Solitary rectal ulcer syndrome: A systematic review

Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case

The primary objective of this study was to evaluate the clinical, laboratory, and histological characteristics of solitary rectal ulcer syndrome (SRUS) and assess the outcomes associated with various management strategies. This retrospective observational study was conducted at Giresun Education and Research Hospital. This study included patients diagnosed with SRUS between January 2020 and January 2024. Demographic information, clinical presentation, primary diagnosis, and laboratory parameters were obtained from electronic medical records. Statistical analysis was performed using SPSS software, and the chi-square test was used to compare categorical variables. A total of 36 patients diagnosed with SRUS were included, with the majority being male (80.6%), and the mean age of participants was 75.6 years. Hematochezia was identified as the most common initial symptom (61.1%), followed by abdominal pain (16.7%) and constipation (11.1%). Laboratory findings revealed significant abnormalities, including mean hemoglobin levels of 10.0 ± 2.4 g/dL and mean CRP levels of 56.7 ± 65.4 mg/L. Histopathological analysis showed that 38.9% of patients had normal biopsy results, whereas inflammation and dysplasia were observed in 41.7% and 2.8% of cases, respectively. Additionally, a statistically significant difference in age was observed between the patients presenting with different initial symptoms (p = 0.028). The study also found that biopsy results varied significantly across symptom groups (p = 0.012), and although differences in hemoglobin and hematocrit levels across biopsy groups were noted, they were not statistically significant. This study offers a comprehensive analysis of SRUS, emphasizing the importance of detailed clinical and laboratory evaluation. Hematochezia emerged as the most prevalent symptom, and ulcerative colitis was identified as the primary diagnosis. Significant associations were observed between various clinical parameters and patient outcomes, highlighting the necessity of a multidisciplinary approach in managing SRUS.

Endoscopic features of rectal mucosal prolapse syndrome (RMPS): Differentiation from malignant rectal tumor

Background and study aims Rectal mucosal prolapse syndrome (RMPS) usually manifests as rectal bleeding and tenesmus. Endoscopically it can be easily misdiagnosed as malignant rectal tumor (MRT). This study aimed to investigate factors to distinguish RMPS and MRT and to explore endoscopic features of RMPS. Patients and methods Data from patients endoscopically diagnosed with rectal lesions, masses, or tumors, were retrospectively collected. Clinical information, endoscopic images, and histologic reports were reviewed. Patients endoscopically and histologically diagnosed with RMPS were included for phenotype classification. Results 826 patients were enrolled, among them 755 (91.4%), 22 (2.7%), 10 (1.2%), and 39 (4.7%) were respectively diagnosed with MRT, RMPS, endometriosis, and neuroendocrine tumors. Compared with MRT, patients with RMPS were significantly younger (33.5 vs. 62, P < 0.001) and lesions were significantly smaller (2 cm vs. 3 cm, P = 0.007). Moreover, the clinical course of patients with RMPS was significantly longer than for those with MRT (12 months vs. 3 months, P < 0.001). Morphologically, we classified lesions of RMPS into five phenotypes, that is, lesions with circumferential stenosis (19.4%), protrusions (41.7%), both ulcers and protrusions (11.1%), ulcers (11.1%), and flat manifestations (16.7%). Protruding lesions were more frequently observed in females ( P = 0.039), whereas ulcerative lesions were found involving a smaller proportion of the rectal circumference ( P = 0.028). Lesions with only ulcers were found with a shorter distance compared with those with only protrusions (5 cm vs. 10 cm, P = 0.034). Conclusions Age, clinical course, and size of the lesion can be applied to distinguish MRT and RMPS. Five phenotypes have been identified and features of ulcers/protrusions should be further explored.

Selective Serotonin Reuptake Inhibitors and Solitary Rectal Ulcer Syndrome: A Bloody Relationship

Introduction

Solitary rectal ulcer syndrome (SURS) is a poorly understood and uncommon benign disorder of the lower gastrointestinal tract. It presents with various symptoms, often misinterpreted as inflammatory bowel disease. To date, there is no association between the use of selective serotonin reuptake inhibitors (SSRIs) and SURS.

Case description

A 29-year-old male on paroxetine for six months and with a non-contributory surgical history presented to the clinic due to three months of haematochezia, abdominal pain and mucoid discharge. Physical examination and a review of systems were unremarkable; a colonoscopy demonstrated a suspicious ulcerated lesion in the rectum, which was identified as SURS on biopsy. The patient was advised lifestyle and dietary modifications. In addition, paroxetine was discontinued, and patient was switched to venlafaxine, a serotonin-norepinephrine reuptake inhibitor. Subsequently, the patient's symptoms resolved gradually, and he did not report any signs of recurrence on follow-up.

Conclusion

Literature confirms that SSRIs can increase the occurrence of GI ulceration yet focuses specifically on upper gastrointestinal bleeding rather than rectal bleeding. This finding raises the need for further research.

LEARNING POINTS

SURS is often underdiagnosed or misdiagnosed as inflammatory bowel disease.The pathophysiology and aetiology behind SURS remain obscure.This case points to a potential correlation between SSRIs use and SURS development.

Argon plasma coagulation: an effective treatment for solitary rectal ulcer syndrome

BACKGROUND

Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy.

OBJECTIVES

Determine the efficacy of APC treatment for patients suffering from SRUS.

DESIGN

Prospective, single center.

SETTINGS

Gastroenterology department at a military hospital in Pakistan.

PATIENTS AND METHODS

This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment.

MAIN OUTCOME MEASURES

Effectiveness of APC for resistant SRUS.

SAMPLE SIZE

99 patients.

RESULTS

The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications.

CONCLUSION

APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients.

LIMITATIONS

Single centered.

Rectal bleeding as a symptom of solitary rectal ulcer syndrome mimicking rectal neoplasm on colonoscopy: A case report

Patients complaining of rectal bleeding, constipation, and a suspicious mass in colonoscopy should undergo biopsy. Histological features such as fibromuscular obliteration in the lamina propria favor SRUS, a benign disorder.

Solitary Rectal Ulcer Syndrome in Patients Presenting With Lower Gastrointestinal Bleeding: A Tertiary-Care Hospital Experience

BACKGROUND

Solitary rectal ulcer syndrome (SRUS) is a benign rectal condition associated with defecation disorder that has multifactor pathologies and variable findings on presentation, endoscopy, and histopathology. A diagnostic dilemma with an overlap of differentials and step-wise management that starts with conservative therapies and goes up to repeated surgeries in case of failure of the conservative approach.

OBJECTIVE

This study aims to observe clinical, endoscopic, and histological features of SRUS in patients presenting with lower gastrointestinal bleeding.

MATERIAL AND METHODS

The study was conducted at the Department of Gastroenterology, Medical Teaching Institute, Lady Reading Hospital Peshawar from October 2018 to April 2020. After written informed consent, 257 patients (149 males and 108 females) from ages 15 to 70 who presented with lower GI bleeding were included via non-probability convenient sampling. Sociodemographic details were recorded in a pre-designed proforma. A colonoscopy was performed with the Colonoscope CF200 Z, Olympus Tokyo, Japan, and findings were noted. Suspected lesions were magnified, dyed with 0.2% indigo carmine, biopsied from the middle and edges of the ulcer, and sent for histopathology. All data were recorded and analyzed in SPSS-20. The mean with SD was calculated for quantitative variables, and frequency and percentages were calculated for qualitative variables. The chi-square test was used to check the significance, and a p-value of <0.05 was considered statistically significant.

RESULTS

SRUS was found in 17 (6.6%) patients with lower GI bleeding, with a male predominance of 57% (n=11). Perirectal bleeding, constipation, mucous discharge, abdominal pain, and anemia were common clinical findings. Solitary lesions, ulceration, and anterior rectum location were the most common endoscopy findings. Obliterated lamina propria with collagen, ulceration, crypt distortion, and inflammatory infiltrates were common histopathological findings.

CONCLUSION

SRUS is a benign defecation disorder commonly presenting with lower GI bleeding, constipation, straining, and abdominal pain. It needs a stepwise approach with conservative management, medical management, biofeedback, and surgeries as a last resort.

Tailoring surgery for obstructed defecation syndrome to the 'iceberg diagram': Long-term results

BACKGROUND

Patients with obstructed defecation syndrome may present with a wide spectrum of disorders. The iceberg diagram, which focuses on the underlying occult diseases, has been proposed for an accurate diagnosis. The iceberg diagram deals with lesions, which, if neglected, may worsen the prognosis. The aim of this study was to evaluate the effect of using the iceberg diagram on the clinical results.

METHODS

Patients operated for obstructed defecation syndrome based on the iceberg diagram between 2008 and 2018 were evaluated pre- and postsurgery. All patients underwent psychosomatic assessment, abdominal and perineal examination, proctoscopy, vaginoscopy, transanal ultrasound, and defecography. Postoperative complications were also evaluated.

RESULTS

Of the 80 operated patients, 73 were females; median age was 47 (range 26-78) years. All had a rectal internal mucosal prolapse and 85% had a rectocele. The most frequent occult diseases were functional (mental distress [46%]) or organic (colpo-cysto-enterocele [44%]). Surgery was tailored according to the iceberg diagram with prolapsectomy and rectocele repair the most commonly used among 8 different procedures. A total of 14% of patients had a postoperative complication. Median follow-up was 72 months. Obstructed defecation syndrome score significantly decreased from 10.5 ± 4.8 (mean + standard deviation) to 3.4 ± 3.6 (P < .01) and 68% of patients reported to be either improved or cured.

CONCLUSION

The use of the iceberg diagram in obstructed defecation syndrome patients assists in identifying latent "submerged lesions' that may negatively impact the functional outcome of surgery. A clinical approach to patients with obstructed defecation syndrome tailored according to the iceberg diagram allows the identification of occult lesions and to achieve good long-term results.

Effects of Huhuang Burn Liniment on wound healing and changes in IL-10 and MMP-9 levels in patients with mixed hemorrhoids

OBJECTIVE

To explore the effects of Huhuang Burn Liniment on wound healing and levels of interleukin-10 (IL-10) and matrix metalloproteinase-9 (MMP-9) in patients with mixed hemorrhoids.

METHODS

The clinical data of 113 patients with mixed hemorrhoids admitted to Chongqing Sanxia Central Hospital were retrospectively collected. All patients underwent Milligan-Morgan hemorrhoidectomy, and were divided into two groups according to different postoperative treatments. Group A was treated with 1/5000 potassium permanganate sitz bath after surgery, while group B was treated with Huhuang Burn Liniment. The treatment efficacy, wound healing time, level of pain, exudation, edema, granulation scores, anal function index, levels of IL-10 and MMP-9, quality of life scores, and complications were compared between the two groups.

RESULTS

The effective rate of group B (94.74%) was higher than that of group A (60.71%) (P < 0.05). Group B had shorter length of anorectal hyperbaric zone, higher anal canal resting pressure, anal canal diastolic pressure, and anal canal systolic maximum pressure (P < 0.05), lower scores of trauma pain, edema, exudation, and granulation (P < 0.05), higher IL-10 levels, and lower MMP-9 levels (P < 0.05). The complication rate of group B (8.77%) was lower than that in group A (23.21%) (P < 0.05). After treatment, group B had shorter wound healing time and higher quality of life score than group A (P < 0.05).

CONCLUSION

The application of Huhuang Burn Liniment in patients with mixed hemorrhoids after surgery could promote wound healing and anal function, reduce trauma pain, exudation and edema, and improve quality of life.

Platelet-rich plasma for the treatment of chronic rectal ulcer: A case report

RATIONALE

Rectum ulcer is a disease of the digestive system, the main symptoms of which includes bloody diarrhea, abdominal pain, hematochezia, etc. At present, drug therapy and surgery are the most common treatments. Platelet-rich plasma (PRP) contains high concentrations of platelets and has been used to promote wound healing. However, the utilization of PRP in rectal ulcers has rarely been reported.

PATIENT CONCERNS

The patient had reported a complaint of blood dripping from the stool for more than 4 months. She had a history of surgery for rectal cancer with postoperative chemotherapy and radiotherapy 19 years prior. Mesalazine suppository was given to her for about 4 months, and glutamine capsules for 2 months, but the rectal ulcer remained unhealed.

DIAGNOSIS

A rectal ulcer was observed on colonoscopy, and the biopsy result was tubular adenoma.

INTERVENTIONS

Autologous PRP treatment was performed for the patient under an anorectal scope together with basic supportive care.

OUTCOMES

The ulcer nearly healed within 9 days after twice PRP treatments.

LESSONS

PRP treatment may bring about novel treatment options for rectal ulcers.

Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. We present a case of a 37-year-old male with a nonulcerated rectal lesion grossly resembling a superficial depressed rectal cancer misdiagnosed in another hospital and describe its appearance on endoscopy and in the analysis of its pathological manifestations. The aim of this case report is to report an easily misdiagnosed case of SRUS, which needs to be distinguished from superficial rectal cancer, which should be educational for endoscopists.

Mimics of Crohn's Disease

Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.

Solitary Rectal Ulcer Syndrome Mimicking Perianal Crohn's Disease

Solitary rectal ulcer syndrome (SRUS) is an uncommon condition that presents with non-specific symptoms shared by other disease processes. This case report shares a unique presentation in which a patient was thought to have fistulous perianal Crohn's disease then underwent treatment with infliximab but was ultimately found to have SRUS. The prognosis and treatment of SRUS vary greatly from inflammatory bowel disease. Making the correct diagnosis is imperative when considering Crohn's disease and its mimickers. 

The Efficacy of Biofeedback Therapy in Patients with Solitary Rectal Ulcer and Dyssynergic Defecation

BACKGROUND

The treatment of solitary rectal ulcer (SRU) is challenging and controversial; generally, no response to conventional treatments can be obtained, particularly in patients with dyssynergic defecation (DD). We assessed the efficiency of biofeedback therapy (BFT) in patients who did not respond to conservative treatments and had coexistence of SRU and DD.

METHODS

BFT responses, as well as anorectal manometry and rectoscopy results of 20 patients with the coexistence of SRU and DD, were assessed.

RESULTS

Mean age was 32.5 years. Of the patients, 12 were female, and 8 of them were male. An average of 12 sessions of BFT was performed on the patients. Ulcer disappeared in 11 patients (55%) after BFT, and the ulcer size decreased in 3 patients (15%). However, ulcers healed in 9 (90%) of 10 patients whose DD pattern disappeared following BFT, and ulcers healed in only 20% of patients whose DD pattern continued (p = 0.005). The change in anal resting pressure after BFT was significant (p = 0.016). Ulcers were healed in 87.5% (7/8) of the patients whose anal resting pressure decreased after BFT and whose DD disappeared, while ulcers remained untreated in 85.7% of the patients whose anal resting pressure decreased, but the DD pattern continued (p = 0.005).

CONCLUSIONS

SRU patients with DD are typically unresponsive to medical treatments. Ameliorating anorectal dyssynergia should be the priority of treatment in these patients. BFT is an effective treatment for DD. BFT enhances the healing of ulcers in patients with SRU by restoring coordination of the pelvic floor.

Solitary rectal ulcer syndrome (SRUS): observational case series findings on MR defecography

OBJECTIVE

Radiological findings in solitary rectal ulcer syndrome (SRUS) are well described for evacuation proctography (EP) but sparse for magnetic resonance defecography (MRD). In order to rectify this, we describe the spectrum of MRD findings in patients with histologically proven SRUS.

MATERIALS AND METHODS

MRD from twenty-eight patients (18 female; 10 males) with histologically confirmed SRUS were identified. MRD employed a 1.5-T magnet and a standardized technique with the rectal lumen filled with gel and imaged sagittally in the supine position, before, during, and after attempted rectal evacuation. A single radiologist observer with 5 years' experience in pelvic floor imaging made the anatomical and functional measurements.

RESULTS

Sixteen patients (10 female) demonstrated internal rectal intussusception and 3 patients (11%) demonstrated complete external rectal prolapse. Anterior rectoceles were noted in 12 female patients (43%). Associated anterior and middle compartment weakness (evidenced by excessive descent) was observed in 18 patients (64%). Cystocele was found in 14 patients (50%) and uterine prolapse was noted in 7 patients (25%). Enterocoeles were detected in 5 patients (18%) and peritoneocoele in 5 patients (18%). None had sigmoidocoele. Sixteen patients (57%) demonstrated delayed voiding and 13 patients (46%) incomplete voiding, suggesting defecatory dyssynergia.

CONCLUSION

MRD can identify and grade both rectal intussusception and dyssynergia in SRUS, and also depict associated anterior and/or middle compartment descent. Distinction between structural and functional findings has important therapeutic implications.

KEY POINTS

MRD can identify and grade both rectal intussusception and dyssynergia in patients with SRUS. MRD is an acceptable substitute to evacuation proctography in assessing anorectal dysfunctions when attempting to avoid ionizing radiation. SRUS influences the pelvic floor globally. MRD depicts associated anterior and/or middle compartment prolapse.

Endoscopic Mucosectomy: A Novel Technique for Management of Polypoidal Solitary Rectal Ulcer Syndrome

Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder often challenging to treat. Surgical treatment is associated with suboptimal outcomes and postoperative complications. Argon plasma coagulation helps control rectal bleeding and healing of ulcers, but more extended follow-up data are not available. The macroscopic appearance of SRUS can be polypoid in 17%–25% of cases. Here, we describe a novel endoscopic technique for treating symptomatic patients with polypoidal variant of SRUS after failed medical and endoscopic argon plasma coagulation treatments.

The Long-term Efficacy of Endoscopic Submucosal Dissection in the Treatment of Symptomatic Mucosal Prolapse Syndrome

Mucosal prolapse syndrome (MPS) is a benign inflammatory disease of the rectum that causes symptoms such as blood-stained stools and anemia. However, there is no treatment with a proven long-term efficacy for MPS. A 53-year-old man presented with blood-stained stools and anemia due to MPS and was treated conservatively for 1 year. However, his symptoms did not improve. We performed endoscopic submucosal dissection (ESD) for MPS. He has had no symptoms for six years after ESD, and the recurrence of MPS was not seen on endoscopy. This case shows that ESD can be effective for the long-term treatment of symptomatic MPS.

Enterococcus faecalis infective endocarditis arising from chronic rectal prolapse in the setting of spinal cord injury

A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.

Anorectal Disorders: An Update

Anorectal disorders encompass structural, neuromuscular, and functional disorders. They are common, often distressing, and in some cases debilitating, and significantly add to the health care burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathology and can pose significant diagnostic and management dilemmas. A meticulous history and comprehensive digital rectal examination can provide clarity on the diagnosis, appropriate testing, and management of these conditions. Today, with the development of sophisticated diagnostic tools such as high-resolution and high-definition (3-D) anorectal manometry, 3-D anal ultrasonography, magnetic resonance defecography and imaging, and neurophysiological tests such as translumbosacral anorectal magnetic stimulation, it is possible to more accurately define and characterize the underlying structural and functional abnormalities. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of anal fissure, hemorrhoids, rectal prolapse, intussusception, rectocele, solitary rectal ulcer syndrome, levator ani syndrome, dyssynergic defecation and fecal incontinence.

Solitary Rectal Ulcer Syndrome: A Narrative Review

Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. Apart from the diagnostic dilemma that may be faced due to similarities of presentation with inflammatory bowel diseases or colorectal neoplastic lesions, the syndrome also overlaps with dyssynergic defecation syndrome, health anxiety disorder, obsessive compulsive disorder, and latent mucosal rectal prolapse, a systematic composite treatment modality including psychological, pharmacological, physiological and possibly surgical interventions are sometimes essential. Selecting appropriate treatment in this condition not only affects clinical outcome but also patients’ experience and further stigma of SRUS life-long. In this review, we will discuss the detailed pathophysiology, diagnostic and therapeutic approaches in dealing with solitary rectal ulcer syndrome.

Gold nanoparticles and hepatitis B virus

Hepatitis B virus (HBV) infection is one of the major health issues in the world presently with high tendency of leading to hepatocarcinoma, cirrhosis and liver cancer, especially if not properly managed. It has been estimated that there are about 2 billion people with a serological profile of HBV infection, and 360 million patients worldwide living with chronic HBV-associated liver disease, hence the need to find an efficient and precise diagnosis technique to drive a robust treatment for Hepatitis B virus cannot be over emphasized. The emergence of analytical device like biosensor which combines biological and physicochemical element to detect HBV in screened samples has been very helpful in providing a timely intervention to tame this virus. This review focuses on the current state of biosensor researches with respect to various in-depth application of gold nanoparticle for the detection of HBV.

Solitary rectal ulcer syndrome: addition of rectal therapies to biofeedback is more effective than biofeedback alone

AIM

We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy.

BACKGROUND

Biofeedback therapy is an appropriate treatment for patients with solitary rectal ulcer syndrome (SRUS) but it seems that it is not effective alone. Topical medical therapies are supposed to have an additive role to biofeedback.

METHODS

This randomized, controlled trial was conducted on 63 patients with SRUS. Patients were randomly enrolled into two groups of combination and single therapy. The patients in combination group (n=31) received biofeedback plus a topical therapy (an enema contained dexamethasone, sulfasalazine and bismuth) and the patients in single therapy group (n=32) were treated with biofeedback alone.

RESULTS

Endoscopic responses to treatment in the combination and single groups were 80% and 50%, respectively (P<0.05). Clinical improvement in symptoms such as difficulty to evacuate, digitation to evacuate, feeling of incomplete evacuation, time to need to evacuation and life style alternation were significantly better in treated group by combination therapy than single therapy. Regarding to the mean total score based on all subjective parameters, the results were also significantly better in the treated group by combination therapy.

CONCLUSION

Topical anti-inflammatory therapies in combination with biofeedback is an efficient treatment for patients with SRUS.