Brusciano Luigi, Brillantino Antonio, Flagiello Luigi, Pennacchio Marianna, Gambardella Claudio, Lucido Francesco Saverio, Pizza Alessandra, Tolone Salvatore, Del Genio Gianmattia, Docimo Ludovico
Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Surgery, A. Cardarelli hospital, Naples, Italy.
Arq Gastroenterol. 2023 Apr-Jun;60(2):201-207. doi: 10.1590/S0004-2803.20230222-150.
•Anorectal functional pain syndrome is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. •The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient. Background - Anorectal functional pain syndrome, also called chronic proctalgia, represents a neglected clinical entity and often confused with other syndromes such as vulvodynia or acute proctalgia. It is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. To improve symptoms in functional anorectal pain syndromes, various rehabilitation techniques are used with the aim of promoting relaxation of the pelvic floor; however, to improve defecatory dynamics in patients with levator ani syndrome, only biofeedback has shown efficacy in a randomized study. The aim of this work is to evaluate whether a rehabilitation protocol with manometric biofeedback and radiofrequency diathermy (mt100 Fremslife emotion Tecar) reduces pain and paradoxical contraction of the levator ani and improves the quality of life in patients with anorectal pain syndromes. functional. Methods - This was a prospective study on 30 patients (20 women and 10 men) with anorectal functional pain syndrome and paradoxical contraction of the pelvic floor enrolled at the UOC of General, Minimally Invasive, Oncological and Obesity Surgery of the AOU "Luigi Vanvitelli" of Naples, Italy, from September 2021 to May 2022. All patients were evaluated with a coloproctological specialist visit followed by anorectal manometry and evaluation of altered clinical physiatric parameters (Brusciano Score). The protocol consisted of 10 rehabilitation sessions of the pelvic floor once a week and lasting approximately 45 minutes. During the sessions the patients were subjected to diathermy / radiofrequency treatment (10 minutes) with a static resistive electrode on the diaphragm, during which they were required to breathe diaphragmatically and to become aware of the perineal muscles, under the supervision of a physiotherapist; followed by application of diathermy with static capacitive (5 minutes) and resistive (10 minutes) electrode at the lumbar level. This was followed by the use of manometric biofeedback (15 minutes of tonic / phasic exercises) in order to instruct the patient on the reflex mechanism to obtain a voluntary relaxation of the external anal sphincter. The variables evaluated were Pain (VAS 0-10) and the questionnaire on the impact of colorectal and anal pathologies on the quality of life (CRAIQ-7) at the beginning, after 3 months and at the end of the treatment. Results - After 10 weeks, the rehabilitation treatment combined with diathermy and manometric biofeedback proved effective in the short term with a reduction in the scores of the Vas scale and CRAIQ-7 questionnaire and an increase in the percentage of release of the anal muscles on anorectal manometry. Conclusion - The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient.
•肛门直肠功能性疼痛综合征是一种常导致功能障碍的疾病，对患者的生活质量产生重大负面影响。在许多患者中，慢性直肠疼痛继发于盆底肌反常收缩，并与胸腹和盆底之间的协同失调有关。•使用带有静态电极系统并结合生物反馈的射频透热疗法，对于患有肛门直肠功能性疼痛综合征的患者来说是一种有效的康复选择，因为它可以减轻疼痛和肛提肌的反常收缩，并改善患者的生活质量。背景 - 肛门直肠功能性疼痛综合征，也称为慢性直肠疼痛，是一个被忽视的临床实体，常与其他综合征如外阴痛或急性直肠疼痛相混淆。它是一种常导致功能障碍的疾病，对患者的生活质量产生重大负面影响。在许多患者中，慢性直肠疼痛继发于盆底肌反常收缩，并与胸腹和盆底之间的协同失调有关。为了改善功能性肛门直肠疼痛综合征的症状，人们采用了各种康复技术，旨在促进盆底肌放松；然而，在一项随机研究中，只有生物反馈在改善肛提肌综合征患者的排便动力学方面显示出疗效。这项研究的目的是评估一项结合压力测量生物反馈和射频透热疗法（mt100 Fremslife emotion Tecar）的康复方案是否能减轻肛门直肠疼痛综合征患者的疼痛和肛提肌的反常收缩，并改善其生活质量。方法 - 这是一项对30例患者（20名女性和10名男性）进行的前瞻性研究，这些患者患有肛门直肠功能性疼痛综合征且存在盆底肌反常收缩，于2021年9月至2022年5月在意大利那不勒斯“路易吉·万维泰利”综合医院的普通、微创、肿瘤和肥胖外科的特殊护理单元入组。所有患者均接受了结肠直肠专科检查，随后进行肛门直肠测压，并评估改变的临床物理治疗参数（布鲁西亚诺评分）。该方案包括每周进行10次盆底康复治疗，每次持续约45分钟。在治疗过程中，患者在物理治疗师的监督下，使用置于横膈膜上的静态电阻电极进行透热/射频治疗（10分钟）,在此期间，要求患者进行膈式呼吸并感知会阴肌肉；随后在腰部水平使用静态电容电极（5分钟）和电阻电极（10分钟）进行透热治疗。之后使用压力测量生物反馈（15分钟的紧张/相位练习）来指导患者掌握反射机制，以实现肛门外括约肌的自主放松。评估的变量包括治疗开始时、3个月后和治疗结束时的疼痛（视觉模拟评分0 - 10分）以及结直肠和肛门疾病对生活质量影响的问卷（CRAIQ - 7）。结果 - 10周后，结合透热疗法和压力测量生物反馈的康复治疗在短期内被证明是有效的，视觉模拟评分量表和CRAIQ - 7问卷的得分降低，肛门直肠测压中肛门肌肉放松的百分比增加。结论 - 使用带有静态电极系统并结合生物反馈的射频透热疗法，对于患有肛门直肠功能性疼痛综合征的患者来说是一种有效的康复选择，因为它可以减轻疼痛和肛提肌的反常收缩，并改善患者的生活质量。
