Solitary Rectal Ulcer Syndrome (SRUS)

Solitary rectal ulcer syndrome (SRUS) is a rare and poorly understood medical condition characterized by the presence of one or more ulcers in the rectum, often accompanied by other symptoms such as rectal bleeding, pain, and difficulty with bowel movements.

Causes and Risk Factors

The exact cause of SRUS is not well understood, but several factors are thought to contribute to its development. These include:

• Chronic constipation or straining during bowel movements, which can lead to increased pressure on the rectal mucosa and subsequent ulceration.
• Prolonged sitting or standing, which can cause increased pressure on the rectum and contribute to the development of ulcers.
• Abnormalities in the muscles of the pelvic floor, such as weakness or spasm, which can disrupt normal bowel function and lead to ulceration.

Symptoms

The symptoms of SRUS can vary from person to person, but common complaints include:

• Rectal bleeding, which may be bright red or occult (hidden).
• Pain or discomfort in the rectum, which may worsen with bowel movements.
• Difficulty with bowel movements, such as straining or feeling of incomplete evacuation.
• Mucous discharge from the rectum.

Diagnosis

The diagnosis of SRUS is typically made based on a combination of clinical evaluation, endoscopy, and histopathological examination. The following tests may be used to diagnose SRUS:

• Sigmoidoscopy or colonoscopy to visualize the rectum and identify any ulcers.
• Biopsy to examine the tissue and rule out other conditions such as cancer or inflammatory bowel disease.
• Defecography to evaluate the function of the pelvic floor muscles during bowel movements.

Treatment

The treatment of SRUS typically involves a combination of medical and lifestyle interventions. The following measures may be recommended:

• Dietary changes, such as increasing fiber intake to soften stool and reduce straining.
• Bowel habit training to establish regular bowel movements and avoid straining.
• Medications, such as laxatives or stool softeners, to help manage constipation and reduce symptoms.
• Surgery, in some cases, to repair any underlying abnormalities in the pelvic floor muscles or to remove the ulcerated tissue.

Complications

If left untreated, SRUS can lead to several complications, including:

• Chronic pain and discomfort.
• Bleeding and anemia.
• Difficulty with bowel movements, leading to constipation or fecal incontinence.

Prognosis

The prognosis for SRUS is generally good, with most patients experiencing significant improvement in symptoms with treatment. However, some patients may experience persistent symptoms or recurrence of the condition over time.