Physiotherapeutic Approaches to Treat Anal Incontinence in Women after Obstetric Trauma
Abstract Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment...
Saved in:
| Published in: | Journal of Coloproctology Vol. 42; no. 1; pp. 77 - 84 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Thieme Revinter Publicações Ltda
01-03-2022
|
| Subjects: | |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | Abstract
Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment, which promotes the reeducation, coordination, and strengthening of the muscles of the pelvic floor to enable patients to return to their regular activities of daily living.
Objective To perform a systematic review on the physiotherapeutic treatments used in women between the ages of 18 and 65 years with a diagnosis of anal incontinence.
Material and methods Clinical studies written in Portuguese, Spanish and English were searched on the the following databases: Science Direct, Medical Literature Analysis and Retrieval System Online (Medline) via PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and Scopus.
Results Of the 998 articles found, only 4 studies met the inclusion criteria of the present systematic review. The physiotherapeutic approaches to treat women with anal incontinence are biofeedback, Kegel exercises, electrostimulation, and training of the pelvic floor muscles. The average score on the PEDro scale was of 6.25, which indicates that the methodological quality was good.
Conclusion Although pelvic physiotherapy is effective to treat anal incontinence, it must be promoted through the performance of evidence-based scientific research. |
|---|---|
| AbstractList | Abstract
Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment, which promotes the reeducation, coordination, and strengthening of the muscles of the pelvic floor to enable patients to return to their regular activities of daily living.
Objective To perform a systematic review on the physiotherapeutic treatments used in women between the ages of 18 and 65 years with a diagnosis of anal incontinence.
Material and methods Clinical studies written in Portuguese, Spanish and English were searched on the the following databases: Science Direct, Medical Literature Analysis and Retrieval System Online (Medline) via PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and Scopus.
Results Of the 998 articles found, only 4 studies met the inclusion criteria of the present systematic review. The physiotherapeutic approaches to treat women with anal incontinence are biofeedback, Kegel exercises, electrostimulation, and training of the pelvic floor muscles. The average score on the PEDro scale was of 6.25, which indicates that the methodological quality was good.
Conclusion Although pelvic physiotherapy is effective to treat anal incontinence, it must be promoted through the performance of evidence-based scientific research. Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment, which promotes the reeducation, coordination, and strengthening of the muscles of the pelvic floor to enable patients to return to their regular activities of daily living. Objective To perform a systematic review on the physiotherapeutic treatments used in women between the ages of 18 and 65 years with a diagnosis of anal incontinence. Material and methods Clinical studies written in Portuguese, Spanish and English were searched on the the following databases: Science Direct, Medical Literature Analysis and Retrieval System Online (Medline) via PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and Scopus. Results Of the 998 articles found, only 4 studies met the inclusion criteria of the present systematic review. The physiotherapeutic approaches to treat women with anal incontinence are biofeedback, Kegel exercises, electrostimulation, and training of the pelvic floor muscles. The average score on the PEDro scale was of 6.25, which indicates that the methodological quality was good. Conclusion Although pelvic physiotherapy is effective to treat anal incontinence, it must be promoted through the performance of evidence-based scientific research. |
| Author | Rodrigues, Iane Castro Uchôa, Silvana Maria Macedo Freitas, Mayanna Machado Carvalho, Valéria Conceição Passos de Moura, Lara Elma Franco Saquetto, Denise |
| Author_xml | – sequence: 1 givenname: Mayanna Machado orcidid: 0000-0001-9029-2796 surname: Freitas fullname: Freitas, Mayanna Machado organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil – sequence: 2 givenname: Lara Elma Franco orcidid: 0000-0001-7756-2536 surname: Moura fullname: Moura, Lara Elma Franco organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil – sequence: 3 givenname: Denise orcidid: 0000-0002-3065-9215 surname: Saquetto fullname: Saquetto, Denise organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil, Centro Universitário Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil – sequence: 4 givenname: Iane Castro orcidid: 0000-0002-0703-7581 surname: Rodrigues fullname: Rodrigues, Iane Castro organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil – sequence: 5 givenname: Valéria Conceição Passos de orcidid: 0000-0001-8314-9000 surname: Carvalho fullname: Carvalho, Valéria Conceição Passos de organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil – sequence: 6 givenname: Silvana Maria Macedo orcidid: 0000-0002-4635-9428 surname: Uchôa fullname: Uchôa, Silvana Maria Macedo organization: Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil |
| BookMark | eNo9kE1rAjEQhkOxUGu99pw_sDbfu3sU6Ycg2IPFY5hNZusWTSRZD_77rlV6mmFgHt73eSSjEAMS8szZjDOtX3LBmBIFL5Uwgt-RsZC8LIwScjTsQpZFLY18INOcu4YJUZZaKTkm28_dOXex32GCI576ztH58ZgiuB1m2ke6SQg9nQfY02VwMfRdwOCQdoFu4wEDhbbHRNdN7rFPw_smwekAT-S-hX3G6W1OyNfb62bxUazW78vFfFU4oRUvGo4KJDbGCGCKQcW8Ae3AKNdKzVopPaDhTeO9VGXtsKmG2EZzI3zdcicnZHnl-gg_9pi6A6SzjdDZv0NM3xbS0GqPFlklNfrKC6-VVgKgrcGXUnDBfSnqgTW7slyKOSds_3mc2Ytlm-3Fsr1Zlr990HGH |
| Cites_doi | 10.1590/s0004-2803.201900000-17 10.1002/14651858.CD001310 10.1002/nau.23258 10.1016/j.gtc.2016.02.002 10.1055/s-0031-1272825 10.1177/014107680409700303 10.1016/j.ajog.2004.07.006 10.4067/S0718-40262011000300016 10.23922/jarc.2020-008 10.1007/BF02236930 10.1007/BF02237236 10.1590/S0102-76382005000100004 10.1001/jama.1995.03530070057030 10.1007/s10484-017-9352-6 10.1007/s10350-004-0899-y 10.1002/14651858.CD002111.pub3 10.1111/1471-0528.14145 10.1007/BF02234575 10.2217/whe.14.66 10.1007/s10350-007-9075-5 10.1590/1809-9823.2007.100310 10.1177/1756283X15614516 10.1016/S2468-1253(19)30193-1 10.1111/ner.12451 10.1016/S0009-739X(04)72362-3 10.3748/wjg.v19.i48.9216 |
| ContentType | Journal Article |
| DBID | AAYXX CITATION DOA |
| DOI | 10.1055/s-0042-1742621 |
| DatabaseName | CrossRef DOAJ Directory of Open Access Journals |
| DatabaseTitle | CrossRef |
| DatabaseTitleList | CrossRef |
| Database_xml | – sequence: 1 dbid: DOA name: Directory of Open Access Journals url: http://www.doaj.org/ sourceTypes: Open Website |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 2317-6423 |
| EndPage | 84 |
| ExternalDocumentID | oai_doaj_org_article_e0835ed8d2d54542aaf9ad732121d729 10_1055_s_0042_1742621 |
| GroupedDBID | .1- .FO 0R~ 0SF 0U6 1P~ 4.4 457 5VS 6I. AACTN AAEDT AAEDW AAFTH AAIKJ AALRI AAXUO AAYXX ABMAC ACGFS ADBBV ADCUG ADEZE ADVLN AEVXI AEXQZ AFCTW AFRHN AFTJW AGHFR AHRAW AITUG AJRQY AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ APOWU AZFZN BAWUL BCNDV CITATION DIK EBS EJD FDB FNPLU GROUPED_DOAJ IPNFZ IXB KQ8 M41 NCXOZ OC. OK1 ON0 RIG RNS ROL RSC RTC SSZ Z5R |
| ID | FETCH-LOGICAL-c2541-b1e4a3eb662a040a80d6a5ca64cf350f33dae61bbdd3479ceb844365162d9f1c3 |
| IEDL.DBID | DOA |
| ISSN | 2237-9363 |
| IngestDate | Tue Oct 22 14:55:28 EDT 2024 Fri Aug 23 01:19:30 EDT 2024 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 1 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c2541-b1e4a3eb662a040a80d6a5ca64cf350f33dae61bbdd3479ceb844365162d9f1c3 |
| ORCID | 0000-0002-3065-9215 0000-0002-4635-9428 0000-0002-0703-7581 0000-0001-7756-2536 0000-0001-8314-9000 0000-0001-9029-2796 |
| OpenAccessLink | https://doaj.org/article/e0835ed8d2d54542aaf9ad732121d729 |
| PageCount | 8 |
| ParticipantIDs | doaj_primary_oai_doaj_org_article_e0835ed8d2d54542aaf9ad732121d729 crossref_primary_10_1055_s_0042_1742621 |
| PublicationCentury | 2000 |
| PublicationDate | 2022-03-01 |
| PublicationDateYYYYMMDD | 2022-03-01 |
| PublicationDate_xml | – month: 03 year: 2022 text: 2022-03-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationTitle | Journal of Coloproctology |
| PublicationYear | 2022 |
| Publisher | Thieme Revinter Publicações Ltda |
| Publisher_xml | – name: Thieme Revinter Publicações Ltda |
| References | C M Lumi (ref2) 2006; 17 J R Guerra-Mora (ref16) 2015; 53 S M Murad-Regadas (ref17) 2019; 56 W H Jost (ref32) 1998; 120 C M Lumi (ref5) 2012; 42 J A Van Koughnett (ref26) 2013; 19 D C Damin (ref24) 2017; 42 A Freeman (ref20) 2016; 45 N Naimy (ref28) 2007; 50 A J García López (ref35) 2002; 15 A MF Barroso (ref1) 2018; 13 J Leite (ref8) 2010; 7 J Duelund-Jakobsen (ref14) 2016; 9 K Nakano (ref15) 2020; 4 D M Hayden (ref6) 2011; 24 C M Lumi (ref12) 2009; III-368 C Norton (ref25) 2012; 7 S Heymen (ref27) 2001; 44 H H Johannessen (ref36) 2017; 124 Y I Yik (ref18) 2016; 19 M M Fynes (ref30) 1999; 42 G Hosker (ref33) 2000; 1 J MM Barbosa (ref3) 2007; 10 A Muñoz-Duyos (ref7) 2004; 76 R T Mahony (ref29) 2004; 191 R C Andalia (ref22) 2010; 21 A Bertotto (ref23) 2017; 36 R Brandau (ref21) 2005; 20 T H Rockwood (ref10) 2000; 43 M T Vergara (ref13) 2011; 63 R Nelson (ref4) 1995; 274 S Kwon (ref11) 2005; 48 I Meyer (ref9) 2015; 11 J E Jelovsek (ref19) 2019; 4 P J Lunniss (ref34) 2004; 97 |
| References_xml | – volume: 56 start-page: 61 issue: 01 year: 2019 ident: ref17 article-title: Predictors of unsuccessful of treatment for fecal incontinence biofeedback for fecal incontinence in female publication-title: Arq Gastroenterol doi: 10.1590/s0004-2803.201900000-17 contributor: fullname: S M Murad-Regadas – volume: 1 start-page: CD001310 year: 2000 ident: ref33 article-title: Electrical stimulation for faecal incontinence in adults publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD001310 contributor: fullname: G Hosker – volume: III-368 start-page: 1 year: 2009 ident: ref12 article-title: Tratamiento quirúrgico de la incontinencia anal publication-title: ECirugía Digestiva. contributor: fullname: C M Lumi – volume: 36 start-page: 2142 issue: 08 year: 2017 ident: ref23 article-title: Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: A randomized controlled trial publication-title: Neurourol Urodyn doi: 10.1002/nau.23258 contributor: fullname: A Bertotto – volume: 45 start-page: 217 issue: 02 year: 2016 ident: ref20 article-title: Fecal Incontinence and Pelvic Floor Dysfunction in Women: A Review publication-title: Gastroenterol Clin North Am doi: 10.1016/j.gtc.2016.02.002 contributor: fullname: A Freeman – volume: 13 start-page: 426 issue: 04 year: 2018 ident: ref1 article-title: Abordagem fisioterapêutica na incontinência fecal: revisão de literatura publication-title: Fisioterapia Ser. contributor: fullname: A MF Barroso – volume: 24 start-page: 64 issue: 01 year: 2011 ident: ref6 article-title: Fecal incontinence: etiology, evaluation, and treatment publication-title: Clin Colon Rectal Surg doi: 10.1055/s-0031-1272825 contributor: fullname: D M Hayden – volume: 42 start-page: 193 issue: 03 year: 2012 ident: ref5 article-title: Ecografía anorrectal y manometría en el estudio de pacientes con incontinencia fecal publication-title: Acta Gastroenterol Latinoam contributor: fullname: C M Lumi – volume: 97 start-page: 111 issue: 03 year: 2004 ident: ref34 article-title: Risk factors in acquired faecal incontinence publication-title: J R Soc Med doi: 10.1177/014107680409700303 contributor: fullname: P J Lunniss – volume: 191 start-page: 885 issue: 03 year: 2004 ident: ref29 article-title: Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence publication-title: Am J Obstet Gynecol doi: 10.1016/j.ajog.2004.07.006 contributor: fullname: R T Mahony – volume: 63 start-page: 320 issue: 03 year: 2011 ident: ref13 article-title: Incontinencia fecal del adulto publication-title: Rev Chil Cir doi: 10.4067/S0718-40262011000300016 contributor: fullname: M T Vergara – volume: 4 start-page: 128 issue: 03 year: 2020 ident: ref15 article-title: Effects of Dietary Guidance without Dietary Fiber Supplements on the Symptoms, Quality of Life, and Dietary Intake in Patients with Fecal Incontinence publication-title: J Anus Rectum Colon doi: 10.23922/jarc.2020-008 contributor: fullname: K Nakano – volume: 42 start-page: 753 issue: 06 year: 1999 ident: ref30 article-title: A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma publication-title: Dis Colon Rectum doi: 10.1007/BF02236930 contributor: fullname: M M Fynes – volume: 43 start-page: 9 issue: 01 year: 2000 ident: ref10 article-title: Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence publication-title: Dis Colon Rectum doi: 10.1007/BF02237236 contributor: fullname: T H Rockwood – volume: 20 start-page: VII issue: 01 year: 2005 ident: ref21 article-title: Importância do uso correto dos descritores nos artigos científicos publication-title: Rev Bras Cir Cardiovasc doi: 10.1590/S0102-76382005000100004 contributor: fullname: R Brandau – volume: 274 start-page: 559 issue: 07 year: 1995 ident: ref4 article-title: Community-based prevalence of anal incontinence publication-title: JAMA doi: 10.1001/jama.1995.03530070057030 contributor: fullname: R Nelson – volume: 42 start-page: 133 issue: 02 year: 2017 ident: ref24 article-title: Patient-Controlled Biofeedback Device for the Treatment of Fecal Incontinence: A Pilot Study publication-title: Appl Psychophysiol Biofeedback doi: 10.1007/s10484-017-9352-6 contributor: fullname: D C Damin – volume: 48 start-page: 323 issue: 02 year: 2005 ident: ref11 article-title: Validity and reliability of the Modified Manchester Health Questionnaire in assessing patients with fecal incontinence publication-title: Dis Colon Rectum doi: 10.1007/s10350-004-0899-y contributor: fullname: S Kwon – volume: 7 start-page: CD002111 year: 2012 ident: ref25 article-title: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD002111.pub3 contributor: fullname: C Norton – volume: 124 start-page: 686 issue: 04 year: 2017 ident: ref36 article-title: Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial publication-title: BJOG doi: 10.1111/1471-0528.14145 contributor: fullname: H H Johannessen – volume: 7 start-page: 68 issue: 02 year: 2010 ident: ref8 article-title: TRATAMENTO DA INCONTINÊNCIA FECAL publication-title: Rev Port Coloproct. contributor: fullname: J Leite – volume: 44 start-page: 728 issue: 05 year: 2001 ident: ref27 article-title: Biofeedback treatment of fecal incontinence: a critical review publication-title: Dis Colon Rectum doi: 10.1007/BF02234575 contributor: fullname: S Heymen – volume: 15 start-page: 190 issue: 03 year: 2002 ident: ref35 article-title: Incontinencia anal publication-title: Iatreia [Internet] contributor: fullname: A J García López – volume: 53 start-page: 472 issue: 04 year: 2015 ident: ref16 article-title: Efectividad del biofeedback en pacientes con incontinencia fecal publication-title: Rev Med Inst Mex Seguro Soc contributor: fullname: J R Guerra-Mora – volume: 17 start-page: 104 issue: 02 year: 2006 ident: ref2 article-title: Neuromodulación sacra para el tratamiento de la incontinencia anal. Técnica y presentación de la primera experiencia nacional / Sacral neuromodulation for the treatment of anal incontinence publication-title: Rev Argent Coloproctología. contributor: fullname: C M Lumi – volume: 11 start-page: 225 issue: 02 year: 2015 ident: ref9 article-title: Impact of fecal incontinence and its treatment on quality of life in women publication-title: Womens Health (Lond) doi: 10.2217/whe.14.66 contributor: fullname: I Meyer – volume: 50 start-page: 2040 issue: 12 year: 2007 ident: ref28 article-title: Biofeedback vs. electrostimulation in the treatment of postdelivery anal incontinence: a randomized, clinical trial publication-title: Dis Colon Rectum doi: 10.1007/s10350-007-9075-5 contributor: fullname: N Naimy – volume: 10 start-page: 383 issue: 03 year: 2007 ident: ref3 article-title: Qualidade de vida e estratégias de enfrentamento em idosos com incontinência fecal: uma revisão da literatura publication-title: Rev Bras Geriatr Gerontol doi: 10.1590/1809-9823.2007.100310 contributor: fullname: J MM Barbosa – volume: 9 start-page: 86 issue: 01 year: 2016 ident: ref14 article-title: Management of patients with faecal incontinence publication-title: Therap Adv Gastroenterol doi: 10.1177/1756283X15614516 contributor: fullname: J Duelund-Jakobsen – volume: 4 start-page: 698 issue: 09 year: 2019 ident: ref19 article-title: Controlling faecal incontinence in women by performing anal exercises with biofeedback or loperamide: a randomised clinical trial publication-title: Lancet Gastroenterol Hepatol doi: 10.1016/S2468-1253(19)30193-1 contributor: fullname: J E Jelovsek – volume: 19 start-page: 515 issue: 05 year: 2016 ident: ref18 article-title: Home Transcutaneous Electrical Stimulation Therapy to Treat Children With Anorectal Retention: A Pilot Study publication-title: Neuromodulation doi: 10.1111/ner.12451 contributor: fullname: Y I Yik – volume: 120 start-page: 153 issue: 04 year: 1998 ident: ref32 article-title: [Electrophysiologic studies of fecal incontinence in the woman] publication-title: Zentralbl Gynäkol contributor: fullname: W H Jost – volume: 76 start-page: 65 year: 2004 ident: ref7 article-title: Incontinencia fecal: Neurofisiología y neuromodulación publication-title: Cir Esp doi: 10.1016/S0009-739X(04)72362-3 contributor: fullname: A Muñoz-Duyos – volume: 21 start-page: 270 year: 2010 ident: ref22 article-title: Scopus: la mayor base de datos de literatura científica arbitrada al alcance de los países subdesarrollados publication-title: Acimed contributor: fullname: R C Andalia – volume: 19 start-page: 9216 issue: 48 year: 2013 ident: ref26 article-title: Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes publication-title: World J Gastroenterol doi: 10.3748/wjg.v19.i48.9216 contributor: fullname: J A Van Koughnett |
| SSID | ssib022775443 ssj0000652016 ssib031354472 |
| Score | 2.244375 |
| Snippet | Abstract
Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in... Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in... |
| SourceID | doaj crossref |
| SourceType | Open Website Aggregation Database |
| StartPage | 77 |
| SubjectTerms | fecal incontinence physiotherapy modalities rehabilitation |
| Title | Physiotherapeutic Approaches to Treat Anal Incontinence in Women after Obstetric Trauma |
| URI | https://doaj.org/article/e0835ed8d2d54542aaf9ad732121d729 |
| Volume | 42 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://sdu.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1LSwMxEA7ag3gRn1hf5CB4Ct1kNtnNsWqLFxW0onhZ8lrwYCtu-_-dZNfSnrx4WdhXCN8kMxOS-T5CLgseRDDaMF0by_IgS1YCd6z2SkuN8btupROei4e38nYUaXKWUl_xTFhLD9wCNwgxRwi-9MJjsM-FMbU2vgB0udxjZpi8b1auLKZwJAmxTuwGHPC2qxBtfbTEyJeU5wQUTIOCX0ZHKQcNS1UrmKwLJfhaxFoh9k8RaLxLdrrUkQ7bLu-RjTDdJ1v33eb4AXlNpzlXK6rosGMMDw2dz-gkJog00pBQdAuzqBER5zX9mNIkZEmTYDh9tGj5SNyPP5jFpzkkL-PR5OaOdboJzOFyjzPLQ24gWKWEwTlqyswrI51RuatBZjWAN0Fxa72PdaQu2BKxUpIr4XXNHRyR3nQ2DceEBpAaXzvrFeQqsxqsy2LDpZEZCNsnV7_YVF8tPUaVtrWlrJoqolh1KPbJdYRu-VWktU4P0NhVZ-zqL2Of_Ecjp2RbxBqGdJDsjPTm34twTjYbv7hIgwiv7_LpB8nZxgM |
| link.rule.ids | 315,782,786,866,2108,27935,27936 |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Physiotherapeutic+Approaches+to+Treat+Anal+Incontinence+in+Women+after+Obstetric+Trauma&rft.jtitle=Journal+of+Coloproctology&rft.au=Freitas%2C+Mayanna+Machado&rft.au=Moura%2C+Lara+Elma+Franco&rft.au=Saquetto%2C+Denise&rft.au=Rodrigues%2C+Iane+Castro&rft.date=2022-03-01&rft.issn=2237-9363&rft.eissn=2317-6423&rft.volume=42&rft.issue=1&rft.spage=77&rft.epage=84&rft_id=info:doi/10.1055%2Fs-0042-1742621&rft.externalDBID=n%2Fa&rft.externalDocID=10_1055_s_0042_1742621 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2237-9363&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2237-9363&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2237-9363&client=summon |