Solitary rectal ulcer syndrome
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Solitary rectal ulcer syndrome (SRUS) is a rare condition where one or more painful sores, known as ulcers, develop in the rectum. The rectum is a muscular tube that connects the colon to the anus, and it allows stool to pass out of the body. SRUS usually affects people who have chronic constipation, and it can cause rectal bleeding and difficulty passing stools.
Rectal ulcers can also occur in people with inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, as well as those who strain or push too hard during bowel movements. These ulcers are painful and can cause discomfort, bleeding, and difficulty passing stools.
Lifestyle changes such as diet modifications and drinking more fluids may help improve SRUS, but severe cases may require surgery. It’s important to see a doctor if you experience symptoms of rectal ulcers, as they can be related to serious underlying conditions such as IBD.
Symptoms
Solitary rectal ulcer syndrome may present with various signs and symptoms, which may include:
- Uncontrolled passing of stool
- Pain and bleeding of the rectum
- Clearing your rectum of mucous
- Pain while having a bowel movement.
- Pelvic pain or a sense of fullness
- A sense of incomplete bowel movement
- Constipation
It is important to note that some individuals with this condition may not experience any noticeable symptoms.
If you are experiencing any concerning signs or symptoms, it’s important to schedule an appointment with your doctor. There are various other conditions that may have similar signs and symptoms to solitary rectal ulcer syndrome. During your appointment, your doctor may suggest tests and procedures to diagnose or eliminate other potential causes besides solitary rectal ulcer syndrome.
Causes
Solitary rectal ulcer syndrome’s exact cause is often unclear. However, medical professionals speculate that rectal ulcers may develop due to stress or damage to the rectum.
Among the potential causes of rectus injury are:
- Difficulty passing constipated or firm rectum stools (impacted stool)
- Pain while having a bowel movement.
- An extended rectum that protrudes from the anus (rectal prolapse)
- The rectum’s blood flow is slowed by the pelvic floor muscles contracting erratically.
- Manual removal of the affected stool
- When an intestine slides within another intestine (intussusception)
Risk factors
Inflammatory bowel disease can affect both adults and children, although it’s commonly diagnosed in people in their 30s. Straining during bowel movements due to constipation can cause rectal ulcers in people of any age. Solitary rectal ulcer syndrome is more prevalent among young adults, but it can also occur in children.
Diagnosis
The following tests may be used to identify solitary rectal ulcer syndrome in you:
- Sigmoidoscopy. A sigmoidoscopy is a medical procedure in which a slender and flexible tube equipped with a small camera is inserted into your rectum to inspect your rectum and a portion of your colon. In case any abnormality is detected, the doctor may obtain a sample of tissue for further examination in a laboratory.
- Ultrasound. An imaging modality that employs sound waves to produce images is known as an ultrasound. If your physician suspects solitary rectal ulcer syndrome and needs to distinguish it from other medical conditions, they may suggest an ultrasound.
- Other imaging studies. Your healthcare provider may recommend a test called defecation proctography to examine any potential issues with muscle coordination or prolapse. During this test, a paste made of barium will be inserted into your rectum, which you will expel as if it were stool. The barium paste will be visible on X-rays, allowing your healthcare provider to identify any problems. Some specialized facilities may offer a similar test called magnetic resonance defecography, which uses a magnetic resonance imaging machine to create a 3D image of the rectum.
Treatment
The severity of your problem will determine how you are treated for solitary rectal ulcer syndrome. While some with more severe symptoms may need medical or surgical treatment, those with milder symptoms may find relief via dietary or lifestyle modifications.
- Dietary changes. You might receive advice on increasing your dietary fiber intake to help with constipation.
- Behavior therapy. Straining during bowel movements could be a result of habitual behavior. Behavioral therapy may be beneficial in aiding individuals to learn to relax their pelvic muscles while passing stool. A technique known as biofeedback involves a specialist training an individual to manage specific involuntary bodily responses, such as the tightening of the pelvic floor or anus muscles during defecation. Through biofeedback, an individual may become more conscious of their straining and can develop better control over it.
- Medications. Your rectal ulcer symptoms may be lessened by some therapies such topical steroids, sulfasalazine enemas, and onabotulinumtoxinA (Botox). Unfortunately, not everyone responds well to these treatments, and several are still regarded as experimental.
Solitary rectal ulcer syndrome is treated surgically using the following techniques:
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- Surgery to correct rectal prolapse. Your doctor might advise a rectopexy procedure if you have a rectal prolapse that’s producing symptoms. The rectum is kept in its anatomically right place via rectopexy.
- Surgical removal of the rectum. If you have severe symptoms that have not responded to conventional therapies, an operation to remove the rectum may be a possibility. The surgeon could join the colon to an abdominal hole to allow waste to exit the body (colostomy). A pouch or bag is then placed to your abdomen to collect waste if you have a colostomy.
