Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: A systematic review

• Published in: Neurourology and urodynamics Vol. 34; no. 8; pp. 703 - 712
• Main Authors: Lin, Kuan-Yin, Granger, Catherine L, Denehy, Linda, Frawley, Helena C
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2015; Wiley Subscription Services, Inc
• Subjects: biofeedback; bowel function; colorectal neoplasms; Colorectal Neoplasms - surgery; Digestive System Surgical Procedures - adverse effects; Exercise Therapy - methods; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Fecal Incontinence - rehabilitation; Humans; pelvic floor; Pelvic Floor - physiopathology; physiotherapy; Quality of Life; rehabilitation; Treatment Outcome; Urinary Incontinence - physiopathology; Urinary Incontinence - rehabilitation; Urinary Incontinence - surgery; biofeedback; bowel function; rehabilitation; pelvic floor; colorectal neoplasms; physiotherapy
• ISSN: 0733-2467; 1520-6777; 1520-6777
• DOI: 10.1002/nau.22654

Aims To identify, evaluate and synthesize the evidence examining the effectiveness of pelvic floor muscle training (PFMT) on bowel dysfunction in patients who have undergone colorectal cancer surgery. Methods Eight electronic databases (MEDLINE 1950–2014; CINAHL 1982–2014; EMBASE 1980–2014; Scopus 1823–2014; PsycINFO 1806–2014; Web of Science 1970–2014; Cochrane Library 2014; PEDro 1999–2014) were systematically searched in March 2014. Reference lists of identified articles were cross referenced and hand searched. Randomized controlled trials, cohort studies and case series were included if they investigated the effects of conservative treatments, including PFMT on bowel function in patients with colorectal cancer following surgery. Two reviewers independently assessed the risk of bias of studies using the Newcastle‐Ottawa Scale (NOS). Results Six prospective non‐randomized studies and two retrospective studies were included. The mean (SD) NOS risk of bias score was 4.9 (1.2) out of 9; studies were limited by a lack of non‐exposed cohort, lack of independent blinded assessment, heterogeneous treatment protocols, and lack of long‐term follow‐up. The majority of studies reported significant improvements in stool frequency, incontinence episodes, severity of fecal incontinence, and health‐related quality of life (HRQoL) after PFMT. Meta‐analysis was not possible due to lack of randomized controlled trials. Conclusions Pelvic floor muscle training for patients following surgery for colorectal cancer appears to be associated with improvements in bowel function and HRQoL. Results from non‐randomized studies are promising but randomized controlled trials with sufficient power are needed to confirm the effectiveness of PFMT in this population. Neurourol. Urodynam. 34:703–712, 2015. © 2014 Wiley Periodicals, Inc.