Solitary Rectal Ulcer Syndrome: Clinical Management and Pathophysiology

Solitary Rectal Ulcer Syndrome (SRUS) is a benign but often debilitating defecatory disorder characterised by a spectrum of clinical, endoscopic and histopathological features. Patients may present with rectal bleeding, mucous discharge, tenesmus and straining, reflecting a complex interplay of mucosal prolapse, ischaemic injury and aberrant neuromuscular coordination. Endoscopically, SRUS may manifest as solitary or multiple ulcers, erythematous patches and polypoidal lesions, while histology consistently demonstrates fibromuscular obliteration of the lamina propria, crypt distortion and ectatic mucosal vessels. The pathophysiology centres on chronic trauma and pressure-induced mucosal injury, with contributory factors including dyssynergic defaecation, rectal hypersensitivity and local hypoperfusion. Management spans conservative measures—dietary fibre, laxatives, biofeedback—to topical agents (sucralfate, corticosteroid enemas) and, in refractory cases, surgical correction of rectal prolapse or endoscopic interventions. A multidisciplinary strategy, integrating gastroenterology, pelvic floor physiotherapy and colorectal surgery, is essential to tailor therapy, alleviate symptoms and reduce morbidity.

Research from Nature Portfolio

A recent retrospective analysis of 36 patients aged predominantly over 60 years has refined our understanding of clinical and laboratory correlates in SRUS. Haematochezia emerged as the most frequent symptom, and significant variations in inflammatory markers were noted among symptom groups. Histopathology revealed inflammation in 42 per cent of cases and rare dysplastic changes, underlining the need for repeated biopsies. Statistically significant associations between age, presenting features and biopsy findings support a stratified diagnostic approach. These insights reinforce the importance of comprehensive evaluation of clinical, laboratory and histological data to inform personalised management pathways and prognostic assessment.

Solitary Rectal Ulcer Syndrome: Clinical Management and Pathophysiology publication trend

The graph below shows the total number of articles in solitary rectal ulcer syndrome: clinical management and pathophysiology across all publications each year (not limited to Nature Index journals).

Technical terms

Tenesmus: A distressing sensation of incomplete rectal evacuation or persistent urge to defaecate despite an empty rectum.

Fibromuscular obliteration: Histological hallmark of SRUS, involving proliferation of fibrous tissue and smooth muscle within the lamina propria.

Argon plasma coagulation: Endoscopic haemostatic technique employing ionised argon gas to cauterise bleeding mucosa.

References

1. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterology (2012).
2. Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case. Scientific Reports (2025).
3. Clinical, Endoscopic, and Histologic Characteristics of Patients with Solitary Rectal Ulcer Syndrome at a Tertiary Care Center. Journal of Digestive Endoscopy (2023).
4. Solitary Rectal Ulcer Syndrome in Patients Presenting With Lower Gastrointestinal Bleeding: A Tertiary-Care Hospital Experience. Cureus (2023).
5. Endoscopic Mucosectomy: A Novel Technique for Management of Polypoidal Solitary Rectal Ulcer Syndrome. ACG Case Reports Journal (2021).