Diagnosis

Tests and procedures used to diagnose rectal ulcers include:

  • Sigmoidoscopy. During this test, 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 (biopsy) for laboratory testing.
  • Ultrasound. This imaging technique uses sound waves to create pictures. Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions.
  • Imaging studies. Your doctor may recommend an imaging procedure, such as defecation proctography. This test allows the doctor to look at your rectum.

    During this procedure, 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.

    Specialized centers may offer magnetic resonance defecography. This test is done on a magnetic resonance imaging (MRI) machine and provides a 3-dimensional image of the rectum.

Treatment

Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief through lifestyle changes, while people with more-severe signs and symptoms may require treatment.

Lifestyle changes. Dietary changes, including increasing fiber in your diet

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 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.

Medications

Certain treatments such as topical steroids, sulfasalazine enemas and botulinum toxin (Botox) may help ease your rectal ulcer symptoms. However, these treatments don't work for everyone, and some are still considered experimental.

Surgery

Surgical procedures used to treat solitary rectal ulcer syndrome include:

  • Rectal prolapse surgery. If you have a rectal prolapse that's causing symptoms, your doctor may recommend a rectopexy procedure. Rectopexy secures the rectum in its anatomically correct position.
  • Surgery to remove the rectum. An operation to remove the rectum may be an option for people with severe signs and symptoms who haven't been helped by other treatments. 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.

Lifestyle and home remedies

You can make changes to your daily life that may help relieve your symptoms, including:

  • 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 20 to 35 grams of fiber each day. Nutrition labels on food packaging list the amount of fiber in a 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.

  • Try bulk laxatives and stool softeners. Bulk laxatives, such as Metamucil and FiberCon, absorb fluid in the intestines and make stools bulkier, which helps trigger the bowel to contract and push stool out. However, they should be taken with water, or they can cause obstruction. Stool softeners help mix fluid into stools, making them easier to pass.
  • Drink water throughout the day. Drinking enough water and other fluids helps to keep your bowel movements soft and easy to pass. For variety, you may want to add lemon juice to water for flavor. Or try other noncarbonated and caffeine-free beverages. Prune juice can be helpful because it has a natural laxative effect.

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).

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, vitamins or supplements that you're taking.
  • Write down questions to ask your doctor.

Questions to ask your doctor

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 long lasting?
  • Do I need treatment?
  • What are my treatment options?
  • I have these other health conditions. How can I best manage these conditions together?
  • Do I need to follow any dietary or activity restrictions?
  • 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 websites do you recommend?
  • Will I need follow-up visits? If so, how often?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on.

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Have you recently had trouble with constipation?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Aug. 18, 2015
References
  1. Zhu QZ, et al. Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies. World Journal of Gastroenterology. 2014;20:738.
  2. Solitary rectal ulcer syndrome. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/solitary-rectal-ulcer-syndrome. Accessed July 7, 2015.
  3. Kim DJ, et al. Solitary rectal ulcer syndrome. http://www.uptodate.com/home. Accessed July 7, 2015.
  4. Bope ET, et al. The management of solitary rectal ulcer syndrome. In: Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed July 7, 2015.
  5. Constipation. National Digestive Diseases Information Clearinghouse. http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/constipation/Pages/overview.aspx. Accessed July 8, 2015.
  6. Phillips RK, et al. Anorectal investigation. In: Colorectal Surgery: A Companion to Specialist Surgical Practice. 5th ed. Philadelphia, Pa.: Elsevier Limited; 2014. http://www.clinicalkey.com. Accessed July 7, 2015.

Solitary rectal ulcer syndrome