Rectal ulcers are sores that develop inside the rectum. These sores can be caused by several conditions, including inflammatory bowel disease, solitary rectal ulcer syndrome and constipation. If you have a rectal ulcer, you may see blood in the stool, have rectal pain or experience painful bowel movements.
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:
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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.
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 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:
Rectal ulcers develop from stress or trauma (injury) to the rectum. Trauma can result from:
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:
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.
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.
To relieve symptoms of a rectal ulcer and help it heal, you should:
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.
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.
If you are using laxatives to treat rectal ulcers, there are several side effects that can happen. These can include:
Talk to your doctor before taking laxatives or other medications.
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.
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.
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.
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.
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.
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