Chapter 9 216 problems, and chronic pelvic pain. Increased tone of the pelvic floor may be a cardinal factor contributing to delayed healing and pain in patients with CAF.23,24 To gain more knowledge on the effect of treatment on increased pelvic floor muscle tone, we systematically reviewed the treatment efficacy of PFPT. The outcome measures were pelvic floor muscle tone and function, pain reports, sexual function, pelvic floor symptom scores, quality of life and patient’s perceived effect. The literature search resulted in 10 eligible studies published between 2000 and 2019. Most studies had a high risk of bias associated with the lack of a comparison group, insufficient sample sizes and non-standardized interventions. Six studies were of low and 4 of medium quality. All studies were narratively reviewed. Three of 4 RCTs found positive effects of PFPT compared to controls on 5 out of 6 outcome measures. The prospective studies found significant improvements in all outcome measures that were assessed. PFPT seems to be efficacious in patients with chronic prostatitis, chronic pelvic pain syndrome, vulvodynia, and dyspareunia. Smallest effects were found in patients with interstitial cystitis and painful bladder syndrome. No studies were found in patients with a chronic anal fissure and the use of PFPT. The findings of this systematic review suggest that PFPT can be beneficial in patients with increased pelvic floor muscle tone. 1An update on the terminology by the International Continence Society was conducted and published in 2021 after this systematic review. ‘Hypertonicity’ is changed into ‘increased pelvic floor muscle tone’ and is further used in this thesis. Chapter 4 To what extent are anorectal function tests comparable? A prospective study comparing digital rectal examination, anal electromyography, 3-dimensional high resolution anal manometry and transperineal ultrasound Anorectal function tests are helpful objectivizing anorectal (dys)functions, but there is no recommendation when to perform which test. The aim of our prospective study was to examine the correlation of anal pressures and diagnosing pelvic floor dyssynergia between digital rectal examination (DRE) and several anorectal function tests. Between January 2020 and April 2022, all men and women aged 18 till 80 years, treated in the Proctos Clinic, who were referred to PFPT by the surgeon and underwent anorectal function tests in their diagnostic work-up, were included. Digital rectal examination was performed to establish the anal pressure in rest, and during squeeze and straining. Anorectal function tests included 3D-High resolution anal
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