What is solitary rectal ulcer syndrome?

Solitary rectal ulcer syndrome (SRUS) is a rare disorder that affects the rectum, leading to the formation of a single or multiple ulcers on the rectal lining. Despite its name, some people develop more than one ulcer. The condition is often linked to chronic straining, constipation, or pelvic floor dysfunction.

What causes solitary rectal ulcer syndrome?

SRUS develops when the rectal tissue becomes damaged due to prolonged pressure or irritation. Contributing factors include:

• Chronic constipation and excessive straining during bowel movements

• Rectal prolapse, where part of the rectum slides down within itself or protrudes through the anus

• Abnormal pelvic floor function, leading to difficulty in coordinating bowel movements

• Internal rectal prolapse (intussusception), where the rectal wall folds inward, causing pressure and damage

• Excessive use of digital manipulation to assist in passing stools

Symptoms of solitary rectal ulcer syndrome

SRUS symptoms can vary, with some people experiencing mild discomfort while others have significant bowel issues. Common symptoms include:

• Rectal bleeding, often seen as blood on toilet paper or in stools

• Mucus discharge from the rectum

• A sensation of incomplete emptying, leading to frequent trips to the toilet

• Straining during bowel movements

• Rectal pain or discomfort

• Constipation or diarrhoea

• A feeling of a lump or fullness in the rectum

Some people with SRUS may be asymptomatic, with the condition only discovered during an investigation for another bowel issue.

How is solitary rectal ulcer syndrome diagnosed?

To confirm SRUS and rule out other bowel conditions, several diagnostic tests may be performed:

• Flexible sigmoidoscopy or colonoscopy – A camera inserted into the rectum to examine the ulcer and surrounding tissue

• Biopsy – A small tissue sample is taken from the rectal ulcer to rule out more serious conditions such as inflammatory bowel disease (IBD) or cancer

• Video proctogram or MRI proctogram – Specialised imaging tests that assess how the rectum functions during bowel movements and detect issues such as rectal prolapse

• Anorectal physiology tests – Used to evaluate pelvic floor function and identify muscle coordination issues

Treatment for solitary rectal ulcer syndrome

Lifestyle and dietary changes

Many cases of SRUS can be managed without surgery by improving bowel habits and reducing strain:

• Increase fibre intake to soften stools and prevent constipation

• Stay hydrated by drinking plenty of fluids

• Avoid excessive straining during bowel movements

• Use laxatives or stool softeners if constipation is persistent

• Pelvic floor physiotherapy to improve bowel coordination and reduce pressure on the rectum

Medical treatments

If lifestyle changes do not improve symptoms, additional treatments may be recommended:

• Topical medications, such as sucralfate enemas or corticosteroids, to help heal the ulcer and reduce inflammation

• Biofeedback therapy to retrain the pelvic floor muscles and improve bowel function

• Treatment of underlying conditions, such as rectal prolapse, which may be contributing to SRUS

Surgical options

In severe cases where symptoms do not respond to conservative treatments, surgery may be necessary. Procedures may include:

• Rectopexy – Used to treat rectal prolapse, securing the rectum in place to prevent further damage

• Excision of the ulcer – Rarely performed but may be considered if the ulcer is persistent and causing significant symptoms

• Colostomy – Only recommended in extreme cases when other treatments have failed

Why choose the Midlands Bowel Clinic?

• Expert colorectal specialists with experience in diagnosing and treating SRUS

• Advanced diagnostic tools, including defecating proctogram and anorectal physiology testing

• Minimally invasive treatment options for faster recovery and symptom relief

• Personalised treatment plans tailored to your specific symptoms and needs

Contact us

If you are experiencing rectal pain, bleeding, or difficulty with bowel movements, contact us today for expert diagnosis and treatment.