Summary of results and general discussion 221 9 manage comorbid conditions that may interfere with therapy compliance and manage expectations.25 The success rate of PFPT depends on a careful diagnosis and patient selection,28 evaluation concerning patients’ motivation and commitment to treatment. The use of behaviour training with biofeedback was effective and durable in our study, but it should be mentioned that it is a labour-intensive treatment, treatment protocols vary among centers, and it is not universally available. Brown et al.29 found that adherence and completion of the treatment are critical for maintaining effectiveness. Monitoring sessions could be performed after the PFPT sessions to verify correct performance of exercises. Studies on effective implementation are the next step. There is evidence of a strong and consistent relationship of sexual and/or physical abuse history in gastro intestinal disorders.30-33 Besides that, increased pelvic floor muscle tone is associated with sexual abuse.34,35 A history of sexual and/or physical abuse may play a role in the divergence between the symptoms patients report and objective measurements and may alter treatment recommendations.36 Besides that, there is a high comorbidity of psychological disorders e.g. anxiety and depression in patients with CAF which could have a negative influence on quality of life and sexual function.6,37-39 More attention should be paid for addressing the issue of sexual health and other associated psychological factors in clinical practice and implementing questions concerning these topics and pelvic floor dysfunction in history taken. Further studies are needed to establish the effect of the underlying psychological mechanisms and the use of additional behavioral interventions including psychoeducation besides PFPT to identify targeted efficacious interventions in patients with CAF. Although we did not perform an evaluation of the actual costs of each treatment including PFPT, we should take this into account. Treatment of CAF is a balance between efficacy, adverse events, risk of recurrence and costs. Improving daily functioning and reducing recurrence rates has cost implications and it is likely that the integrated nature of our conservative treatment is more cost-effective because of the diminishing need for surgery. A cost consideration study would be sensible calculating costs in time, effort, and finance for undergoing PFPT. The findings of our study highlight the feasibility and effectiveness of a multidisciplinary treatment and points out the importance of integrating across health care professionals to improve the treatment in patients with CAF. The treatment of CAF should be sequential and tailored to the patients’ needs and a holistic and multimodal approach is a requisite.
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