Tricyclic antidepressants for the treatment of tenesmus associated with rectal prolapse

• Published in: Colorectal disease Vol. 17; no. 12; pp. 1094 - 1099
• Main Authors: Livovsky, D. M., Adler, S. N., Adar, T., Bar‐Gil Shitrit, A., Lysy, J.
• Format: Journal Article
• Language: English
• Published: England 01.12.2015
• Subjects: Aged; Aged, 80 and over; Amitriptyline - administration & dosage; Antidepressive Agents, Tricyclic - administration & dosage; Defecation - drug effects; Desipramine - administration & dosage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nortriptyline - administration & dosage; Rectal Diseases - drug therapy; Rectal Diseases - etiology; Rectal Diseases - psychology; rectal hypersensitivity; rectal prolapse; Rectal Prolapse - complications; Rectal Prolapse - pathology; Rectal Prolapse - psychology; Retrospective Studies; Tenesmus; Treatment Outcome; tricyclic antidepressants; rectal hypersensitivity; Tenesmus; rectal prolapse; tricyclic antidepressants
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13040

Aim 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. Method 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%. Conclusion 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.