Solitary rectal ulcer syndrome involves having one or more benign (noncancerous) sores inside your rectum. Signs and symptoms include bright red blood in your stool, anal or rectal pain and painful bowel movements. Treatments include lifestyle changes that allow you to pass stools more easily, prescription medications, biofeedback and surgery.
Solitary rectal ulcer syndrome (SRUS) is a chronic (long-term), noncancerous condition where sores form inside your rectum. Your rectum connects your colon (large intestine) to your anus (butthole). Stool passes through your rectum and your anus when you have a bowel movement (poop).
But the name “solitary rectal ulcer syndrome” is misleading. For example, if you have SRUS, you may have a single (“solitary”) ulcer, or you may have more than one. Also, the sores aren’t always ulcers or even only in your rectum. They may be inflamed tissue or located in the part of your colon above your rectum.
There’s still a lot that researchers are learning about SRUS, including causes and the most effective treatments.
Solitary rectal ulcer syndrome is rare. It occurs in about 1 out of every 100,000 people. Most people who get this diagnosis are in their 30s or 40s, but it also affects children and older adults.
Although the ulcers can be uncomfortable, they’re usually not serious. The condition that’s causing a rectal ulcer can be serious, though. This is why you should see your provider to receive a diagnosis if you’re experiencing symptoms of solitary rectal ulcer syndrome.
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Symptoms of a rectal ulcer usually develop gradually and involve unpleasant bathroom visits. Signs and symptoms of a rectal ulcer include:
Up to 25% of people with solitary rectal ulcer syndrome don’t have symptoms.
Experts haven’t identified a single cause. But several conditions that can injure the lining of your rectum may cause rectal ulcers to form. For example, solitary rectal ulcer syndrome often happens alongside:
One theory is that solitary rectal ulcer syndrome happens when the muscles that help you poop (pelvic floor muscles) don’t coordinate correctly to allow stools to pass. The lack of coordination can lead to ulcers. This is especially the case if you have a condition like rectal prolapse or intussusception that causes tissues that don’t normally come into contact to touch or rub together.
Your healthcare provider will ask about your symptoms and bathroom habits that may have caused your symptoms (like frequently straining to poop). To check for rectal ulcers, providers use digital rectal exams and imaging tests.
The most common test is an:
You may need additional tests so your provider can rule out conditions that cause symptoms similar to solitary rectal ulcer syndrome, like inflammatory bowel disease (IBD) and colon cancer. Tests include:
Treatment for solitary rectal ulcer syndrome depends on the severity of your symptoms and what’s causing them.
Many people with mild to moderate symptoms find relief by changing their eating habits and bowel habits to relieve constipation. Often, not straining to poop gives your ulcer time to heal. Your provider may recommend that you:
If these treatments aren’t providing relief, your provider may recommend biofeedback therapy. This type of behavior modification therapy can help you recognize when you’re tightening the muscles you use to poop so that you relax them instead. Biofeedback can teach you not to strain when pooping.
If rectal prolapse or intussusception is causing your rectal ulcers, you may need a surgical procedure called a rectopexy to repair your rectum and place it into position. Your provider can perform this procedure laparoscopically or robotically (through small incisions).
It isn’t always possible to prevent rectal ulcers. You can reduce your risk, though, by trying to keep your bowel movements regular so you’re not straining at the toilet and damaging rectal tissue. Staying hydrated, eating high-fiber foods and trying stool softeners can help.
Rectal ulcers are benign and don’t cause serious long-term medical problems. Still, they can cause pain and ongoing unpleasant symptoms without proper treatment.
Your provider will work with you to determine what caused the tissue damage inside your rectum. They can prescribe treatments and recommend lifestyle changes that can help manage solitary rectal ulcer syndrome.
Contact your healthcare provider if you’re bleeding from your anus, finding blood in your stool or experiencing persistent pain during bowel movements. They’ll work with you to determine if you have a rectal ulcer.
Questions you may ask include:
A note from Cleveland Clinic
An ulcer on any body part feels like an unwelcome visitor. This is especially the case when it’s in a sensitive area, like your rectum. The good news is that there are treatments that heal sores and help manage solitary rectal ulcer syndrome. It’s essential, though, to work with your provider to figure out the underlying cause. Investigating the cause and waiting for the healing to happen will take patience, but your provider can help you arrive at a treatment plan that can provide relief.
Last reviewed by a Cleveland Clinic medical professional on 01/17/2024.
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