Rectal Ulcer

Rectal ulcers can form in the rectum, a part of your digestive system where stool passes out of your body. This condition, called Solitary Rectal Ulcer Syndrome (SRUS), is uncommon and not well-understood. It's often linked to long-term (chronic) constipation.

In SRUS, a sore (or sometimes multiple sores) develops in the rectum. This can cause bleeding from the rectum and make going to the bathroom very difficult, as you may need to strain. The "solitary" part of the name doesn't always mean just one ulcer; sometimes there are more.

Fortunately, many cases of SRUS can be managed by simple changes to your daily habits. This might include adjusting your diet to be higher in fiber and drinking more water to help your bowels move more easily. If lifestyle changes aren't enough, surgery might be necessary in more serious situations.

Solitary rectal ulcer syndrome (SRUS) is a condition where a sore develops in the rectum. This sore can cause several different symptoms.

Common signs of SRUS include:

• Trouble having bowel movements (constipation): This means you might have difficulty passing stool regularly.
• Blood in your stool (rectal bleeding): You might see blood on the toilet paper or in the stool itself.
• Trying too hard to have a bowel movement (straining): This can be uncomfortable and can sometimes lead to pain.
• Pain or a feeling of pressure in your lower belly (pelvic pain/fullness): This discomfort can happen during or after bowel movements.
• Feeling like you haven't emptied your bowels completely (incomplete bowel movements): You might feel like there's still stool left in your rectum.
• Passing mucus from your rectum: This is a clear or whitish discharge from the rectum.
• Leakage of stool (fecal incontinence): This means you might have accidents where stool leaks out.
• Pain in your rectum: This can be a sharp or dull ache.

Important to note: Some people with SRUS don't have any noticeable symptoms at all. This makes diagnosis a bit more challenging. If you're experiencing any of these symptoms, it's important to talk to a doctor to get a proper diagnosis and treatment plan.

If you notice any unusual or concerning symptoms in your rectum, schedule a doctor's appointment.

Many other health problems can have similar symptoms to solitary rectal ulcer syndrome (SRUS). Your doctor will likely want to run some tests to figure out if something else is causing your discomfort. These tests might include different examinations or procedures to determine if SRUS is the cause or if another issue is at play.

Solitary rectal ulcer syndrome (SRUS) isn't always easy to understand, but doctors think it might be caused by problems that damage the lining of the rectum. This damage can lead to sores or ulcers.

Several things could cause this damage:

• Hard or impacted stool: Having trouble passing hard, compacted stool (impacted stool) can put pressure on the rectum and injure it. This is often a major factor.
• Straining during bowel movements: Pushing too hard to have a bowel movement can also injure the rectum. This is similar to the impact of impacted stool.
• Rectal prolapse: Sometimes, the rectum can bulge out of the anus. This stretching and straining can cause damage to the rectal lining.
• Problems with pelvic floor muscles: The muscles around the rectum and pelvis help control bowel movements. If these muscles don't work together smoothly, blood flow to the rectum can be reduced, potentially causing damage.
• Manual removal of impacted stool: Trying to manually remove hard stool can be very forceful and injure the rectum. It's usually best to let a healthcare professional handle this.
• Intussusception: In this rare condition, one part of the intestine slides into another part. This can put pressure on the rectum and cause damage.

Understanding these potential causes can help people discuss their symptoms with a doctor and potentially find ways to prevent future issues.

Diagnosing Solitary Rectal Ulcer Syndrome

Doctors use several tests to diagnose solitary rectal ulcer syndrome (SRUS). These tests help them find the cause of the problem and rule out other conditions. Here are some common tests:

Imaging Tests:

• Defecography: This test, sometimes called defecation proctography, involves inserting a special, soft, barium paste into your rectum. You then try to pass this paste as you would a bowel movement. X-rays show the barium, allowing doctors to see how your rectum and pelvic floor muscles work during bowel movements. They can look for problems like a prolapse (a part of your rectum pushing out) or issues with how your muscles are working together. This test can help reveal if something is blocking the rectum or if the muscles aren't working properly.

• Magnetic Resonance Defecography (MR Defecography): This is a more advanced version of defecography. Instead of X-rays, it uses a magnetic resonance imaging (MRI) machine to create a 3D image of your rectum and pelvic floor during a bowel movement. This provides a clearer picture of the muscles' function and any potential problems. MR defecography is often used in specialized medical centers.

Other Important Tests:

• Sigmoidoscopy: A thin, flexible tube with a tiny camera on the end (a sigmoidoscope) is inserted into your rectum and part of your colon. This allows your doctor to look directly at the lining for any sores or other abnormalities. If something unusual is found, a small tissue sample (biopsy) might be taken. This sample can be sent to a lab for further analysis to help determine the cause.

• Ultrasound: Ultrasound uses sound waves to create images. Doctors might use ultrasound to compare the appearance of your rectum to other possible conditions that might have similar symptoms. This helps rule out other potential causes of the problem.

These tests work together to help your doctor understand the specific issue you're facing and make an accurate diagnosis. It's important to remember that the best test for you will depend on your individual situation and the specific concerns of your doctor.

Solitary rectal ulcer syndrome (SRUS) treatment depends on how bad your symptoms are. If your symptoms are mild, lifestyle changes might be enough. If they're more severe, you might need medical or surgical help.

Lifestyle Changes and Behavior Therapy:

Sometimes, you might strain during bowel movements because it's become a habit. Behavioral therapy can help you break this habit. This therapy teaches you how to relax your pelvic muscles during bowel movements. A specific technique, called biofeedback, involves a specialist helping you control involuntary muscle responses, like tightening of the muscles around your anus and lower pelvis, during bowel movements. Biofeedback can make you more aware of when you're straining and help you stop. Increasing fiber in your diet is also a common recommendation to help with constipation, which often accompanies SRUS.

Medical Treatments:

Certain medications might help relieve the pain and inflammation of the ulcer. These include topical steroids, sulfasalazine enemas, and a medicine called onabotulinumtoxinA (Botox). However, these aren't guaranteed to work for everyone, and some are still being studied.

Surgical Options:

If you have a rectal prolapse (the rectum bulging out), surgery called rectopexy can reposition the rectum. This procedure fixes the rectum back to its normal place.

In very severe cases where other treatments haven't helped, surgery to remove the rectum might be considered. If the rectum is removed, the surgeon will connect the colon (part of the large intestine) to an opening in your abdomen, creating a colostomy. A bag is then attached to the opening to collect waste. This is a significant procedure, so it's usually only considered as a last resort when other options haven't worked.