Results of behavioral treatment (biofeedback) for solitary rectal ulcer syndrome

BACKGROUND: Treatment of solitary rectal ulcer syndrome with behavioral tec hniques (biofeedback) has been shown to be successful in a majority of pati ents in the short term. We aimed to determine the longer-term outcome of pa tients treated with this therapy. PATIENTS AND METHODS: Thirteen consecutiv e patients (3 male; median age, 34 years) with solitary rectal ulcer who ha d been treated by biofeedback and assessed a median of nine months after tr eatment were reassessed by questionnaire. Three patients were also examined using rigid sigmoidoscopy. RESULTS: Median follow up was 36 (range, 32-59) months after initial biofeedback treatment. One patient (previously report ed as failing biofeedback therapy) was lost to follow-up. Of the four patie nts previously reported as asymptomatic, one remained asymptomatic, one mai ntained marked improvement, and another slight improvement; one had reverte d to pretreatment status. Of the three patients previously reported as havi ng marked improvement, one maintained moderate improvement, and two had rev erted to pretreatment status. The patient previously reporting slight impro vement had reverted to pretreatment status. Of the five previously reported failures, two patients experienced no improvement after further courses of biofeedback. At the three different times of review (pretreatment vs. 9 mo nths vs. 36 months after biofeedback), reported bowel function was as follo ws: the need to strain (12 vs. 5 vs. 9 patients), anal digitation (10 vs. 3 vs. 8 patients), laxative use (9 vs. 4 vs. 4 patients), median time spent in the toilet per attempt at defecation (30 vs. 10 vs. 25 minutes), median visits to the toilet (5.5 vs. 2 vs. 4 per day), and ability to maintain emp loyment (3 vs. 7 vs. 6 patients). CONCLUSION: Improvement in symptoms of so litary rectal ulcer syndrome after biofeedback retraining deteriorates in s ome patients with time. Half the patients with an early clinical response t o retraining, however, can be expected to have ongoing clinical benefit at a median of three years.