Summary of results and general discussion 217 9 manometry (3D-HRAM), balloon expulsion test, transperineal ultrasound and surface electromyography (s-EMG). A total of 50 patients, 37 (74%) females, were included with a median age of 51 years. Twenty-three (62%) females had two or more vaginal deliveries in the past. Most frequent indication for referral for PFPT was fecal incontinence in 54% of the patients. The assessed pressures and pelvic floor function measured with digital rectal examination by the surgeon and the pelvic floor physical therapist during rest, squeeze and straining correlated in 78%, 78% and 84%, respectively. Correlation between digital rectal examination and 3D-HRAM or s-EMG, was better for squeeze pressures than resting pressures. The correlation between surface electromyography and 3D-HRAM was better during squeeze- than in rest with an agreement of 59% and 37% respectively. Digital rectal examination by an experienced investigator is of sufficient value for daily clinical practice to detect dyssynergia and measuring sphincter tone. Commonly performed anorectal function tests do not correlate with digital rectal examination, nor with other anorectal function tests. Although anorectal function tests can allay anxiety, these tests are invasive to the patient and expensive for health insurances.25 They can however give some clarity in specific complex combined incontinence and obstructive defecation complaints. Perhaps we should reserve anorectal function tests for these kinds of patients and to those who are refractory to conservative treatments, where more invasive procedures, surgery, botulinum toxin e.g., are considered. Furthermore, these tests are valuable when evaluating new (surgical) therapies. Chapter 5 Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): study protocol for a randomized controlled trial Prolonged persistence of symptoms and recurrence in patients with CAF indicate that present treatment modalities are not always sufficient. Currently, there is a gap in treatment modalities between conservative management and surgery. We aim to provide a management protocol for PFPT to bridge this gap. The protocol prescribes the rationale, design, and methodology of a randomized controlled trial investigating PFPT as a treatment option for patients with CAF. The Pelvic Floor Anal Fissure study (PAF-study) is a single-centre, two armed, randomized controlled trial. The PAF-study aims to determine the efficacy and effectiveness of PFPT on improvement
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