Türkan AKBAYRAK, Emine BARAN, Ceren ORHAN, Esra UZELPASACI, Serap ÖZGÜL, Gülbala NAKİP

Fekal inkontinansı olan erkek hastada pelvik taban kas eğitimi ile ekstrakorporeal manyetik stimülasyonun etkisi: vaka raporu

Çalışmanın amacı, internal anal sfinkter yetmezliğine bağlı fekal inkontinansı (Fİ) olan erkek hastada Pelvik Taban Kas Eğitimi(PTKE) ile kombine Ekstrakorporeal Manyetik Stimülasyonnun (ExMS) Fİ semptomları üzerine etkilerini araştırmaktı. Fİ’si olan26 yaşında erkek hasta çalışmaya dâhil edildi. Subjektif iyileşme algısı Likert-tip skala ile, inkontinans şiddeti Wexnerİnkontinans Derecelendirme Skalası ile; yaşam kalitesi Görsel Analog Skalası (VAS) ile değerlendirildi. Pelvik taban kaskuvveti ve enduransının değerlendirilmesi için anal perineometrik ölçüm yapıldı. Tüm sonuç ölçümleri başlangıç, 8 haftalıktedavi sonrası ve 6. ayda değerlendirildi. PTKE, ilk hafta günde 5 set egzersiz ile başladı. Her hafta 5 set artırılarak 4. haftada20 sete çıkarıldı ve 6 ay boyunca günde 20 set ev programı şeklinde uygulandı. ExMS ise, her bir seans 20 dk (10dk 10Hz,10dk 50Hz) olmak üzere haftada 3 seans, 8 hafta süresince uygulandı. 8. hafta ve 6. ayda subjektif iyileşme algısı,başlangıçtaki durum ile karşılaştırıldığında “daha iyi” olarak bildirildi. Pelvik taban kas kuvveti ve enduransı, başlangıç,tedaviden hemen sonra ve 6. ay takipte sırasıyla; 2,06-4,2-4,1 kPa ve 1-3,7-3.5 sn olarak bulundu. Wexner ve VAS skorlarısırasıyla 7-3-3 ve 3,7-0,5-0,6 olacak şekilde iyileşti. Hastanın 8. hafta ve 6. aydaki egzersiz uyumu VAS iledeğerlendirildiğinde 5,9-4,7 cm olarak bulundu. Bu vaka raporu, PTKE ve ExMS’nin Fİ’si olan bu hastada etkin bir tedaviolduğunu göstermiştir. Daha büyük örneklemli ve uzun dönem takipli ileri rastgele kontrollü çalışmalara ihtiyaç vardır.

Effect of pelvic floor muscle training with extracorporeal magnetic stimulation in a male patient with fecal incontinence: a case report

The aim of this study was to investigate the effects of Pelvic Floor Muscle Training (PFMT) combined with extracorporeal magnetic stimulation (ExMS) on fecal incontinence (FI) symptoms in a male patient with FI due to internal anal sphincter insufficiency. A male patient with FI (26 years of age) was included to the study. Subjective perception of improvement was assessed with Likert-type scale and severity of incontinence was assessed with Wexner Incontinence Rating Scale. The Visual Analog Scale (VAS) was used for quality of life assessment. An anal perineometric measurement was performed to assess the pelvic floor muscle strength (PFMS) and endurance. All outcome measures were assessed at baseline, immediately after the treatment, and at 6thmonth. PFMT started with 5 sets of exercises per day (1set exercise= 10 fast+10 slow contractions) in the first week, increased 5 sets per week to 20 sets in the 4thweekand 20 sets per day for 6 months were performed as a homebased program. ExMS was administered for 3 sessions per week for 8 weeks, each session lasting 20 min (10min 10Hz, 10min 50Hz). The subjective perception of improvement was reported as "better" at 8th week and 6th month compared to the baseline. PFMS and endurance was found as 2.06-4.2-4.1 kPa and 1-3.7-3.5 s at the baseline, immediately after the treatment and 6 months follow-up; respectively. Wexner and VAS scores were improved from 7-3-3 to 3.7-0.5-0.6, respectively. The exercise adherence of the patient at the 8th week and 6thmonth was 5.9-4.7 cm by VAS. This case report showed that PFMT and ExMS were effective treatments for this patient with FI. Further randomized controlled trials with larger sample size and long-term follow-up are needed.

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