Gilliland R, Heymen J S, Altomare D F, Vickers D, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 1997 Feb;40(2):190-6. doi: 10.1007/BF02054987.
A number of modalities have been used for the treatment of intractable rectal pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years.
Medical records of 86 patients who completed at least one session of biofeedback for rectal pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12-96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of rectal pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale.
Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P = 0.63), duration of symptoms (P = 1.0), or a prior history of surgery (P = 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puborectalis contraction demonstrated on either EMG (P = 1) or defecography (P = 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P < 0.001).
Although idiopathic rectal pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on patients' willingness to pursue a full course of therapy.
多种治疗方法已被用于治疗顽固性直肠疼痛，但其成功率各不相同。在过去六年中，基于肌电图（EMG）的生物反馈疗法已被用于治疗这种疾病。
回顾性分析了1989年2月至1995年8月期间完成至少一次直肠疼痛生物反馈治疗的86例患者的病历。所有治疗均为与训练有素的生物反馈治疗师进行的一小时门诊治疗。有31例男性和55例女性患者，中位年龄为68岁（范围12 - 96岁）。手术（19.8%）或压力（15.1%）常被认为是直肠疼痛发生的诱发因素。11例患者仅完成了一次生物反馈治疗，被排除在进一步分析之外。其余患者中，28例伴有便秘。治疗效果的评估基于患者对症状程度的主观报告，并辅以线性模拟量表。
26例患者（34.7%）报告症状有所改善。结果不受患者年龄（P = 0.63）、症状持续时间（P = 1.0）或既往手术史（P = 0.14）的影响。症状缓解与肌电图（P = 1）或排粪造影（P = 0.12）显示的矛盾性耻骨直肠肌收缩的存在无显著相关性。重要的是，与自行出院的患者相比，完成治疗方案的患者的治疗效果有显著改善（P < 0.001）。
尽管特发性直肠疼痛难以治疗，但基于肌电图的生物反馈可以缓解症状。然而，成功取决于患者坚持完成整个疗程的意愿。
