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Biofeedback for intractable rectal pain

Outcome and predictors of success

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: A number of modalities have been used for the treatment of intractable rectal pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years. MATERIALS AND METHODS: Medical records of 86 patients who completed at least one session of biofeedback for rectal pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12–96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of rectal pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale. RESULTS: Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P = 0.63), duration of symptoms (P = 1.0), or a prior history of surgery (P = 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puborectalis contraction demonstrated on either EMG (P = 1) or defecography (P = 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P < 0.001). CONCLUSIONS: Although idiopathic rectal pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on patients' willingness to pursue a full course of therapy.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, 33309, Fort Lauderdale, Florida

    Robert Gilliland M.B., F.R.C.S. (visiting surgeon), J. Steve Heymen M.S.,  Donato F. Altomare M.D. (visiting surgeon) &  Steven D. Wexner M.D.

  2. Istituto di Clinica Chirurgica, Universita Degli Studi di Bari, Bari, Italy

    Donato F. Altomare M.D. (visiting surgeon) & Dawn Vickers R.N.

  3. Department of Surgery, Queen's University of Belfast, Northern Ireland

    Robert Gilliland M.B., F.R.C.S. (visiting surgeon)

Authors
  1. Robert Gilliland M.B., F.R.C.S.
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  2. J. Steve Heymen M.S.
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  3. Donato F. Altomare M.D.
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  4. Dawn Vickers R.N.
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  5. Steven D. Wexner M.D.
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Supported in part by a grant from the Eleanor Naylor Dana Trust.

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Gilliland, R., Heymen, J.S., Altomare, D.F. et al. Biofeedback for intractable rectal pain. Dis Colon Rectum 40, 190–196 (1997). https://doi.org/10.1007/BF02054987

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  • DOI: https://doi.org/10.1007/BF02054987

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