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Evaluation and treatment of chronic intractable rectal pain—A frustrating endeavor

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Diseases of the Colon & Rectum

Abstract

A study was undertaken to assess the evaluation and treatment of chronic intractable rectal pain. Sixty consecutive patients, 23 males and 37 females with a mean age of 69 (range, 29–87) years and a mean length of symptoms of 4.5 years, were evaluated by questionnaire, office examination, anal manometry, electromyography, cinedefecography, and pudendal nerve study. In all cases, organic abdominopelvic and anorectal etiologies for the pain were excluded by extensive radiologic and endoscopic evaluation. All patients had failed conservative and medical therapy. Ninety-five percent of patients had one or more associated factors: constipation or dyschezia (57 percent), prior pelvic surgery (43 percent), prior anal surgery (32 percent), prior spinal surgery (8 percent), irritable bowel syndrome (10 percent), or psychiatric disorders (depression or anxiety; 25 percent). Possible etiologies for the pain included levator spasm or anismus in 62 percent, coccygodynia in 8 percent, and pudendal neuropathy in 24 percent of patients. Therapy for pain control included electrogalvanic stimulation (EGS) in 29, biofeedback (BF) in 14, and steroid caudal block (SCB) in 11 patients. Pain control was assessed by an independent observer at a mean of 15 (range, 2–36) months after completion of therapy. Continued successful pain relief was classified by patients as good or excellent after EGS in 38 percent, after BF in 43 percent, and after SCB in 18 percent; overall success was reported by 47 percent of patients. The presence of levator spasm, coccygodynia, or pudendal neuropathy did not influence outcome. The routine use of physiologic investigation of rectal pain may not be justifiable. Moreover, more than half of the patients were refractory to all three therapeutic options used in this study.

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Authors and Affiliations

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

    Gow Ching Ger M.D. (Visiting Clinician), Steven D. Wexner M.D., J. Marcio N. Jorge M.D., Eleanor Lee L.P.N., Steve Heymen M.A., Juan J. Nogueras M.D. & David G. Jagelman M.D.

  2. Department of Anesthesiology, Cleveland Clinic Florida, Fort Lauderdale, Florida

    L. Amar Amaranath M.D.

  3. Section of Colon and Rectal Surgery, Department of Surgery, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan

    Gow Ching Ger M.D. (Visiting Clinician)

Authors
  1. Gow Ching Ger M.D.
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  2. Steven D. Wexner M.D.
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  3. J. Marcio N. Jorge M.D.
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  4. Eleanor Lee L.P.N.
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  5. L. Amar Amaranath M.D.
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  6. Steve Heymen M.A.
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  7. Juan J. Nogueras M.D.
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  8. David G. Jagelman M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.

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Ger, G.C., Wexner, S.D., Jorge, J.M.N. et al. Evaluation and treatment of chronic intractable rectal pain—A frustrating endeavor. Dis Colon Rectum 36, 139–145 (1993). https://doi.org/10.1007/BF02051169

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