Rectal Ulcers

Overview

What are rectal ulcers?

A rectal ulcer is a painful sore that develops inside the rectum. The rectum is a tube connecting the colon (lower intestine) to the anal opening (anus). Stool passes through the rectum and anus when it leaves the body.

These ulcers are related to several different conditions. People who have a condition called solitary rectal ulcer syndrome (SRUS) can develop rectal ulcers. Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, may also cause ulcers to form in the rectum and intestines. Constipation and straining (pushing too hard) during a bowel movement can cause rectal ulcers to develop as well.

Signs of a rectal ulcer may include:

How common are rectal ulcers?

Solitary rectal ulcers syndrome is a rare disorder. It occurs in 1 out of every 100,000 people. About 40% of people with solitary rectal ulcer syndrome develop ulcers.

Who is affected by rectal ulcers?

Adults and children can develop inflammatory bowel disease, but most people are diagnosed with the condition in their 30s. People of all ages can develop a rectal ulcer due to constipation and straining (pushing too hard) during a bowel movement.

Young adults are most likely to develop solitary rectal ulcer syndrome, although it can happen in children.

Symptoms and Causes

What are the symptoms of rectal ulcers?

Symptoms of a rectal ulcer usually develop gradually. They often appear along with other symptoms, such as constipation.

Some people with rectal ulcers feel like they always need to have a bowel movement, even after going to the bathroom. Other signs of a rectal ulcer are:

  • Pain in the anal area, especially when having a bowel movement.
  • Bloody stool.
  • Anal bleeding and rectal bleeding (blood is usually bright red).
  • Mucus in the stool.

How do people get rectal ulcers?

Rectal ulcers develop from stress or trauma (injury) to the rectum. Trauma can result from:

  • Severe or chronic (long-term) constipation.
  • Straining or pushing too hard during a bowel movement (often because of constipation).
  • Inflammation (swelling and irritation) in the rectum due to IBD, solitary rectal ulcer syndrome, or proctitis (a condition that causes inflammation in the intestines).
  • Using fingers to remove stool that has become stuck in the rectum.
  • Rectal prolapse, a condition that causes the rectum to herniate out of the anal opening.
  • Anal sex or inserting foreign objects (enemas) into the anus and rectum.
  • Sexually transmitted diseases and infections (STDs and STIs), such as herpes and syphilis.

Diagnosis and Tests

How are rectal ulcers diagnosed?

Your doctor will examine you and ask about habits that may have caused your symptoms (such as pushing too hard while having a bowel movement). To check for rectal ulcers, doctors use physical (rectal) examination, tests and imaging studies. These tests include:

  • Anoscopy: Your doctor may use a tool called an anoscope to examine you. An anoscope is a short tube that your doctor inserts into your anus. Your doctor uses a light to see through the tube and check for ulcers or lesions inside your rectum.
  • Sigmoidoscopy: Doctors insert a flexible instrument into your rectum during a sigmoidoscopy. The thin device has a camera on the end. With it, your doctor can see inside your rectum and the lower part of the colon.
  • Colonoscopy: To look at the entire colon, doctors insert a long scope with a camera. Like a sigmoidoscopy, a colonoscopy is an outpatient procedure (you go home the same day). It is a more invasive test than a sigmoidoscopy.
  • Rectal ultrasound: During this test, doctors insert a small probe in your rectum. The probe uses sound waves to show images of the inside of the rectum so your doctor can see ulcers and other growths.
  • Biopsy: Your doctor may take a biopsy (sample) of the tissue surrounding the ulcer and send it to a lab. The lab tests the tissue for other conditions, such as cancer.

How do I know if I have rectal ulcers?

If you have anal pain, anal bleeding, or blood in your stools, you should see your doctor. Only a doctor can diagnose rectal ulcers and check for conditions that may be causing your symptoms.

Management and Treatment

What are the treatments for rectal ulcers?

Treatment for rectal ulcers depends on the severity of your symptoms and whether you have another condition, such as inflammatory bowel disease. Many rectal ulcers get better with dietary changes to relieve constipation and lifestyle changes to improve bowel habits.

What treatments heal rectal ulcers without surgery?

To relieve symptoms of a rectal ulcer and help it heal, you should:

  • Drink plenty of water: Dehydration can make stool hard, dry and more difficult to pass.
  • Eat a healthy diet: Fiber-rich foods can relieve constipation. Fiber softens stool and helps it pass through your intestines faster.
  • Avoid straining: Straining or pushing too hard when defecating can cause rectal ulcers. Your doctor or physical therapist can show you how to control the muscles in your anus so you can have a bowel movement without damaging your anus or rectum.
  • Ask your doctor about laxatives: Your doctor may recommend taking a stool softener or laxative. These medications can relieve constipation by making your stool easier to pass. Talk to your doctor about which laxative you should take and how long you should take it.
  • Try a topical medication: A corticosteroid cream or suppository (such as hydrocortisone) can reduce inflammation, relieve pain and help the ulcers heal. Talk to your doctor about how to use this medication.
  • Take antibiotics: If an STD or STI is causing rectal ulcers, your doctor will prescribe medicine to treat the infection.

If you have an inflammatory bowel disease such as ulcerative colitis, your doctor will recommend a treatment plan. Your plan may include a combination of prescription anti-inflammatory drugs, immunosuppressant drugs and dietary changes.

What conditions need surgery to treat rectal ulcers?

Rectal prolapse is a condition where part of the rectum protrudes (sticks out) from the anus. If rectal prolapse is causing your rectal ulcers, you may need a surgical procedure called a rectopexy to repair your rectum. This procedure can be done laparoscopically (through small incisions) or robotically.

After making a few small incisions near your belly button, doctors insert a laparoscope (a thin instrument with a camera) into your abdomen. Your doctor uses tiny tools to move your rectum into the proper position.

What are the side effects of treatment for rectal ulcers?

If you are using laxatives to treat rectal ulcers, there are several side effects that can happen. These can include:

  • Diarrhea.
  • Bloating.
  • Gas.
  • Abdominal cramping.

Talk to your doctor before taking laxatives or other medications.

What are the complications associated with rectal ulcers?

Rarely, a condition called acute hemorrhagic rectal ulcer syndrome can cause severe anal bleeding. This condition happens in older adults who have underlying medical conditions (such as diabetes) and are taking blood thinner medications. Acute hemorrhagic rectal ulcer syndrome can be fatal if it isn’t treated.

What can I do to help relieve symptoms of rectal ulcers?

To relieve constipation, you should eat a healthy diet that includes high-fiber foods, such as fruit, oats, and lentils. Drinking plenty of water can make your stool softer and more comfortable to pass through your rectum. Try not to strain or push out a bowel movement too forcefully.

Prevention

How can you prevent rectal ulcers?

It isn’t possible to prevent IBD (a condition that causes rectal ulcers). You can reduce your risk of developing a rectal ulcer by staying hydrated and eating foods that are rich in fiber. Water and high-fiber foods help prevent constipation, which can lead to rectal ulcers.

Outlook / Prognosis

What is the outlook for patients who have rectal ulcers?

Your outlook depends on what is causing the ulcers to appear. Rectal ulcers are usually benign (harmless) and don’t cause long-term medical problems. If ulcerative colitis is causing your rectal ulcers, you should talk to your doctor about ways to manage the condition.

Living With

When should I call my doctor about rectal ulcers?

You should see your doctor if you have anal bleeding, blood in your stool or persistent pain during bowel movements. Your doctor will work with you to determine what is causing your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 02/05/2020.

References

  • Zhu QC, Shen RR, Qin HL, Wang Y. . World J Gastroenterol. 2014 Jan 21;20(3):738-44. Accessed 2/10/2020.Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921483/)
  • American Gastroenterological Association. . Accessed 2/10/2020.Inflammatory Bowel Disease (IBD) (https://www.gastro.org/practice-guidance/gi-patient-center/topic/inflammatory-bowel-disease-ibd)
  • Crohn’s and Colitis Foundation. . Accessed 2/10/2020.Overview of Ulcerative Colitis (https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/overview)
  • Centers for Disease Control (CDC). . Accessed 2/10/2020.Diseases Characterized by Genital, Anal, or Perianal Ulcers (https://www.cdc.gov/std/tg2015/genital-ulcers.htm)

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