Biofeedback Treatment Provides Relief for LAS

Summary
Levator ani syndrome or LAS is a condition causing episodes of severe pain in the rectum, due to spasms of the “levator ani” muscle. Methods such as biofeedback, electrogalvanic stimulation and massage are the most commonly available treatment modalities. A study was done to assess the best of the available methods. People highly prone to this condition were selected and treated with one of the methods. It was seen that the highest relief was noted in the case of those treated with the biofeedback method.

Introduction
Levator ani syndrome affects approximately 6.6 percent of men and women. The pain in this condition can be very severe. Biofeedback is a method used for treating LAS. It is a process by which a patient is made aware of various bodily functions, using instruments that provide information about the activity of the body. There are other methods of treatment too. Various studies have commented on the efficiency of each of the methods for treating LAS. However, most of them are variable and inconsistent. Therefore, this investigation was done to identify the best treatment and to assess whether the treatment would be effectual for a year or more. The study is also extended to assess bodily changes that could occur by way of treatment and to predict the likely beneficiaries from the treatment.

Methodology
•    One hundred and fifty-seven patients were randomly selected for any one of the three treatments, namely (a) Biofeedback training (b) Electrogalvanic Stimulation or (c) Localized Massage. Each treatment had nine sessions.
•    The first group was given biofeedback training. The participants were trained to exercise their pelvic and abdominal muscles optimally and were also counseled regarding recognizing and avoiding triggers for episodes of LAS.
•    For the second group, the rectal area was stimulated by means of an electrogalvanic probe placed into the anus while the third group was directed to take Sitz baths and use finger massages twice a day.
•    The participants were followed up at one, three and six months after starting their treatments. Measuring rectal pressure and pain levels provided a good assessment of the degree of relief to patients.

Results
•    Almost 87 percent of the patients who had undergone biofeedback treatment reported relief, as compared to about 45 and 22 percent of those who underwent electrogalvanic stimulation and massage respectively.
•    The initial frequency of “painful days” was 14 days in a month, on average. This reduced to 3.3 when treated with the biofeedback method, 8.9 following electrogalvanic stimulation and 13.3 following massaging.
•    The intensity of rectal pain decreased from the initial 6.8 (on a scale of 0 to 10) to 1.8 following biofeedback, 4.7 following electrogalvanic stimulation and 6.0 subsequent to massage.

Shortcomings
Most of the patients in the massage group had stopped the treatment before six months. This study had no placebo set; so it wasn’t possible to assess the benefit of the least effectual treatment. The authors also claim that quality of life assessment of all patients could have provided valuable data.

Conclusion
This study illustrates the advantage of biofeedback for treating LAS. The authors recommend that finger massage is unsuccessful and must be abandoned as a treatment modality for LAS while electrogalvanic stimulation could be used in the absence of the biofeedback method. A few criteria that can predict a successful outcome of the biofeedback method were identified from this study. For instance, patients who experienced pain on rectal examination and who could not pass a filled balloon in stools were more prone to gain from biofeedback training. In this manner, this study has been constructive in prioritizing the treatment modalities of LAS.

For More Information:
Biofeedback – An Effective Treatment for Levator Ani Syndrome
Publication Journal: Gastroenterology, April 2010
By Giuseppe Chiarioni, Adriana Nardo; University of Verona, Italy; Valeggio sul Mincio-Department of Biomedical and Surgical Sciences, Azienda Ospedaliera and University of Verona, Valeggio sul Mincio Hospital and Policlinico GB Rossi, Verona, Italy; Casa di Cura San Clemente Hospital, Mantova, Italy

*FYI Living Lab Reports Are Summaries of the Original Research.
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