Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Abstract

Background-Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. Aim-To determine whether biofeedback retraining is a useful treatment for this condition. Patients-Thirteen consecutive patients with SRUS (three men, median age 34 years, median duration of symptoms three years) underwent treatment. Previous surgical treatment had failed in five. Methods-Patients were evaluated prospectively. Anorectal physiological studies were performed in 11 patients before treatment. A standardised questionnaire was used before and after treatment, and all but two patients were examined after treatment. Results-Median follow up was nine months (range 3-22 months). After treatment four patients were asymptomatic, and four felt improved. Symptom improvement or elimination occurred in: need to strain (7/13 patients), digitation (7/11), laxative use (5/9). Time in the toilet (median 30 v 10 minutes, before v after treatment) and number of visits to toilet (6 v 3/day) were also improved. Three patients were able to maintain employment before treatment compared with eight after treatment. The solitary ulcer did not heal completely in any of the nine patients examined after treatment, but improved in four. Previous surgery, the macroscopic appearance of the ulcer, the presence of pelvic floor paradox, and other physiological parameters did not predict outcome. Conclusion-Biofeedback retraining is a useful treatment for this condition. Long term studies are now required. (Gut 1997; 41: 817-820)

Anorectal Physiology in Solitary Ulcer Syndrome: A Case-Matched Series

“…From a pathophysiologic point of view, this casecontrolled study supports the symptomatic improvement (but not ulcer healing) induced by biofeedback retraining. 6,7 …”

“…Sixty-one patients met these criteria: 25 patients with rectal lesions had no external rectal prolapse and 14 experienced both rectal lesions and overt rectal prolapse. Twenty-two patients were excluded because other conditions might have interfered with analyses: surgical history of pelvic or rectal prolapse (6), doubtful diagnosis at histopathology (6), missing data of anal physiology (9), and concomitant psychiatric illness (1).…”

“…Anal primary dysfunction in solitary ulcer syndrome may be suspected by the prevalence of pelvic floor dysfunction in retrospective series, insufficient improvement as a result of rectopexy, 5 and symptomatic benefit to behavioral approach. 6,7 Prevalence of pelvic floor dysfunction is diversely quantified in case series [8][9][10] because physiology evaluation may differ (defecography, electromyography, anal manometry) 11,12 and variations in the degree of rectal prolapse may be important. 2,11 To our knowledge, only one casecontrolled study compared solitary ulcer syndrome with external rectal prolapse but occurrence of mucosal lesions in patients with overt rectal prolapse was not taken into account.…”

Spontaneous Resolution of Solitary Rectal Ulcer Syndrome During Pregnancy: Report of a Case

“…Behavioral therapy (biofeedback retraining) improves rectal mucosal blood flow as measured by laser Doppler and improves symptoms in up to 75 percent of patients with complete ulcer resolution in a third. 2,9 Surgery is reserved for those who have demonstrable abnormalities amenable to surgical correction, such as full-thickness prolapse, or failure of medical therapies. 1 Surgical approaches may be abdominal or perineal, or resectional or nonresectional.…”

Solitary Rectal Ulcer: A Literature Review

“…Surgery is reserved for patients unresponsive to conservative therapy (59). Conservative treatments including laxatives, fiber supplementation and attempted reduction of straining are reported as the first line of treatment (60).…”