Solitary Rectal Ulcer Syndrome
Introduction
Solitary rectal ulcer syndrome is a condition in which, typically, a single ulcer occurs in the rectum — producing signs such as rectal bleeding and straining when you pass bowel movements.
In some cases, solitary rectal ulcer syndrome can result in more than one lesion or in lesions that aren't ulcers, such as polyp-like masses. This rare and poorly understood disorder occurs in people with chronic constipation and may be due to injury to the rectum. Solitary rectal ulcer syndrome affects an estimated one in 100,000 people and can be recurrent.
Because solitary rectal ulcer syndrome is rare, it's best diagnosed and treated by a specialist in disorders of the colon and rectum. Treatments range from changing your diet and fluid intake in mild cases to medications or surgery.
Signs and symptoms
Some people with solitary rectal ulcer syndrome may experience:
- Rectal bleeding
- Straining during bowel movements
- A feeling of fullness in the pelvis
- Constipation
- Rectal pain or anal sphincter spasms
- Diarrhea
- Difficulty controlling bowel movements (incontinence)
- Passing mucus
- Feeling of incomplete passing of stool (feces)
Causes
Doctors don't entirely understand the cause of this condition. But theories include direct injury to the affected area or decreased blood flow to the area (ischemia).
Such injury or blood loss may occur in cases of rectal prolapse, a condition in which the rectal mucous membrane, or lining, moves down or through the anus. This is particularly true when accompanied by contraction of the muscle that circles the front portion of the upper anal canal (puborectalis muscle). The combination of downward pressure and movement of the mucous lining and stool when defecating and the upward pressure from the puborectalis muscle contraction may create enough pressure to injure the rectum. The pressure also may limit blood flow to the area.
However, not everyone with solitary rectal ulcer syndrome experiences these conditions, and experts don't know whether rectal prolapse causes ulcers or whether the prolapse and the ulcers are both signs of a similar disease.
Other causes of injury and subsequent ulcers may include:
- Constipation or impacted stool
- Attempts to remove impacted stool with a finger
- Straining during defecation
- Radiation treatment that limits blood flow to the area
- Use of ergotamine suppositories, an anti-migraine treatment
Treatment of a rectal ulcer depends on your symptoms and whether you also have rectal prolapse. If you don't have any symptoms or your symptoms are mild, treating and preventing constipation, such as by increasing fiber and fluid intake, may improve symptoms and heal the ulcer. If your symptoms are more severe or you have rectal prolapse, other therapies may include:
- Topical medications. These include 5-aminosalicylate enemas. They may help reduce inflammation and help with ulcer healing.
- Enemas. Sucralfate enemas contain an aluminum salt and work by coating the ulcer and creating a barrier against irritants, allowing the ulcer to heal. Corticosteroid enemas may also help decrease inflammation and aid ulcer healing.
- Biofeedback. Using feedback from a variety of monitoring procedures and equipment, a biofeedback specialist will try to teach you to control certain involuntary body responses such as straining during defecation. Biofeedback may be most helpful if you have a nonrelaxed puborectalis muscle.
- Surgery. Surgery is especially useful when the condition is recurrent and accompanied by rectal prolapse. Surgery may include removal of the lesions. It may also include fecal diversion, which is the use of an ostomy — a surgically created opening in which a portion of the colon above the rectum is brought to the abdominal surface. There, stool is expelled into a pouch or bag that you empty.
Rectopexy, another surgical option, corrects rectal prolapse by using stitches to secure the rectum in its anatomically correct position.
Credit: National Institute of Health.