Solitary Rectal Ulcer Syndrome

What is it?
Solitary rectal ulcer syndrome (SRUS) is a condition in which a benign ulcer occurs in the rectum in association with prolapse or difficulty emptying the bowels.

What causes SRUS?
There are a number of theories as to how SRUS is caused. Many patients have a history of constipation and straining and some people believe that this causes the lining of the bowel to prolapse down. The ulcer then may occur from trauma to the bowel from it rubbing against itself. Some patients with SRUS have difficulty in opening their bowels and may insert a finger into the anal canal to aid defaecation and it is possible that the ulcer comes from the finger being inserted.

What symptoms does it cause?
The typical symptoms are of bleeding and mucus discharge. Patients often report a sensation of incomplete emptying and a persistent feeling of fullness in the pelvis.

How is it diagnosed?
After an assessment in clinic, we may recommend a flexible sigmoidoscopy or colonoscopy to look at the bowel higher up and to biopsy the ulcer in order to rule out other causes of ulceration. We often recommend other tests including a proctogram which looks for evidence of rectal prolapse, commonly seen in association with SRUS. This may direct future treatments.

How can SRUS be treated?
Often people with SRUS can be treated with changes to their diet and laxatives. Biofeedback may retrain the voluntary and involuntary processes involved with opening your bowels, improving symptoms. In patients with persistent symptoms and bowel prolapse, treatment of the underlying sometimes an operation to treat the prolapse can give symptom relief.