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A randomized controlled trial of STARR versus Biofeedback for obstructed defaecation has reported a benefit for STARR in terms of anorectal function and quality of life (PAC-QOL). This study aimed to determine whichpretreatment symptoms were most likely to be associated with a change in QOL.Patients from a randomized trial were classified into four subgroups: patients with an improvement or no improvement in PAC-QOL following STARR or Biofeedback. Change in PAC-QOL was measured from baseline to 12 months or last observation carried forward (LOCF). Baseline Symptom Severity and Obstructed Defaecation scores were compared with change in PAC-QOL.A total of 53 STARR and 38 Biofeedback patients were evaluable for change in PAC-QOL. 48/53 (91%) STARR and 28/38 (74%) Biofeedback patients showed improvement in PAC-QOL. ‘difficulty with evacuation’ and ‘need to return to the toilet’ were associated with an improvement in PAC-QOL after Biofeedback. ‘Anal pain’ and ‘incontinence/soiling’, and to a lesser degree ‘need for laxatives’ and ‘low frequency of defaecation’, were associated with a lack of improvement in PAC-QOL after STARR.The STARRprocedure may be less successful in improving QOL for patients with severe anal pain and incontinence/soiling.