Solitary Rectal Ulcer Syndrome -

Solitary rectal ulcer syndrome is a condition in which one or more open sores, called ulcers, form in the rectum. The rectum is a muscular tube connected to the end of the colon. Stool passes through the rectum on its way out of the body.

Solitary rectal ulcer syndrome is a rare and poorly understood disorder that can happen in people with long-lasting constipation. It can cause rectal bleeding, pain and straining when passing stool. Despite the name, sometimes more than one rectal ulcer develops in solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome may improve with simple lifestyle strategies, such as changing your diet and drinking more fluids. In severe cases, however, surgery may be needed.

Symptoms
Causes
Risk factors
Diagnosis
Treatment

Symptoms of solitary rectal ulcer syndrome include:

Constipation.
Rectal bleeding.
Straining during bowel movements.
Pain or a feeling of fullness in the pelvis or rectum.
A feeling of incomplete passing of stool.
Passing mucus from your rectum.
Not being able to control bowel movements, called fecal incontinence.

However, some people with solitary rectal ulcer syndrome may experience no symptoms.

When to see a doctor

Make an appointment with a healthcare professional if you notice any symptoms that worry you.

Several other conditions may cause symptoms similar to those of solitary rectal ulcer syndrome. At your appointment, your healthcare professional may recommend tests and procedures to identify or rule out causes other than solitary rectal ulcer syndrome.

It’s not always clear what causes solitary rectal ulcer syndrome. Researchers believe that stress or injury to the rectum may cause rectal ulcers to form.

Among the things that could injure the rectum are:

Constipation or hardened stool in the rectum that’s difficult to pass, called impacted stool.
Straining when passing stool.
A stretched rectum that comes out of the anus, known as rectal prolapse.
Tightening of the pelvic floor muscles that slows blood flow to the rectum.
Attempts to manually remove impacted stool.
One part of the intestine sliding inside another part, known as intussusception.

Though anyone can have solitary rectal ulcer syndrome, adults between the ages of 30 and 40 are most affected.

One or more of the following tests may be used to diagnose solitary rectal ulcer syndrome:

Sigmoidoscopy. During this test, a thin, flexible tube with a tiny camera is inserted into the rectum to examine the rectum and part of the colon. If a lesion is found, a tissue sample may be taken for laboratory testing. This is known as a biopsy.
Anorectal manometry. Anorectal manometry is a test that evaluates bowel function. During the procedure, a flexible, tubelike device is inserted into the rectum. The response of anal and rectal muscles and nerves is then measured. Anorectal manometry is used to assess people with constipation, fecal incontinence and other disorders related to control of passing stool.
Defecography. In defecography, a soft paste made of barium is inserted into the rectum. The barium paste is then passed in the stool while imaging is done. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.
Specialized centers may offer magnetic resonance defecography. This test is done with a magnetic resonance imaging (MRI) machine and provides a 3D image of the rectum.
Ultrasound. This imaging technique uses sound waves to create pictures. Your healthcare team may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions.

Treatment for solitary rectal ulcer syndrome depends on the severity of the condition. People with mild symptoms may find relief through lifestyle changes, while people with more-severe symptoms may require medical or surgical treatment.

Dietary changes. To relieve constipation, you may be given tips on increasing fiber in your diet.
Behavior therapy. You may strain out of habit when passing stool. Behavior therapy can help you learn to relax your pelvic muscles when passing stool.
A behavioral technique called biofeedback can help lessen straining. In biofeedback, a specialist teaches you to control certain body responses that are not voluntary when passing stool, such as the tightening of your anus or pelvic floor muscles. Biofeedback may make you more aware of straining and help you control it.
Medicines. Certain treatments such as topical steroids, sulfasalazine enemas, onabotulinumtoxinA (Botox) or argon plasma coagulation may help ease your rectal ulcer symptoms. However, these treatments don’t work for everyone, and some are still considered experimental.

Surgical procedures used to treat solitary rectal ulcer syndrome include:

Rectal prolapse surgery. If you have a rectal prolapse that’s causing symptoms, a procedure called rectopexy may be recommended. Rectopexy secures the rectum in its anatomically correct position.
Surgery to remove the rectum. An operation to remove the rectum may be an option if you have severe symptoms that haven’t been helped by other treatments. The surgeon may connect the colon to an opening in the abdomen for waste to leave the body. This is called a colostomy. If you have a colostomy, a pouch or bag is attached to the abdomen to collect waste.

References

Kim DJ, et al. Solitary rectal ulcer syndrome. https://www.uptodate.com/contents/search. Accessed March 22, 2024.
Solitary rectal ulcer syndrome. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/solitary-rectal-ulcer-syndrome. Accessed March 22, 2024.
Townsend CM Jr, et al. Colon and rectum. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 22, 2024.
Ejaz Z, et al. Solitary rectal ulcer syndrome in patients presenting with lower gastrointestinal bleeding: A tertiary-care hospital experience. 2023; doi:10.7759/cureus.35247.
Feldman M, et al., eds. Other diseases of the colon. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed March 22, 2024.
Gouriou C, et al. Management of solitary rectal ulcer syndome: Results of a French national survey: Société Nationale Française de Coloproctologie SNFCP, France. Digestive and Liver Disease. 2020; doi:10.1016/j.dld.2020.05.013.
Constipation. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation. Accessed March 22, 2024.
Khanna S (expert opinion). Mayo Clinic. March 23, 2024.

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