BIOFEEDBACK FOR INTRACTABLE RECTAL PAIN - OUTCOME AND PREDICTORS OF SUCCESS

PURPOSE: A number of modalities hare been used for the treatment of in tractable rectal pain, with varying degrees of success. Electromyograp hy (EMG)-based biofeedback therapy has been used in the treatment of t his condition during the past six years. MATERIALS AND METHODS: Medica l records of 86 patients who completed at least one session of biofeed back for rectal pain between February 1989 and August 1995 were retros pectively reviewed. All sessions were one-hour outpatient encounters w ith 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 p ercent) or stress (15.1 percent) were frequently cited as precipitatin g factors for the development of rectal pain. Eleven patients complete d only one session of biofeedback and were excluded from further analy sis. Of the remaining patients, 28 complained of concomitant constipat ion. Assessment of the benefit of therapy was based on the patients' s ubjective reports of the level of symptoms, aided by a linear analog s cale. RESULTS: Twenty six patients (34.7 percent) reported an improvem ent in symptoms. Outcome was not influenced by patients' ages (P = 0.6 3), duration of symptoms (P = 1.0), or a prior history of surgery (P = 0.14). Alleviation of symptoms was not significantly related to the p resence of paradoxical puborectalis contraction demonstrated on either EMG (P = 1) or defecography (P = 0.12). Importantly, outcome was sign ificantly improved in patients who completed the treatment schedule co mpared with those who self-discharged (P < 0.001). CONCLUSIONS: Althou gh idiopathic rectal pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on pati ents' willingness to pursue a full course of therapy.