Effects of osteopathic manipulative therapy in patients with colorectal endometriosis

Colorectal endometriosis represents one of the most common and severe forms of deep infiltrating endometriosis

Key Points

Highlights:

• Colorectal endometriosis represents one of the most common and severe forms of deep infiltrating endometriosis

Importance:

• This study evaluated the effect of osteopathic manipulative therapy (OMT) in women affected by colorectal endometriosis

What’s done here?

• They enrolled a group of 46 patients affected by colorectal endometriosis
• They provide them an OMT, and they asked them to complete before and after the OMT an international recognized questionnaire evaluating different symptoms and an SF-36 french questionnaire evaluating physical and mental life quality
• They performed a comparison and clustering analysis to identify subgroups of patient’s profile and symptom classification

Key results:

• A significant improvement in SF-36 QOL physical component summary (P < 0.001) and mental component summary (P < 0.001) was observed after OMT.
• They also observed a significant improvement in gynecological, digestive and general symptoms values
• Clustering analysis showed that OMT is most useful especially in those patients who are more symptomatic

Limitations of the study:

• Low sample size and short period of study
• Researchers used a general life questionnaire rather than a specific endometriosis questionnaire
• The treated population was composed of a severe form of endometriosis, and the results cannot be extrapolated to other endometriosis subgroups.
• Other factors affecting the quality of the results are; non-response to the survey for more than 30% of patients, the difficulty of evaluation of the effect of concomitant medical therapies,  also the absence of any significant positive impact on urinary symptoms.

Lay Summary

Alternative treatments have been used for colorectal endometriosis, between them Chinese medicine, acupuncture and more recently osteopathic manipulative therapy. The osteopathic manipulative therapy has been shown to reduce the chronic pain working on muscular contractions due to vicious analgesic positions. Dr. Daraï and collaborators conducted a prospective study evaluating the clinical impact of osteopathic manipulative therapy (OMT) on symptoms and quality of life for patients with symptomatic colorectal endometriosis.

They enrolled a group of forty-six patients with colorectal endometriosis with a mean age of mean age of 32 ± 6.2 years, most of them with a prior surgery for endometriosis (none with deep infiltrating endometriosis) and nulliparous. The osteopathic manipulative therapy was based on uterine mobilization, test, and treatment of peritoneum motility, colon mobility concerning different intestinal segments with indirect lumbar technique.The patients were asked to complete before and after OMT an international recognized questionnaire evaluating gynecological, digestive, urinary and general symptoms and an SF-36 french questionnaire, assessing physical and mental life quality. A comparison and clustering analysis were performed to identify subgroups of patient’s profile and symptom classification.

They observed after an OMT a significant improvement in SF-36 QOL physical component summary (P < 0.001) and mental component summary (P < 0.001). In addition, they observed a significant improvement in gynecological, digestive and general symptoms values. No improvements were observed for urinary symptoms. In addition, subdividing patients into subgroups with different intensity of symptoms for endometriosis, they demonstrated that the OMT is most effective especially in those patients who are more symptomatic. 

"Regardless of the limitations of this pilot study, the results support that the OMT may have a place for the patients with colorectal endometriosis," concluded researchers.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28869181