Ulcerative colitis: rectal dilations in a patient with refractory diarrhea. Report of a case

Abstract

A 45-year-old man with an eight-year history of ulcerative colitis was evaluated for severe, nonbloody diarrhea. Symptoms, which began two years earlier, were characterized by 15 bowel movements per day, accompanied by urgency and incontinence. A reduced rectal compliance was measured at manometry. All conventional treatments were not able to modify the symptoms despite improvement of inflammatory colonic lesions.

Purpose: The aim was to reduce bowel movements and incontinence by increasing rectal compliance.

Methods: Gradual pneumatic dilations of the rectum were performed three times per week for three weeks.

Results: The patient's diarrhea improved dramatically, decreasing in frequency from approximately 15 to only 3 bowel movements per day, while contemporaneously increasing rectal compliance. Such effect, still evident 15 months after discontinuation of dilation, was probably obtained by improvement of viscoelastic features of the intestinal wall.

Conclusions: Rectal pneumatic dilation may be a successful attempt in some forms of intractable diarrhea in long-lasting ulcerative colitis.