Effect of pelvic floor training and anal intracavitary electrostimulation on anal incontinence: A case study

Anal incontinence (AI) is defined as the inability to control the elimination of feces and flatus, and among the most common causes are third- and fourth-degree lacerations, known as Obstetric Anal Sphincter Injury (OASIS). Treatment options for AI are varied; however, physiotherapy has already shown widely recognized benefits. Therefore, this case report aims to present the physiotherapy treatment for AI focusing on the anorectal sensitivity of a patient after a fourth-degree perineal laceration. Twenty-five-year-old, primiparous patient with a history of vaginal delivery with a birth canal fourth-degree laceration. Since the immediate puerperium, she reported loss of flatus and feces. She subsequently underwent surgical correction of a rectovaginal fistula; however, two and a half years after delivery, she continued to present fecal and flatus incontinence, with insensible fecal loss and daily pad use. 10 sessions of electrostimulation-assisted physiotherapy and pelvic floor muscle training (PFMT) with supervision and exercises at home were carried out. A specialized physiotherapist measured symptoms and severity of AI (Werner scale), pelvic floor muscle function (digital palpation and dynamometry), and the effect of the AI on quality of life and sexual function (Questionnaire of Quality of Life in Fecal Incontinence and Female Sexual Function Index). Improvement in PFM function (strength and endurance) was observed after treatment and after the 3-month follow-up. Quality of life, symptoms of AI and sexual function also improved at both time points, especially symptoms related to desire and orgasm domains of the FSFI. In this patient with AI, anal electrostimulation combined with PFMT had a significant impact on improving muscle function, quality of life, and sexual function.