대한대장항문학회

Purpose: The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for rectocele.<br>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 beforehand with a standardized questionnaires, immediately after biofeedback therapy,<br>and<br>at<br>follow up. Defecography, manometry, colon transit studies and electrophysiology were also analyzed.<br>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<br>relief. At<br>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<br>post-biofeedback,<br>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<br>to<br>0, 5<br>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<br>digitation<br>(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<br>biofeedback,<br>gynecologic surgery history, and rectocele size at defecography had no prognostic value. Anismus and colonic inertia did not influence the outcome of biofeedback.<br>Conclusions: Biofeedback is an effective treatment option for patients with obstructed defecation due to rectocele.<br>