J Korean Soc Coloproctol.  2001 Apr;17(2):69-75.

Biofeedback Therapy for Patients with Rectocele

• Kim BS
• Hwang YH
• Choi KP

Abstract

PURPOSE
The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for rectocele.
METHODS
Twenty four female patients (mean age 43.8 years) with rectal emptying difficulties and a rectocele greater than 2 cm at defecography were evaluated before hand with a standardized questionnaires, immediately after biofeedback therapy, and at follow up. Defecography, manometry, colon transit studies and electrophysiology were also analyzed.
RESULTS
Follow up (mean 7.2; range 2~17 months) results were evaluated by an independent observer in 20 patients. At the end of biofeedback, 22 (92 percent) patients felt improvement in symptoms, including 13 (54 percent) with symptomatic relief. At follow-up, 14 (70 percent) patients felt improvement in symptoms, including 3 (15 percent) with complete relief of symptoms. There was a significant reduction in difficult defecation (from 79 to 29, 40 percent, from pre-biofeedback to post-biofeedback, at follow-up respectively; P<0.001, P<0.05), sensation of incomplete defecation (from 96 to 46, 60 percent; P<0.001, P<0.005), laxative use (from 54 to 25, 30 percent; P<0.05), enema use (from 21 to 0,0 percent; P<0.05), anal pain (from 21 to 0, 5 percent; P<0.05) and digitation (from 21 to 4, 5 percent). Normal spontaneous bowel movement was significantly increased from 50 percent pre-biofeedback to 83 post-biofeedback (P<0.05), 65 percent at follow-up. Abdominal pain (P<0.05) and digitation (P<0.05) related to poor results. High mean squeeze pressure (P<0.001) and high maximum squeeze pressure (P<0.05) on pre-biofeedback manometry were also related to a poor outcome. Age, duration of symptoms, parity, number of sessions of biofeedback, gynecologic surgery history, and rectocele size at defecography had no prognostic value. Anismus and colonic inertia did not influence the outcome of biofeedback.
CONCLUSIONS
Biofeedback is an effective treatment option for patients with obstructed defecation due to rectocele.

Keyword

Rectocele; Constipation; Biofeedback; Anismus; Colonic inertia

MeSH Terms

Abdominal Pain
Biofeedback, Psychology*
Colon
Constipation
Defecation
Defecography
Electrophysiology
Enema
Female
Follow-Up Studies
Gynecologic Surgical Procedures
Hand
Humans
Manometry
Parity
Surveys and Questionnaires
Rectocele*
Sensation