Rectal ulcer

Abdomen | Gastroenterology | Rectal ulcer (Disease)


Description

Solitary rectal ulcer syndrome (SRUS) is a rare disorder of defaecation that has typical histological findings. This syndrome commonly presents with bleeding per rectum (BPR) in association with other symptoms such as abdominal pain, passage of mucus, straining at defaecation and feeling of incomplete evacuation.

A history of manual evacuation can be elicited by direct questioning. Unless recognised, the diagnosis can be delayed and be mistaken for non-specific ulcer, inflammatory bowel disease or neoplasm. This can lead to inappropriate treatment being given. However, despite a correct diagnosis, the outcome can be unsatisfactory, leading to non-healing of the rectal lesions and persistence of symptoms.

Persistence of symptoms such as BPR is common and can be distressing for the patients.

The name of the syndrome is misleading, since patients can often present with lesions that are neither solitary nor ulcerated. The lesions are located in the anterior rectal wall within 10 cm of the anal verge in the majority of patients. Endoscopic and radiologic findings vary and can include mucosal ulcerations, polypoid and mass lesions (mimicking rectal cancer), or simply erythema.

Causes and Risk factors

Its not always clear what causes solitary rectal ulcer syndrome. Doctors believe stress or injury to the rectum may cause rectal ulcers to form.

Examples of situations that could injure the rectum include: attempts to manually remove impacted stool, constipation or impacted stool, anal intercourse, intussusception, which occurs when part of the intestine slides inside another part, radiation therapy used to treat cancer in the abdomen or pelvis, rectal prolapse, which occurs when the rectum protrudes from the anus, straining during bowel movements, use of ergotamine suppositories, an anti-migraine treatment, uncoordinated tightening of the pelvic floor muscles that slows blood flow to the rectum.

Diagnosis and Treatment

Current treatment includes the use of bulking agents, laxatives, sucralfate, bowel retraining with or without biofeedback and surgery. However, currently available therapies have major limitations. ...