Summary of results and general discussion 215 9 preferred surgical treatment in guidelines,15,16 there is a potential risk of incontinence.18-21 Therefore the need for conservative management cannot be overemphasized. Chapter 2 Management of chronic anal fissure, results of a national survey among gastrointestinal surgeons in the Netherlands The knowledge among clinicians across medical community concerning the pelvic floor and pelvic floor disorders and regarding when and how to refer to pelvic floor physical therapy (PFPT) varies.22 Our aim was to evaluate current practice in the management of CAF amongst gastrointestinal surgeons in the Netherlands. A 21item questionnaire was sent by email to Dutch gastrointestinal surgeons and residents between June 2021 and September 2021. The questionnaire consisted of questions concerning work experience, physical examination, diagnostic- and surgical techniques and follow-up. Overall, 106 (33%) surgeons completed the survey and 59% had at least 10 years of experience in treating CAF. Only 23% always addressed pelvic floor complaints. Fifty-one percent performed digital rectal examination and 22% always, or almost always, examined the pelvic floor muscles. Most respondents started treatment with fibers and/or laxatives and ointment (96%) and diltiazem was in 90% the preferred ointment. Twenty-two percent referred patients for PFPT. Botulinum toxin was in 54% performed under general- or spinal anesthesia or sedation. The first surgical procedure of choice was fissurectomy (71%) followed by lateral internal sphincterotomy (27%). Fissurectomy was in 51% always combined with botulinum toxin. Fifty-seven percent of the respondents preferred a physical follow-up appointment. Guideline recommendations are largely followed in the Netherlands, starting with conservative measures followed by surgical procedures. Surgeons do not consistently assess pelvic floor complaints, nor do they routinely examen the pelvic floor muscles. Awareness of pelvic floor dysfunctions is important to refer patients for pelvic floor physical therapy. Chapter 3 Pelvic floor physical therapy for pelvic floor hypertonicity1: a systematic review of treatment efficacy Increased pelvic floor muscle tone (non-neurogenic hypertonicity) is a disabling condition with urological, gynaecological, and gastrointestinal symptoms, sexual
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