Chapter 7 172 Abstract Background Chronic anal fissure (CAF) is one of the most common anorectal diseases and is associated with reduced quality of life. The aim of this study was to investigate the effects of pelvic floor physical therapy on quality of life in patients with CAF using the Short-Form 36 Health Survey (RAND-36). Methods Adult patients with CAF and concomitant pelvic floor dysfunction such as dyssynergia and increased pelvic floor muscle tone were randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy, or assigned to a control group receiving postponed pelvic floor physical therapy (PAF-trial). Quality of life and pain ratings were outcomes of the study and were measured at 8- and 20-week follow-up. Results One hundred patients (50 women and 50 men, median age 44.6 years [range 19–68 years]), completed the RAND- 36 questionnaire and visual analog (VAS) pain scale score at admission. A significant improvement was found at 20-week follow-up in all domains of the RAND-36; physical functioning, pain, health change (p< 0.001); physical role, vitality, general health, social functioning, emotional role, mental health (p< 0.05). VAS pain was significantly reduced at 8 weeks (mean estimated difference 1.98; 95% CI 1.55–2.42, p< 0.001) and remained significant at 20-week follow-up (p< 0.001). The difference between the groups as regards change in the mean pain intensity scores at 8 weeks was 2.48 (95% CI − 3.20 to − 1.75; p< 0.001). Compared to the reference values of the general Dutch population, the patients in our study with a chronic anal fissure and pelvic floor dysfunction reported an impaired quality of life in 8 of 9 domains of the RAND-36. After treatment, significant lower scores were found in 2 out of 9 domains. Conclusions The results of this study provide evidence that treatment by pelvic floor physical therapy improves quality of life and reduces pain, making it an important tool in management of CAF and concomitant pelvic floor dysfunction.
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