title: Tricyclic antidepressants for the treatment of tenesmus associated with rectal prolapse.
abstract: OBJECTIVE
  Tenesmus in rectal prolapse leads to a vicious circle of straining with deterioration of prolapse. The primary phenomenon triggering this may be rectal hypersensitivity. We aimed to assess whether treatment with tricyclic antidepressants (TCAs) may break the vicious circle and improve tenesmus.
  
  
  METHODS
  A retrospective review was carried out of patients with rectal prolapse and severe tenesmus who were poor surgical candidates or had refused surgery. They were treated at our tertiary centre with low dose tricyclic antidepressants.
  
  
  RESULTS
  Twenty-three (18 female) patients were included, with mean age 75.3 (±SD 14.6) years. The mean duration of symptoms was 10.8 (± 8.6) months. Full-thickness rectal prolapse was diagnosed in 16 (70%) patients while seven (30%) had mucosal or incomplete prolapse. Ten (43%), eight (35%) and five (22%) patients were treated with nortriptyline (25 mg daily), amitriptyline (10 mg daily) and desipramine (25 mg daily). After a mean follow-up of 9.05 (± 8.2) months, 14 (61%) patients reported significant improvement in symptoms, five (22%) had a partial response, three (13%) were lost to follow-up and one (4%) failed to respond. The response rates for nortriptyline, desipramine and amitriptyline were 90%, 100% and 62.5%.
  
  
  CONCLUSIONS
  To the best of our knowledge this is the first report to address the symptomatic, conservative treatment of tenesmus in patients with rectal prolapse. TCAs may be an acceptable option for poor surgical candidates or patients refusing surgery.
authors.affiliation: Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
authors.forename: D M
authors.initials: DM
authors.lastname: Livovsky
authors.affiliation: Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
authors.forename: S N
authors.initials: SN
authors.lastname: Adler
authors.affiliation: Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Adar
authors.affiliation: Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Bar-Gil Shitrit
authors.affiliation: Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Lysy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000639:Amitriptyline / Q000008:administration & dosage; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D003672:Defecation / Q000187:drug effects; D003891:Desipramine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000008:administration & dosage; D012002:Rectal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D012005:Rectal Prolapse / Q000150:complications* / Q000473:pathology / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D009661:Nortriptyline; D003891:Desipramine
keywords: Tenesmus; rectal hypersensitivity; rectal prolapse; tricyclic antidepressants