(See also Evaluation of Anorectal Disorders Evaluation of Anorectal Disorders The anal canal begins at the anal verge and ends at the anorectal junction (pectinate line, mucocutaneous junction, dentate line), where there are 8 to 12 anal crypts and 5 to 8 papillae. The... read more .)
Solitary rectal ulcer syndrome is caused by mucosal ischemia of the distal rectal mucosa resulting from trauma.
Causes include
Paradoxical contraction of the puborectalis muscle
Attempts at manual disimpaction of hard stools
Symptoms and Signs of Solitary Rectal Ulcer Syndrome
Affected patients have straining during defecation, a sense of incomplete evacuation or pelvic fullness, and sometimes passage of blood and mucus by rectum.
The syndrome is poorly named because associated lesions may be solitary or multiple and ulcerated or nonulcerated; they range from mucosal erythema to ulcers to small mass lesions. Lesions are typically located in the anterior rectal wall within 10 cm of the anal verge.
Diagnosis of Solitary Rectal Ulcer Syndrome
Clinical evaluation
Flexible sigmoidoscopy with biopsy
Diagnosis of solitary rectal ulcer syndrome is typically made by clinical history alone, but flexible sigmoidoscopy with biopsy is sometimes done for confirmation. Assessment for internal or full-thickness rectal prolapse should be done (see diagnosis of rectal prolapse Diagnosis Rectal prolapse is painless protrusion of the rectum through the anus. Procidentia is complete prolapse of the entire thickness of the rectum. Diagnosis is by inspection. Surgery is usually... read more 
).
Histopathologic examination of the biopsy specimen shows a thickened mucosal layer with distortion of the crypt architecture and replacement of the lamina propria with smooth muscle and collagen, leading to hypertrophy and disorganization of the muscularis mucosa.
Treatment of Solitary Rectal Ulcer Syndrome
Bulk laxatives
Sometimes surgery for rectal prolapse
Mild cases are treated with reassurance and establishment of a bowel regimen with bulk laxatives Types of laxatives Constipation is difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation. (See also Constipation in Children.) No bodily function is more variable and... read more to relieve chronic constipation.
If rectal prolapse is the cause, surgery may be needed (see treatment of rectal prolapse Treatment Rectal prolapse is painless protrusion of the rectum through the anus. Procidentia is complete prolapse of the entire thickness of the rectum. Diagnosis is by inspection. Surgery is usually... read more ).
