Solitary Rectal Ulcer Syndrome Revisited: A Comprehensive Narrative Review.
| Title: | Solitary Rectal Ulcer Syndrome Revisited: A Comprehensive Narrative Review. |
|---|---|
| Authors: | Prabagar K; Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, GQ, 10110, Sri Lanka.; Chandrasinghe PC; Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, 11010, GQ, Sri Lanka.; Hewavisenthi SJS; Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, 11010, GQ, Sri Lanka.; de Silva AP; Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, GQ, 10110, Sri Lanka.; Niriella MA; Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, GQ, 10110, Sri Lanka. madunil.niriella@kln.ac.lk. |
| Source: | Current gastroenterology reports [Curr Gastroenterol Rep] 2026 May 18; Vol. 28 (1). Date of Electronic Publication: 2026 May 18. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: Current Science Inc Country of Publication: United States NLM ID: 100888896 Publication Model: Electronic Cited Medium: Internet ISSN: 1534-312X (Electronic) Linking ISSN: 15228037 NLM ISO Abbreviation: Curr Gastroenterol Rep Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, PA : Current Science Inc., c1999- |
| MeSH Terms: | Ulcer*/therapy ; Ulcer*/diagnosis ; Ulcer*/etiology ; Rectal Diseases*/therapy ; Rectal Diseases*/diagnosis ; Rectal Diseases*/etiology; Humans ; Syndrome ; Diagnosis, Differential |
| Abstract: | Purpose of Review: Solitary rectal ulcer syndrome (SRUS) is a gastrointestinal disorder with a varied range of clinical, endoscopic and histological features. It is often misdiagnosed as inflammatory bowel disease or rectal malignancy. This review aims to outline a practical approach to diagnosing and managing SRUS.; Recent Findings: The aetiology remains unclear, with contributing factors such as mucosal prolapse, ischemia, paradoxical puborectalis contraction, and digital trauma. Diagnosis involves a comprehensive approach, including clinical history, digital rectal examination, endoscopy, histopathology, and physiological studies. Treatment includes lifestyle modifications, biofeedback therapy, topical agents, sclerotherapy, and surgical intervention for refractory cases. Ongoing surveillance is necessary, especially in patients at high risk for recurrence. Management of SRUS should be individualised and multidisciplinary, particularly in patients with psychiatric comorbidities or during pregnancy, where invasive interventions are minimised. Further research and standardised treatment protocols for SRUS are needed.; (© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
| Competing Interests: | Declarations. Ethics Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable. Disclosure Statement: The authors reported no potential conflicts of interest. Clinical Trial Number: Not Applicable. Complying with the Ethics of Experimentation: Not applicable. Health and Safety: Not applicable. Using Third-Party Material: Not applicable. Competing interests: The authors declare no competing interests. |
| References: | Rutter KRP. Solitary rectal ulcer syndrome. J R Soc Med. 1975;68:22–6. https://doi.org/10.1177/003591577506800110 . (PMID: 10.1177/003591577506800110); Madigan MR, Morson BC. Solitary ulcer of the rectum. Gut. 1969;10:871–81. https://doi.org/10.1136/gut.10.11.871 . (PMID: 10.1136/gut.10.11.87153585781553062); Morio O, Meurette G, Desfourneaux V, D’Halluin PN, Bretagne JF, Siproudhis L. Anorectal physiology in solitary ulcer syndrome: a case-matched series. Dis Colon Rectum. 2005;48:1917–22. https://doi.org/10.1007/s10350-005-0105-x . (PMID: 10.1007/s10350-005-0105-x16132482); Martin CJ, Parks TG, Biggart JD. Solitary rectal ulcer syndrome in Northern Ireland, 1971–1980. Br J Surg. 1981;68:744–7. https://doi.org/10.1002/bjs.1800681021 . (PMID: 10.1002/bjs.18006810217284739); Dehghani SM, Haghighat M, Imanieh MH, Geramizadeh B. Solitary rectal ulcer syndrome in children: a prospective study of cases from southern Iran. Eur J Gastroenterol Hepatol. 2008;20:93–5. https://doi.org/10.1097/MEG.0b013e3282f1cbb6 . (PMID: 10.1097/MEG.0b013e3282f1cbb618188027); Jones PN, Lubowski DZ, Swash M, et al. Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum. 1987;30:667–70. https://doi.org/10.1007/BF02561685 . (PMID: 10.1007/BF025616853622173); Kang YS, Kamm MA, Nicholls RJ. Solitary rectal ulcer and complete rectal prolapse: one condition or two? Int J Colorectal Dis. 1995;10:87–90. https://doi.org/10.1007/BF00341203 . (PMID: 10.1007/BF003412037636379); Mackle EJ, Parks TG, The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome. 1986. https://doi.org/10.1016/S0009-6358(86)80086-5 .; Kang YS, Kamm MA, Engel AF, Talbot IC. Pathology of the rectal wall in solitary rectal ulcer syndrome and complete rectal prolapse. Gut. 1996;38:587–90. https://doi.org/10.1136/gut.38.4.587 . (PMID: 10.1136/gut.38.4.58787070931383120); Jarrett MD, Emmanuel AV, Vaizey CJ, Kamm AM. Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow. Gut. 2004;53:368–70. (PMID: 10.1136/gut.2003.025643149605171773992); Yamagiwa H. Protruded variants in solitary ulcer syndrome of the rectum. Pathol Int. 1988;38:471–8. https://doi.org/10.1111/j.1440-1827.1988.tb02320.x . (PMID: 10.1111/j.1440-1827.1988.tb02320.x); Abid S, Khawaja A, Bhimani SA, Ahmad Z, Hamid S, Jafri W. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol. 2012;12:22–6. https://doi.org/10.1186/1471-230X-12-72 . (PMID: 10.1186/1471-230X-12-72); Cetin FH, Emiroglu HH, Calisir S, Turkoglu S. Digital rectal stimulation associated with psychiatric disorders as a rare reason of solitary rectal ulcer in children and adolescents: a case series. Dusunen Adam. 2019;32:352–4. https://doi.org/10.14744/DAJPNS.2019.00050 . (PMID: 10.14744/DAJPNS.2019.00050); Sood SK, Garner JP, Amin SNO. Spontaneous resolution of solitary rectal ulcer syndrome during pregnancy: report of a case. Dis Colon Rectum. 2008;51:1149–52. https://doi.org/10.1007/s10350-008-9268-6 . (PMID: 10.1007/s10350-008-9268-618392597); Di Ciaula A, Wang DQH, Sommers T, Lembo A, Portincasa P. Impact of endocrine disorders on gastrointestinal diseases. Endocrinology (Switzerland), 2021:179–225, https://doi.org/10.1007/978-3-319-68729-2_7 .; Ciobanu L, Dumitrascu DL. Gastrointestinal motility disorders in endocrine diseases. Pol Arch Intern Med. 2011;121:129–36. https://doi.org/10.20452/pamw.1042 . (PMID: 10.20452/pamw.1042); Kato K, Nagase A, Iwasaki Y, Taniguchi M. Massive bleeding from visible vessels within a solitary rectal ulcer. Surgery (United States). 2014;155:956–7. https://doi.org/10.1016/j.surg.2012.12.006 . (PMID: 10.1016/j.surg.2012.12.006); Geramizadeh B, Baghernezhad M, Jahanshani Afshar A. Solitary rectal ulcer: a literature review. Ann Colorectal Res. 2015;3:72–6. https://doi.org/10.5812/acr.20749 . (PMID: 10.5812/acr.20749); Tjandra JJ, Fazio VW, Church JM, Lavery IC, Oakley JR, Milsom JW. Clinical conundrum of solitary rectal ulcer. Dis Colon Rectum. 1992;35:227–34. https://doi.org/10.1007/BF02051012 . (PMID: 10.1007/BF020510121740066); Behera MK, Dixit VK, Shukla SK, et al. Solitary rectal ulcer syndrome: clinical, endoscopic, histological and anorectal manometry findings in north Indian patients. Trop Gastroenterol. 2015;36(4):244–50. https://doi.org/10.7869/tg.298 . (PMID: 10.7869/tg.29827509702); Ertem D, Acar Y, Karaa EK, Pehlivanoglu E. A rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome. Pediatrics. 2002;110:110–79. https://doi.org/10.1542/peds.110.6.e79 . (PMID: 10.1542/peds.110.6.e79); Contractor TQ, Contractor QQ. Traumatic solitary rectal ulcer in Saudi Arabia: a distinct entity? J Clin Gastroenterol. 1995;21:298–300. https://doi.org/10.1097/00004836-199512000-00010 . (PMID: 10.1097/00004836-199512000-000108583104); Suresh N, Ganesh R, Sathiyasekaran M. Solitary rectal ulcer syndrome: a case series. Indian Pediatr. 2010;47:1059–61. https://doi.org/10.1007/s13312-010-0177-0 . (PMID: 10.1007/s13312-010-0177-020453265); Bishop PR, Nowicki MJ, Subramony C, Parker PH. Solitary rectal ulcer: a rare cause of gastrointestinal bleeding in an adolescent with hemophilia A. J Clin Gastroenterol. 2001;33:72–6. https://doi.org/10.1097/00004836-200107000-00018 . (PMID: 10.1097/00004836-200107000-0001811418797); Lin Z, Kumar A, Rahman M, Wang X, Tewari V. S1796 solitary rectal ulcer presented as a pseudotumor. Am J Gastroenterol. 2021;116:S792–3. https://doi.org/10.14309/01.ajg.0000780716.62190.01 . (PMID: 10.14309/01.ajg.0000780716.62190.01); Forootan M, Darvishi M. Solitary rectal ulcer syndrome. Medicine (United States). 2018;97:5–65. https://doi.org/10.1097/MD.0000000000010565 . (PMID: 10.1097/MD.0000000000010565); Gouriou C, et al. Solitary rectal ulcer syndrome in 102 patients: Do different phenotypes make sense? Dig Liver Dis. 2021;53:190–5. https://doi.org/10.1016/j.dld.2020.10.041 . (PMID: 10.1016/j.dld.2020.10.04133199231); Rao SSC, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016;22:423–35. https://doi.org/10.5056/jnm16060 . (PMID: 10.5056/jnm16060272709894930297); Wald A, et al. ACG clinical guidelines: Management of benign anorectal disorders. Am J Gastroenterol. 2021;116:1987–2008. https://doi.org/10.14309/ajg.0000000000001507 . (PMID: 10.14309/ajg.000000000000150734618700); Bhusal U, Basukala S, Tamang A, Dhakal S, Sharma S, Karki A. Solitary rectal ulcer syndrome in a young adult - A surgeon’s dilemma with rectal carcinoma. Clin Case Rep. 2022;10:6–316. https://doi.org/10.1002/ccr3.6316 . (PMID: 10.1002/ccr3.6316); Alireza SK, Harry CW, Graham SC. Diagnosis and management of children with intractable constipation. Semin Pediatr Surg. 2004;14:300–9.; TUNG S, RICHARDS P, HUNTER G, TUNG J (2021) Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population. International Journal of Clinical Pediatrics, North America, 10. Available at: https://www.theijcp.org/index.php/ijcp/article/view/422/374 . Accessed 16 May 2026.; Tjandra JJ, et al. Clinical and pathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome. Dis Colon Rectum. 1993;36:146–53. https://doi.org/10.1007/BF02051170 . (PMID: 10.1007/BF020511708425418); Amaechi I, Papagrigoriadis S, Hizbullah S, Ryan SM. Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI. Br J Radiol. 2010. https://doi.org/10.1259/bjr/24752209 . (PMID: 10.1259/bjr/24752209209658923473720); Sharara AI, Azar C, Amr SS, Haddad M, Eloubeidi MA. Solitary rectal ulcer syndrome: endoscopic spectrum and review of the literature. Gastrointest Endosc. 2005. https://doi.org/10.1016/j.gie.2005.07.016 . (PMID: 10.1016/j.gie.2005.07.01616246692); Cola B, Cuicchi D, Dalla Via B, Lecce F. Endosonographic pattern of solitary polypoid rectal ulcer [1]. Tech Coloproctol. 2005;9:71–2. https://doi.org/10.1007/s10151-005-0199-0 . (PMID: 10.1007/s10151-005-0199-015868506); Gopal DV, Young C, Katon RM. Solitary rectal ulcer syndrome presenting with rectal prolapse, severe mucorrhea and eroded polypoid hyperplasia: Case report and review of the literature. Can J Gastroenterol. 2001;15:479–83. https://doi.org/10.1155/2001/145041 . (PMID: 10.1155/2001/14504111493953); Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut. 1989;30:1737–49. https://doi.org/10.1136/gut.30.12.1737 . (PMID: 10.1136/gut.30.12.173726129881434461); Siproudhis L, et al. Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? - radiologic and manometric studies in 41 patients. Int J Colorectal Dis. 1992;7:102–7. https://doi.org/10.1007/BF00341295 . (PMID: 10.1007/BF003412951613294); Snooks SJ, Nicholls RJ, Henry MM, Swash M. Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome. Br J Surg. 1985;72:131–3. https://doi.org/10.1002/bjs.1800720221 . (PMID: 10.1002/bjs.18007202213971120); Mahieu PHG. Defecography explorations fonctionnelles. Ann Gastroenterol Hepatol (Paris). 1990;26:161–5. (PMID: 2375618); Halligan S, Nicholls RJ, Bartram CI. Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for a successful outcome. Br J Surg. 1995;82:314–7. https://doi.org/10.1002/bjs.1800820309 . (PMID: 10.1002/bjs.18008203097795993); A T, B T, M T. A rare cause of chronic rectal bleeding in children: solitary rectal ulcer (case report). Turk J Trauma Emerg Surg. 2011;2:173–6. https://doi.org/10.1007/s10350-006-0720-x . (PMID: 10.1007/s10350-006-0720-x); Minguez M, et al. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology. 2004;126:57–62. https://doi.org/10.1053/j.gastro.2003.10.044 . (PMID: 10.1053/j.gastro.2003.10.04414699488); Frattini JC, Nogueras JJ. Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg. 2008;21:146–52. https://doi.org/10.1055/s-2008-1075864 . (PMID: 10.1055/s-2008-1075864200114112780201); Tendler DA, Aboudola S, Zacks JF, O’Brien MJ, Kelly CP. Prolapsing mucosal polyps: an underrecognized form of colonic polyp-a clinicopathological study of 15 cases. Am J Gastroenterol. 2002;97:370–6. https://doi.org/10.1111/j.1572-0241.2002.05472.x . (PMID: 10.1111/j.1572-0241.2002.05472.x11866275); Van den Brandt-Grädel V, Huibregtse K, Tytgat GNJ. Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation. Dig Dis Sci. 1984;29:1005–8. https://doi.org/10.1007/BF01311251 . (PMID: 10.1007/BF013112516092015); Sathish R, Ramazan O, Ocampo D. Pathophysiology and role of biofeedback therapy in solitary rectal ulcer: official journal of the American College of Gastroenterology | ACG. Am J Gastroenterol. 2006;3:613–8. https://doi.org/10.1111/j.1572-0241.2006.00466.x . (PMID: 10.1111/j.1572-0241.2006.00466.x); Malouf AJ, Vaizey CJ, Kamm MA. Results of behavioral treatment (biofeedback) for solitary rectal ulcer syndrome. Dis Colon Rectum. 2001;44:72–6. https://doi.org/10.1007/BF02234824 . (PMID: 10.1007/BF0223482411805566); Arı D, Öztürk Ö, Özin Y, Tenlik İ, Bacaksız F, Gökbulut V, et al. The efficacy of biofeedback therapy in patients with solitary rectal ulcer and dyssynergic defecation. Dig Dis. 2022;40(6):728–33. https://doi.org/10.1159/000522180 . (PMID: 10.1159/00052218035100590); Zargar SA, Khuroo MS, Mahajan R. Sucralfate retention enemas in solitary rectal ulcer. Dis Colon Rectum. 1991;34:455–7. https://doi.org/10.1007/BF02049928 . (PMID: 10.1007/BF020499282036924); Keshtgar AS, Ward HC, Sanei A, Clayden GS. Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: long-term follow-up of a double-blind randomized trial. J Pediatr Surg. 2007;42:672–80. https://doi.org/10.1016/j.jpedsurg.2006.12.045 . (PMID: 10.1016/j.jpedsurg.2006.12.04517448764); Shahid A, Hinna RE, Haider E, Khan RSA, Siddiqi FA, Khan ZA. Argon plasma coagulation: an effective treatment for solitary rectal ulcer syndrome. Ann Saudi Med. 2024;44(1):26–30. https://doi.org/10.5144/0256-4947.2024.26 . (PMID: 10.5144/0256-4947.2024.263831187110839455); Vincenzo S, et al. Argon plasma coagulation of hemorrhagic solitary rectal. J Clin Gastroenterol. 2003;5:392–4. https://doi.org/10.1097/00004836-200311000-00008 . (PMID: 10.1097/00004836-200311000-00008); Nadi A, Cherouaqi Y, Oulammou Z, Delsa H, Rouibaa F. The impact of argon plasma coagulation in the treatment of a solitary rectal ulcer syndrome revealed by massive hemorrhage. Cureus. 2022;14:23–112. https://doi.org/10.7759/cureus.23112 . (PMID: 10.7759/cureus.23112); Sitzler PJ, Kamm MA, Nicholls RJ, Mckee RF. Long-term clinical outcome of surgery for solitary rectal ulcer syndrome. Br J Surg. 1998;85:1246–50. https://doi.org/10.1046/j.1365-2168.1998.00854.x . (PMID: 10.1046/j.1365-2168.1998.00854.x9752869); Tweedie DJ, Varma JS. Long-term outcome of laparoscopic mesh rectopexy for solitary rectal ulcer syndrome. Colorectal Dis. 2005;7:151–5. https://doi.org/10.1111/j.1463-1318.2004.00729.x . (PMID: 10.1111/j.1463-1318.2004.00729.x15720353); Marchal F, et al. Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years. Int J Colorectal Dis. 2001;16:228–33. https://doi.org/10.1007/s003840100303 . (PMID: 10.1007/s00384010030311515682); Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971;173(6):993–1006. https://doi.org/10.1097/00000658-197106010-00018 . (PMID: 10.1097/00000658-197106010-0001855788081397506); Jamabo R, Ogu R. Rectal prolapse in pregnancy: a case report. J Med Biomed Res. 2009;4:22–6. https://doi.org/10.4314/jmbr.v4i1.10675 . (PMID: 10.4314/jmbr.v4i1.10675) |
| Contributed Indexing: | Keywords: Anorectal manometry; Biofeedback therapy; Defecography; Rectal bleeding; Rectal prolapse; Solitary rectal ulcer syndrome |
| Entry Date(s): | Date Created: 20260518 Date Completed: 20260518 Latest Revision: 20260518 |
| Update Code: | 20260518 |
| DOI: | 10.1007/s11894-026-01045-2 |
| PMID: | 42149300 |
| Database: | MEDLINE |
Journal Article; Review