title: Pathophysiology and role of biofeedback therapy in solitary rectal ulcer syndrome.
abstract: BACKGROUND
  Solitary rectal ulcer syndrome (SRUS) is a behavioral disorder whose pathophysiology is incompletely understood. Likewise, its treatment, particularly the role of biofeedback therapy (BT) is unclear.
  
  
  OBJECTIVE
  To evaluate anorectal function and morphology and to assess efficacy of BT.
  
  
  METHODS
  Eleven patients (8f) with refractory SRUS underwent symptom assessments, anorectal manometry, defecography, balloon expulsion test, and sigmoidoscopy. Physiological tests were also performed in 15 (11f) healthy controls. Subsequently, SRUS patients underwent biofeedback treatment. Symptoms and manometry were reassessed.
  
  
  RESULTS
  Nine (82%) patients exhibited dyssynergia ( p < 0.001). Rectal sensory thresholds were decreased (p < 0.04). After biofeedback, straining effort and stool frequency decreased ( p < 0.05), and bowel satisfaction score (VAS) improved ( p < 0.001). Digital maneuvers were discontinued by all five patients and bleeding stopped in 56%. The defecation index increased ( p < 0.05), dyssynergia normalized, and balloon expulsion time decreased ( p < 0.05). There was complete healing in 4 (36%), > or =50% healing in 2 (18%), and <50% healing in 4 (36%) patients.
  
  
  CONCLUSIONS
  SRUS associated with excessive straining, digital disimpaction, rectal hypersensitivity, dyssynergic defecation, and prolonged evacuation. BT may improve symptoms and anorectal function and facilitate healing.
authors.affiliation: Section of Neurogastroenterology, Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.forename: Ramazan
authors.initials: R
authors.lastname: Ozturk
authors.forename: Sherrie
authors.initials: S
authors.lastname: De Ocampo
authors.forename: Mary
authors.initials: M
authors.lastname: Stessman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D001676:Biofeedback, Psychology / Q000502:physiology*; D019841:Defecography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000503:physiopathology* / Q000628:therapy*; D012007:Rectum / Q000503:physiopathology; D012812:Sigmoidoscopy; D013577:Syndrome; D014456:Ulcer / Q000503:physiopathology* / Q000628:therapy*