Pelvic floor muscle exercise and functional rehabilitation after anal external sphincter reconstruction surgery

Abstract

Objective To present the study of pelvic floor muscle exercise and functional rehabilitation after anal external sphincter reconstruction surgery in children.Methods Twenty seven children aged 5 to 12 years old,who had fecal incontinence caused by previous operations for congenital anorectal malformations,were enrolled in this study.They included 17 males and 10 females.Their anal sphincter function was scored poor.All of the patients were performed anal external sphincter reconstruction surgeries using gracilis muscle transplantation.Sixteen patients started biofeedback exercises of pelvic floor muscle 3 months later after surgery.Eleven patients didn't keep exercising after being discharged.Results Before training,there was no significant difference of the resting anal canal pressure,squeeze pressure and continued contracting time in training group and non-training group (16.7 ± 4.9 mmHg vs 15.5 ± 4.1 mmHg,61.6 ± 14.6 mmHg vs 59.3±13.0 mmHg,and 2.3 ± 0.7 svs 2.2 ± 0.7 s,respectively).After 1 year pelvic floor muscle exercise and functional rehabilitations,the patients' resting anal canal pressure,sqeeze pressure and continued contracting time were 35.4 ±8.7 mmHg,150.6 ± 17.8 mmHg and 7.2 ± 1.2 s.The anal sphincter function was good in 12 cases,fair in 3 cases and poor in 1 case.In these patients without muscle exercise and functional rehabilitations,their resting anal canal pressure,anal sqeeze pressure and continued contracting time were 21.1±3.1 mmHg,94.7 ± 12.7mmHg and 4.6 ± 0.8 s,respectively.The anal sphincter function was good in 3 cases,fair in 6 cases and poor in 2 cases.Overall,the anal sphincter function was significantly improved in the patients with postoperative pelvic floor muscle exercise and functional rehabilitation compared with the patients didn't have the exercises.Conclusions Pelvic floor muscle exercise is important for anal external sphincter functional rehabilitation after anal external sphincter reconstruction using gracilis muscle transplantation in children Key words: Fecal incontinence; Anal canal