Solitary Rectal Ulcer

What is a solitary rectal ulcer (a sore in the rectum)?

Solitary rectal ulcer is a usually benign condition seen in the rectum, the last part of the large bowel near the back passage.

In this condition a sore, redness or a raised area can form on the inside lining of the bowel. Although its name contains the word “solitary” (single), sometimes more than one sore is seen. In some patients there may even be no obvious sore at all.

Solitary rectal ulcer is not cancer. Its appearance, however, can sometimes be confused with other bowel diseases.

Why does it form?

The condition is mostly linked to straining of the rectum when opening the bowels and to repeated damage to the bowel wall.

It can be seen especially in the following situations:

• Long-lasting constipation
• Pushing too hard on the toilet
• The bowel not emptying fully when opening the bowels
• The muscles of the back passage and the pelvic floor not working together properly
• The inner part of the rectum slipping or sagging downwards

What are the symptoms?

• Blood coming from the back passage
• Pain or straining when opening the bowels
• A constant need to go to the toilet
• A feeling that the bowel has not emptied fully after opening the bowels
• Slimy discharge (mucus) coming with the stool
• Constipation

Some patients may have no symptoms at all.

How is it diagnosed?

The condition is usually investigated by colonoscopy or endoscopic examination of the rectum.

Small tissue samples (biopsies) are taken from the suspicious area and examined under the microscope.

The biopsy is important, because solitary rectal ulcer can sometimes be confused with rectal cancer or inflammatory bowel disease.

When needed, special tests that assess how the muscles used to open the bowels are working may be carried out.

How is it treated?

Treatment is planned according to the cause of the condition and how severe the complaints are.

• Correcting constipation and softening the stool
• A high-fibre diet and drinking enough water
• Avoiding sitting on the toilet for a long time and pushing too hard
• Special exercises and biofeedback treatment if the muscles used to open the bowels are not working together properly
• Drugs or other treatments in patients who need them

In some patients with obvious structural problems, such as the bowel sagging, surgical treatment may be needed.

When should you see a doctor?

If you have repeated bleeding from the back passage, long-lasting constipation, difficulty in opening the bowels or a constant need to go to the toilet, you are advised to see a gastroenterologist.

Remember: solitary rectal ulcer is usually benign. Making the right diagnosis and treating the problem with opening the bowels are important, however, for the complaints to get better and to stop the condition coming back.