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Definition
Solitary rectal ulcer syndrome is a condition that occurs when a sore (ulcer) develops in the rectum. The rectum is a muscular tube that's connected to the end of your colon. Stool passes through the rectum on its way out of the body.
Solitary rectal ulcer syndrome can cause rectal bleeding with straining when you pass bowel movements.
Solitary rectal ulcer syndrome most commonly involves one ulcer, but sometimes more than one rectal ulcer can occur or polyp-like masses may form. Solitary rectal ulcer syndrome is a rare and poorly understood disorder that occurs in people with chronic constipation.
Treatments for solitary rectal ulcer syndrome range from changing your diet and fluid intake to surgery.
Symptoms
Signs and symptoms of solitary rectal ulcer syndrome include:
- Constipation
- A feeling of incomplete passing of stool
- Pain or a feeling of fullness in your pelvis
- Passing mucus from your rectum
- Rectal pain or anal sphincter spasms
- Rectal bleeding
- Straining during bowel movements
However, some people with solitary rectal ulcer syndrome may experience no symptoms.
When to see a doctor
Make an appointment with your doctor if you notice any signs or symptoms that worry you.
Other diseases and conditions may cause signs and symptoms similar to those of solitary rectal ulcer syndrome. At your appointment, your doctor may recommend tests and procedures to rule out other causes of your signs and symptoms.
Causes
It's 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
- 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
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have signs or symptoms that worry you. If your doctor suspects you may have solitary rectal ulcer syndrome, you may be referred to a doctor who specializes in the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so prepare a list of questions to make the most of your time together. List your questions from most important to least important in case time runs out. For solitary rectal ulcer syndrome, some basic questions to ask your doctor include:
- What is likely causing my rectal ulcer signs and symptoms?
- What are other possible causes for my symptoms?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- Do I need treatment?
- What are my treatment options?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Tests and diagnosis
Tests and procedures used to diagnose rectal ulcers include:
- Using a scope to examine your rectum. During sigmoidoscopy, your doctor inserts a flexible tube equipped with a lens into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing.
- Using sound waves to create images of your rectum. Ultrasound is an imaging technique that uses sound waves to create pictures. Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions.
- An X-ray of your rectum. During a procedure called defecation proctography, your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.
Treatments and drugs
Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief by making lifestyle changes to control chronic constipation. People with more severe signs and symptoms may require treatments such as behavior therapy and surgery.
Behavior therapy to stop straining during bowel movements
Some people strain during bowel movements out of habit. Behavior therapy can help you learn to relax your pelvic muscles and avoid straining during bowel movements. In one technique called biofeedback, a specialist teaches you to control certain involuntary body responses, such as tightening of your anus or pelvic floor muscles during defecation. Biofeedback may make you more aware of your straining and help you to control it.
Surgery
Surgical procedures used to treat rectal ulcer include:
- Surgery to remove the rectum. An operation to remove the rectum may be an option for people with severe rectal ulcer signs and symptoms. The surgeon may connect the colon to an opening in the abdomen for waste to leave the body (colostomy). If you have a colostomy, a pouch or bag is then attached to your abdomen to collect waste.
- Rectal prolapse surgery. If you have a rectal prolapse that's causing rectal ulcer, your doctor may recommend a rectopexy procedure. Rectopexy corrects rectal prolapse by using stitches to secure the rectum in its anatomically correct position.
Lifestyle and home remedies
If you experience chronic constipation, you can make changes to your daily life that may help relieve your symptoms. Relieving your constipation may help reduce the signs and symptoms of rectal ulcer.
You may find relief from constipation if you:
- Drink water throughout the day. Aim for 64 ounces (about 1.9 liters) of water each day. If you tire of water, add lemon juice to give water some flavor. Or try other noncarbonated and caffeine-free beverages. Prune juice is often recommended for people with constipation because of its natural laxative effect.
- Increase the amount of fiber in your diet. Fiber adds bulk to your stool. The bulk helps push the contents of your intestines along so that they can be eliminated when you have a bowel movement. Try to eat at least 25 to 35 grams of fiber each day. Nutrition labels on food packaging list the amount of fiber per serving. The best sources of fiber are fruits, vegetables and whole grains. Eat fruits and vegetables with the skin on, and choose whole fruits and vegetables over juices. Look for breads and cereals that list whole wheat, oats or bran as the first ingredients.
- Make changes slowly. Add more water and fiber to your diet over the course of a few weeks. This helps your body adjust to the changes gradually. A sudden increase in fiber could make constipation worse.
- Exercise most days of the week. Try to exercise for at least 30 minutes most days of the week. If you haven't been active for a while, get your doctor's OK. Then start slowly, with walking or another gentle activity. Gradually work your way up to more activity each day.
Last Updated: 2010-03-13
