Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome

In all patients with chronic proctalgia (pooled highly likely and possible LAS), biofeedback achieved adequate pain relief in 59.6% at 1 month compared to 32.7% for EGS and 28.3% for massage, with bio

Effect: improvement; 59.6% biofeedback vs 32.7% EGS vs 28.3% massage

Among patients with highly likely LAS (tenderness on palpation), biofeedback achieved 87.1% adequate pain relief at 1 month compared to 45.2% for EGS and 22.2% for massage, with improvements sustained

Effect: improvement; 87.1% adequate relief at 1 month (biofeedback) vs 45.2% (EGS) vs 22.2% (massage)

In patients with highly likely LAS, biofeedback reduced pain days per month from 14.7 to 3.3 and pain intensity from 6.8 to 1.8 on a 0-10 scale, both significantly greater reductions than EGS or massa

Effect: improvement; Pain days: 14.7 baseline to 3.3 after biofeedback vs 8.9 EGS vs 13.3 massage. VAS: 6.8 to 1.8 biofeedback vs 4.7 EGS vs 6.0 massage.

Patients with only a possible diagnosis of LAS (no tenderness on palpation) did not benefit from biofeedback, EGS, or massage on any primary or secondary outcome measure.

Effect: null; No significant treatment benefit on any outcome measure

Biofeedback restores the ability to relax pelvic floor muscles during straining (94% successful) and evacuate a water-filled balloon (97% successful), and these physiological improvements are strongly

Effect: improvement; 94% biofeedback patients achieved pelvic floor relaxation; 97% could defecate balloon; 94.2% of all patients who improved pelvic floor fu

No adverse events were reported in any of the three treatment arms (biofeedback, EGS, or massage) during the study.

Effect: null; 0 adverse events in any treatment arm