: 10.1002/jgh3.12207. eCollection 2019 Dec.
Large bowel functional symptoms are common in patients with inflammatory bowel disease (IBD) who are in disease remission. The efficacy of pelvic floor muscle training for symptoms of evacuation difficulty or fecal incontinence is well established in patients without organic bowel disease but is unknown in these patients. This study aimed to systematically evaluate the published evidence in this group of patients.
A systematic review was conducted of articles evaluating pelvic floor muscle training, with or without biofeedback, to improve bowel function in patients with quiescent IBD, including those with an ileoanal pouch. The outcome of interest was improved bowel function measured by bowel diary, patient report, or validated questionnaire in randomized controlled studies, cohort studies, or case series.
Two randomized controlled trials, four retrospective case series, and one prospective study met eligibility criteria. Pelvic floor muscle training for patients with quiescent IBD improved symptoms in 51 of 76 (68%) patients with evacuation difficulty and 20 of 25 (80%) patients with fecal incontinence. Pelvic floor muscle training for patients with an ileoanal pouch, prior to stoma closure, did not appear to reduce the risk or severity of fecal incontinence following stoma closure. Studies were limited by small numbers, study design, methodological quality, and lack of long-term follow-up.
Pelvic floor muscle training appears to be of therapeutic value in some patients with quiescent IBD and evacuation difficulty or fecal incontinence. The effectiveness of this approach warrants further investigation.
大肠功能症状在炎症性肠病（IBD）病情缓解的患者中很常见。盆底肌训练对无器质性肠道疾病患者的排便困难或大便失禁症状的疗效已得到充分证实，但在这些患者中的效果尚不清楚。本研究旨在系统评价该组患者的已发表证据。
对评估盆底肌训练（有无生物反馈）以改善静止期IBD患者肠道功能的文章进行系统综述，包括回肠袋肛管吻合术患者。感兴趣的结局是在随机对照研究、队列研究或病例系列中，通过排便日记、患者报告或经过验证的问卷测量的肠道功能改善情况。
两项随机对照试验、四项回顾性病例系列和一项前瞻性研究符合纳入标准。对静止期IBD患者进行盆底肌训练，76例排便困难患者中有51例（68%）症状改善，25例大便失禁患者中有20例（80%）症状改善。对回肠袋肛管吻合术患者在造口关闭前进行盆底肌训练，似乎并未降低造口关闭后大便失禁的风险或严重程度。研究受到样本量小、研究设计、方法学质量和缺乏长期随访的限制。
盆底肌训练对一些有排便困难或大便失禁的静止期IBD患者似乎具有治疗价值。这种方法的有效性值得进一步研究。
