TREATMENT OF PUBORECTALIS SYNDROME WITH PROGRESSIVE ANAL DILATION

PURPOSE: The aim of this study is to assess the ability of progressive anal dilations to improve frequency of spontaneous bowel movements in patients with puborectalis syndrome (PRS). METHOD: Thirteen patients (9 females and 4 males; mean age, 37 years) with severe, chronic const ipation caused by PRS were treated with daily, progressive anal dilati on for a three-month period. Three dilators of 20, 23, and 27 mm in di ameter were used. Dilators were inserted every day for 30 minutes (10 minutes each dilator). Patients were evaluated with anorectal manometr y and defecography halfway through treatment, at the end of treatment, and six months after the end of treatment. At six months, patients al so underwent physical examination. RESULTS: There was a significant im provement of weekly mean spontaneous bowel movements from zero to six (P < 0.0001), and the need for laxatives decreased from 12 patients wi th a weekly mean of 4.6 to 2 patients once per week (P < 0.001). Enema s used before treatment by eight patients who had a weekly mean of 2.3 were, after treatment, needed only by three patients once per week (P < 0.01). During straining, tone measured with anorectal manometry dec reased from 93 to 62 mmHg after six months of the end of therapy (F = 6.97; P < 0.01), and anorectal angle measured with defecography during the strain increased from 95 degrees to 110 degrees (P = not signific ant). CONCLUSIONS: Daily progressive anal dilation should be considere d as the first and most simple therapeutic approach in patients with P RS.