Because NRPS is a behavioral rather than an anatomic abnormality, biofeedback is the standard therapy. In biofeedback training, patients are allowed to view their own EMG or manometric tracings on a video monitor while attempting to relax the pelvic floor and sphincter muscles. Numerous reports have demonstrated success rates ranging from 37% to 100%.4 In the largest series to date, Gilliland and Wexner5 found only one variable to be predictive of a successful outcome: patients who self-discharged from therapy had a success rate of only 29%, whereas patients who remained in therapy until discharged by the therapist had a success rate of 63%.

Where biofeedback therapy has failed to relieve a patient's symptoms, botulinum toxin type A injection under EMG guidance can be offered in selected cases. We found high initial success rates with moderate long-term results.6 Another therapeutic modality available is electro-galvanic stimulation (EGS). Hull et al.7 reported poor long-term outcome (19% had their symptoms relieved, 24% had partial relief at 28 months follow-up) for the treatment of levator syndrome. More recently, Chiarioni et al.8 reported a 50% success rate when they treated 30 patients with pelvic floor "dyssynergia" with EGS. Overall, we believe EGS may represent a useful adjunct in the treatment options for these patients because of its simplicity and low morbidity.

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