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Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Background—Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. Aim—To determine whether biofeedback retraining is a useful treatment for this condition. Patients—Thirteen consecutive patients with SRUS (three men, median age 34 years, median duration of symptoms three years) underwent treatment. Previous surgical treatment had failed in five. Methods—Patients were evaluated prospectively. Anorectal physiological studies were performed in 11 patients before treatment. A standardised questionnaire was used before and after treatment, and all but two patients were examined after treatment. Results—Median follow up was nine months (range 3–22 months). After treatment four patients were asymptomatic, and four felt improved. Symptom improvement or elimination occurred in: need to strain (7/13 patients), digitation (7/11), laxative use (5/9). Time in the toilet (median 30 v 10 minutes, beforev after treatment) and number of visits to toilet (6v 3/day) were also improved. Three patients were able to maintain employment before treatment compared with eight after treatment. The solitary ulcer did not heal completely in any of the nine patients examined after treatment, but improved in four. Previous surgery, the macroscopic appearance of the ulcer, the presence of pelvic floor paradox, and other physiological parameters did not predict outcome. Conclusion—Biofeedback retraining is a useful treatment for this condition. Long term studies are now required.