Materiały źródłowe

• #1 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. […] In addition, the etiology is not known but may involve a number of mechanisms. For example, ischemic injury from pressure of impacted stools and local trauma due to repeated self-digitation may be contributing factors. […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. The most accepted theories are related to direct trauma or local ischemia as causes. […] Mucosal prolapse, overt or occult, is the most common underlying pathogenetic mechanism in SRUS.

• #1 Health Information Library | Rumah Sakit Pusat Pertamina

  https://rspp.co.id/dcontent.html?id=CON-20377737&n=Solitary%20rectal%20ulcer%20syndrome

  Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation. […] It’s not always clear what causes solitary rectal ulcer syndrome. Doctors believe stress or injury to the rectum may cause rectal ulcers to form. […] Among the things that could injure the rectum are: Constipation or hardened stool in the rectum that’s difficult to pass (impacted stool), Straining during bowel movements, A stretched rectum that comes out of the anus (rectal prolapse), Uncoordinated tightening of the pelvic floor muscles that slows blood flow to the rectum, Attempts to manually remove impacted stool, When one part of the intestine slides inside another part (intussusception).

• #1 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. […] The underlying mechanisms leading to SRUS are not certainly recognized. However, various factors are considered to have a role. Here we propose four main categories known to be involved. First, prolonged straining during defecation, which might end in direct trauma to the vulnerable rectal mucosa. […] Disorganized contraction of puborectalis muscle in response to attempt on defecation is a well-proposed etiology, which result in higher pressures in anorectal area. […] The excessive pressure generated as the aggregate result of constipation, straining and puborectalis aberrant contraction may end in rectal prolapse and intussusception in the long run. […] Apart from these explanations, some unknown factors may also be involved. […] Overall, it seems that chronic mucosal injury and ischemic trauma are the main mechanisms though further studies may shed more light on the process.

• #1

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  The pathogenesis of SRUS is not well known; various factors may be involved in its creation and development, which should be considered. It has been stated that the most important theories are associated with direct trauma or causes of local ischemia. […] Lengthened straining during bowel movements in the patient who suffers from constipation may result in a direct trauma to the mucosa. […] Self-instrumentation can be occurred when individuals attempt to remove impacted stool by rectal digitation. […] Uncoordinated muscle contraction in the puborectalis muscle has been indicated to be associated with increased intrarectum pressure and anal canal, resulting in ischemic production and ulceration. […] Rectal intussusception can lead to localized vascular trauma and consequently the onset of solitary local ulceration.

• #1 Solitary Rectal Ulcer Syndrome – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is caused by mucosal ischemia of the distal rectal mucosa resulting from trauma. […] Causes include rectal prolapse, paradoxical contraction of the puborectalis muscle, chronic constipation, and attempts at manual disimpaction of hard stools. […] If rectal prolapse is the cause, surgery may be needed.

• #1 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  The cause of ischemia may also be related to fibroblasts replacing blood vessels, and pressure by the anal sphincter. […] Self-digitation maneuver to reduce rectal prolapse or to evacuate an impacted stool may also cause direct trauma of the mucosa and ulceration. […] Although this hypothesis seems plausible, it remains unproven because rectal mucosal intussusception is common even in healthy subjects, but rectal prolapse and SRUS are rare. […] In children, secondary to chronic mechanical and ischemic trauma, inflammation by hard stools, and intussusceptions of the rectal mucosa, some histological features of SRUS can be seen, such as fibromuscular obliteration of the lamina propria and disorientation of muscle fibers.

• #1 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  It is thought that this self-induced trauma is one possible mechanism of SRUS. […] Prolonged straining may cause direct trauma to the rectal mucosa. […] The excessive pressure caused by straining (i.e. dyssynergic defecation and constipation) may in the long term lead to development of the spectrum of rectal prolapse conditions (mucosal versus full-thickness prolapse, internal versus external rectal prolapse). […] Psychological factors are also thought to be involved, since patients with SRUS sometimes have psychological disorders such as obsessive-compulsive disorder.

• #1 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Solitary rectal ulcer syndrome (SRUS) is a disorder affecting all ages and presents with rectal bleeding, mucorrhea, tenesmus and feeling of incomplete evacuation. Pathogenesis of SRUS is not known. Mucosal ischemia was proposed to be an etiological factor in the past. Recently, fecal evacuation disorder (FED; also known as functional defecation disorder) has been proposed to be an important factor in the pathogenesis of SRU in a few uncontrolled studies on small number of patients. The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without. Pathogenesis of SRUS is largely unknown. Mucosal ischemia was proposed to be one of the mechanisms in the past. A few recent uncontrolled studies on small number of patients suggested a role of FED in the pathogenesis of SRUS. We found that a large proportion of patients with SRU had underlying FED and those with FED had thicker IAS. However, whether FED and increased IAS thickness are causes or effects of SRUS is not known. In conclusion, FED was more common among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal anal sphincter on EUS than those without.

• #1

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  Solitary rectal ulcer syndrome (SRUS) is an unusual rectal disorder that does not necessarily end with an ulcer and may affect different parts of the rectum and other site of gastrointestinal tract. […] The cause of this syndrome is unclear and may have various factors in causing a lesion simultaneously, including rectal prolapse, chronic, and severe constipation. SRUS is often caused by chronic constipation, which can be associated with straining during defecation, rectal bleeding, tenesmus, mucoid secretion from the rectum, rectal pain, and a sense of incomplete evacuation. […] However, the etiology, pathophysiology, and clinical manifestations of SRUS are not fully understood. Given different clinical symptoms and endoscopic findings, SRUS may be confused with disorders such as inflammatory bowel disease (IBD) and neoplasms.

• #1 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the rectal mucosa (the lining of the rectum). […] The condition may be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation (anismus). […] The exact cause is unclear and the condition is not fully understood. […] There are thought to be multiple factors which simultaneously cause the condition. […] Long term injury to the rectal mucosa and ischemic trauma (restriction in blood supply and oxygen to tissues) are thought to be the main mechanisms. […] In a report of 36 patients with SRUS, the underlying cause was internal rectal prolapse (internal intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients.

• #1 Solitary Rectal Ulcer Syndrome Treatment in Pune- Kaizen Gastro Care

  https://www.kaizengastrocare.com/solitary-rectal-ulcer-syndrome-treatment-in-pune/

  Solitary rectal ulcer syndrome (SRUS) is a rare condition that affects the rectum, which is the last part of the large intestine. It is characterized by the presence of a single ulcer or a cluster of ulcers in the rectal lining. SRUS is assumed a benign condition and is not associated with an improved risk of colorectal cancer. […] The exact causes of solitary rectal ulcer syndrome (SRUS) are not well understood. However, several aspects have been proposed to contribute to the evolution of SRUS. These possible causes include: Chronic constipation, Straining during bowel movements, A prolonged rectum that arrives out of the anus (rectal prolapse), Abnormal rectal muscle function, Attempts to manually remove impacted stool, Ischemia and impaired blood flow, Trauma or injury to the rectal area, Inflammatory bowel disease (IBD). […] Its important to note that while these aspects are often associated with SRUS, the disorder can also occur in the absence of any identifiable cause. Further study is needed to fully understand the underlying mechanisms and causes of SRUS.

• #1 Coexistence of Solitary Rectal Ulcer Syndrome and Ulcerative Colitis: A Case Report and Literature Review

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2014.12.1.70

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. […] Its pathogenesis is probably multifactorial, and most accepted causes implicate direct trauma by repetitive self-digitation and ischemic injury to the rectal mucosa. […] SRUS is diagnosed by a combination of clinical aspects, endoscopic presentations, and histologic findings. […] SRUS is an uncommon benign disorder of defecation and is difficult to distinguish from malignancy and IBD because of variable clinical and endoscopic manifestations. […] Misdiagnosis of SRUS as malignancy can lead to unnecessary surgery. […] SRUS accompanied by IBD is extremely rare, and an accurate differential diagnosis is difficult to achieve.

• #1

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  The diagnosis of SRUS is usually done by analyzing the outcomes of symptoms, endoscopy, sigmoidoscopy, and histology. […] The syndrome is characterized by histological features, the importance of which can be summarized according to the following characteristic appearance: Thickening of the mucosal layer along with crypts distortion; Fibromuscular obliteration in the lamina propria has been reported to be the cornerstone for diagnosing SRUS. […] Medical imaging technique such as magnetic resonance imaging (MRI), defecating proctography, transrectal and endoanal ultrasound, and barium enema have been reported to be most important diagnostic methods for imaging evaluation. […] Surgical treatment is recommended for patients who suffer from full-thickness or rectal mucosal prolapse or for those who are resistant to conservative management and biofeedback treatment. […] Options that are recommended for surgery include rectopexy, perineal proctectomy (Altemeier procedure), excision, diversion, as well as Delorme procedure as mucosal resection. […] The pathogenesis of SRUS is not adequately described, but various factors can be involved.

• #1 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  Currently, no specified treatment guideline is available for SRUS. The treatment includes correcting the pathogenic mechanisms by softening the stool through behavioral changes (to avoid staying on the toilet for a long time, not straining for a long time, and using a squat toilet or putting a step under the feet if the feet do not reach the floor when using a European toilet), bowel training, and the use of laxatives. Topical treatments for ulcers include sucralfate, sulfasalazine/mesalazine, and corticosteroids. In recent years, argon plasma coagulation therapy has been included in the treatment. […] The treatment of SRUS varies according to the severity of symptoms. Treatment planning is usually individualized. First, patient education and behavioral changes, such as not staying on the toilet for a long time, not straining for a long time, high fiber diet, and laxatives are recommended to prevent and treat constipation. If these conservative measures produce no improvement, topical treatments, including sucralfate, sulfasalazine/mesalazine, and corticosteroids, can be added.

• #2 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the rectal mucosa (the lining of the rectum). […] The condition may be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation (anismus). […] The exact cause is unclear and the condition is not fully understood. […] There are thought to be multiple factors which simultaneously cause the condition. […] Long term injury to the rectal mucosa and ischemic trauma (restriction in blood supply and oxygen to tissues) are thought to be the main mechanisms. […] In a report of 36 patients with SRUS, the underlying cause was internal rectal prolapse (internal intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients.

• #2 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Solitary rectal ulcer syndrome (SRUS) is a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] The etiology is not known but may involve a number of mechanisms. For example, ischemic injury from pressure of impacted stools and local trauma due to repeated self-digitation may be contributing factors. […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. The most accepted theories are related to direct trauma or local ischemia as causes. […] It has been suggested that descent of the perineum and abnormal contraction of the puborectalis muscle during straining on defecation or defecation in the squatting position result in trauma and compression of the anterior rectal wall on the upper anal canal, and internal intussusceptions or prolapsed rectum.

• #2 Solitary rectal ulcer syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/symptoms-causes/syc-20377749?_escaped_fragment_=&p=1

  Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation. […] It’s not always clear what causes solitary rectal ulcer syndrome. Doctors believe stress or injury to the rectum may cause rectal ulcers to form.

• #2 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  It is thought that this self-induced trauma is one possible mechanism of SRUS. […] Prolonged straining may cause direct trauma to the rectal mucosa. […] The excessive pressure caused by straining (i.e. dyssynergic defecation and constipation) may in the long term lead to development of the spectrum of rectal prolapse conditions (mucosal versus full-thickness prolapse, internal versus external rectal prolapse). […] Psychological factors are also thought to be involved, since patients with SRUS sometimes have psychological disorders such as obsessive-compulsive disorder.

• #2 Solitary Rectal Ulcer Syndrome and Stercoral Ulcers | Abdominal Key

  https://abdominalkey.com/solitary-rectal-ulcer-syndrome-and-stercoral-ulcers/

  As mentioned earlier, the underlying cause for this type of ulceration is chronic local ischemia of the colonic wall. Although the gradual sequence of this pathology may originate for various reasons, SRUS has been related to several independent clinical settings. […] Rectal intussusception, which may lead to full-thickness rectal prolapse, results in localized vascular trauma and ischemia, initiating solitary local ulceration. […] This uncoordinated sequence of muscle contraction and relaxation required for the defecation process, also called puborectalis syndrome or pelvic outlet obstruction, causes increased pressure inside the rectum and anal canal, generating ischemia and ulceration. […] Localized rectal trauma, mainly from digitation or self-instrumentation, has been proposed as one of the causes of SRUS. […] Further supportive evidence for the substantial role of mucosal perfusion and ischemia in the pathogenesis of SRUS is the use of ergotamine suppositories. […] Radiotherapy, which in the long term affects permanently small blood vessels, has been cited as potentially antecedent to SRUS as well.

• #2 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Mucosal prolapse, overt or occult, is the most common underlying pathogenetic mechanism in SRUS. […] The cause of ischemia may also be related to fibroblasts replacing blood vessels, and pressure by the anal sphincter. […] Self-digitation maneuver to reduce rectal prolapse or to evacuate an impacted stool may also cause direct trauma of the mucosa and ulceration. […] The cause of SRUS is unknown. […] The clinical presentation varies, therefore, early diagnosis requires a high index of suspicion from both the surgeon and the pathologist, especially because the term solitary rectal ulcer is a misnomer and only a quarter of the adults with SRUS have a true rectal ulcer, and the lesion is not necessarily solitary or ulcerated.

• #2 Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

  https://www.mdpi.com/1648-9144/58/8/1136

  A relevant study considered that rectal intussusception could lead to localized vascular trauma and, consequently, the onset of solitary local ulceration, while other studies showed that uncoordinated muscle contraction in the puborectalis muscle may be associated with increased intra-rectum pressure and pressure in the anal canal, which resulted in ulceration. […] The histological features of SRUS are characterized by a thickening mucosal layer, fibromuscular obliteration, mucous cell proliferation, mucosal gland distortion, etc. […] SRUS is easily misdiagnosed as rectal cancer, based on the similarity in the symptomatic profiles and endoscopic features, which include bleeding, mucus discharge, and chronic and severe constipation.

• #2 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome/print

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] The pathogenesis of the solitary rectal ulcer is incompletely understood. However, a number of factors appear to have a causative role in individual reports. It is possible that different etiologies may contribute to the development of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle.

• #2 Solitary rectal ulcer syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation. […] It’s not always clear what causes solitary rectal ulcer syndrome. Doctors believe stress or injury to the rectum may cause rectal ulcers to form. […] Among the things that could injure the rectum are: constipation or hardened stool in the rectum that’s difficult to pass (impacted stool), straining during bowel movements, a stretched rectum that comes out of the anus (rectal prolapse), uncoordinated tightening of the pelvic floor muscles that slows blood flow to the rectum, attempts to manually remove impacted stool, when one part of the intestine slides inside another part (intussusception).

• #2 Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

  https://www.termedia.pl/Solitary-rectal-ulcer-syndrome-and-enterocele-in-a-13-year-old-boy,41,21157,1,1.html

  Occult or overt rectal prolapse and paradoxical contraction of the pelvic floor muscles are the most commonly attributed factors involved in development of SRUS. […] Psychological problems associated with the syndrome have been explored only superficially. […] A disturbance of toileting behavior as an expression of psychological problems appears to be an important pathogenic factor in some patients.

• #2 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Solitary rectal ulcer syndrome (SRUS) is a disorder affecting all ages and presents with rectal bleeding, mucorrhea, tenesmus and feeling of incomplete evacuation. Pathogenesis of SRUS is not known. Mucosal ischemia was proposed to be an etiological factor in the past. Recently, fecal evacuation disorder (FED; also known as functional defecation disorder) has been proposed to be an important factor in the pathogenesis of SRU in a few uncontrolled studies on small number of patients. The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without. Pathogenesis of SRUS is largely unknown. Mucosal ischemia was proposed to be one of the mechanisms in the past. A few recent uncontrolled studies on small number of patients suggested a role of FED in the pathogenesis of SRUS. We found that a large proportion of patients with SRU had underlying FED and those with FED had thicker IAS. However, whether FED and increased IAS thickness are causes or effects of SRUS is not known. In conclusion, FED was more common among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal anal sphincter on EUS than those without.

• #2 Solitary Rectal Ulcer Syndrome Treatment in Pune- Kaizen Gastro Care

  https://www.kaizengastrocare.com/solitary-rectal-ulcer-syndrome-treatment-in-pune/

  Solitary rectal ulcer syndrome (SRUS) is a rare condition that affects the rectum, which is the last part of the large intestine. It is characterized by the presence of a single ulcer or a cluster of ulcers in the rectal lining. SRUS is assumed a benign condition and is not associated with an improved risk of colorectal cancer. […] The exact causes of solitary rectal ulcer syndrome (SRUS) are not well understood. However, several aspects have been proposed to contribute to the evolution of SRUS. These possible causes include: Chronic constipation, Straining during bowel movements, A prolonged rectum that arrives out of the anus (rectal prolapse), Abnormal rectal muscle function, Attempts to manually remove impacted stool, Ischemia and impaired blood flow, Trauma or injury to the rectal area, Inflammatory bowel disease (IBD). […] Its important to note that while these aspects are often associated with SRUS, the disorder can also occur in the absence of any identifiable cause. Further study is needed to fully understand the underlying mechanisms and causes of SRUS.

• #2 Solitary Rectal Ulcer Syndrome – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is caused by mucosal ischemia of the distal rectal mucosa resulting from trauma. […] Causes include rectal prolapse, paradoxical contraction of the puborectalis muscle, chronic constipation, and attempts at manual disimpaction of hard stools. […] If rectal prolapse is the cause, surgery may be needed.

• #2 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  Solitary rectal ulcer syndrome (SRUS) is rarely seen in the pediatric population and is encountered more frequently in adolescent children. The etiology of SRUS is unclear. In healthy individuals, the puborectalis muscle relaxes during defecation, allowing the rectum to flatten and empty. On the other hand, this relaxation does not occur in patients with SRUS, who show tertiary contractions. Rectal hypersensitivity, which causes the feelings of a constant need to defecate and incomplete excretion, results in trauma, ischemia, and ulceration of the mucosa because of the inappropriate contraction of the puborectalis muscle and rectal mucosal prolapse. The diagnosis is based on the clinical findings, detection of an ulcer on the anterior wall of the rectum by colonoscopy, and characteristic histopathological changes. Although suggestive of a single ulcer, lesions may be multiple and of different shapes and sizes (ulcerative, polypoidal/nodular, or erythematous mucosa only). The histopathological findings distinguishing these lesions from other rectal diseases are fibromuscular obliteration of the lamina propria and the disorientation of muscle fibers.

• #2 Causes of Solitary Rectal Ulcer: 2024 Insights | Vejthani

  https://www.vejthani.com/diseases-conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndromes exact cause is often unclear. However, medical professionals speculate that rectal ulcers may develop due to stress or damage to the rectum. Among the potential causes of rectus injury are: […] Difficulty passing constipated or firm rectum stools (impacted stool) […] Pain while having a bowel movement. […] An extended rectum that protrudes from the anus (rectal prolapse) […] The rectums blood flow is slowed by the pelvic floor muscles contracting erratically. […] Manual removal of the affected stool […] When an intestine slides within another intestine (intussusception)

• #2 Solitary Rectal Ulcer Syndrome – Birmingham Pelvic Floor Clinic

  https://birminghampelvicfloorclinic.com/conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome is not very common. Patients have inflammation and thickening in the rectum sometimes this is associated with an internal rectal prolapse (intusseception). […] The causes are uncertain, but a number of factors have been implicated. Excessive straining can cause a degree of internal prolapse. If this happens and the prolapse telescopes down into the anus it can be rubbed, causing it to become inflamed and ulcerated. Some patients use a finger in the anus to help open their bowel and this may be a cause of inflammation.

• #2 Rectal Ulcer: Symptoms, Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/rectal-ulcer

  The exact cause of a rectal ulcer isnt always clear. […] In rare cases, rectal ulcers can also develop without an obvious cause if you have a condition called solitary rectal ulcer syndrome (SRUS). SRUS often means youll have rectal ulcers without any other symptoms like pain or changes in your stool.

• #2

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  Solitary rectal ulcer syndrome (SRUS) is an unusual rectal disorder that does not necessarily end with an ulcer and may affect different parts of the rectum and other site of gastrointestinal tract. […] The cause of this syndrome is unclear and may have various factors in causing a lesion simultaneously, including rectal prolapse, chronic, and severe constipation. SRUS is often caused by chronic constipation, which can be associated with straining during defecation, rectal bleeding, tenesmus, mucoid secretion from the rectum, rectal pain, and a sense of incomplete evacuation. […] However, the etiology, pathophysiology, and clinical manifestations of SRUS are not fully understood. Given different clinical symptoms and endoscopic findings, SRUS may be confused with disorders such as inflammatory bowel disease (IBD) and neoplasms.

• #2 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?uid=5986&vmd=Full&

  Currently, no specified treatment guideline is available for SRUS. The treatment includes correcting the pathogenic mechanisms by softening the stool through behavioral changes (to avoid staying on the toilet for a long time, not straining for a long time, and using a squat toilet or putting a step under the feet if the feet do not reach the floor when using a European toilet), bowel training, and the use of laxatives. Topical treatments for ulcers include sucralfate, sulfasalazine/mesalazine, and corticosteroids. In recent years, argon plasma coagulation therapy has been included in the treatment.

• #2

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  The diagnosis of SRUS is usually done by analyzing the outcomes of symptoms, endoscopy, sigmoidoscopy, and histology. […] The syndrome is characterized by histological features, the importance of which can be summarized according to the following characteristic appearance: Thickening of the mucosal layer along with crypts distortion; Fibromuscular obliteration in the lamina propria has been reported to be the cornerstone for diagnosing SRUS. […] Medical imaging technique such as magnetic resonance imaging (MRI), defecating proctography, transrectal and endoanal ultrasound, and barium enema have been reported to be most important diagnostic methods for imaging evaluation. […] Surgical treatment is recommended for patients who suffer from full-thickness or rectal mucosal prolapse or for those who are resistant to conservative management and biofeedback treatment. […] Options that are recommended for surgery include rectopexy, perineal proctectomy (Altemeier procedure), excision, diversion, as well as Delorme procedure as mucosal resection. […] The pathogenesis of SRUS is not adequately described, but various factors can be involved.

• #3 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome/print

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] The pathogenesis of the solitary rectal ulcer is incompletely understood. However, a number of factors appear to have a causative role in individual reports. It is possible that different etiologies may contribute to the development of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle.

• #3 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. […] The underlying mechanisms leading to SRUS are not certainly recognized. However, various factors are considered to have a role. Here we propose four main categories known to be involved. First, prolonged straining during defecation, which might end in direct trauma to the vulnerable rectal mucosa. […] Disorganized contraction of puborectalis muscle in response to attempt on defecation is a well-proposed etiology, which result in higher pressures in anorectal area. […] The excessive pressure generated as the aggregate result of constipation, straining and puborectalis aberrant contraction may end in rectal prolapse and intussusception in the long run. […] Apart from these explanations, some unknown factors may also be involved. […] Overall, it seems that chronic mucosal injury and ischemic trauma are the main mechanisms though further studies may shed more light on the process.

• #3

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  The pathogenesis of SRUS is not well known; various factors may be involved in its creation and development, which should be considered. It has been stated that the most important theories are associated with direct trauma or causes of local ischemia. […] Lengthened straining during bowel movements in the patient who suffers from constipation may result in a direct trauma to the mucosa. […] Self-instrumentation can be occurred when individuals attempt to remove impacted stool by rectal digitation. […] Uncoordinated muscle contraction in the puborectalis muscle has been indicated to be associated with increased intrarectum pressure and anal canal, resulting in ischemic production and ulceration. […] Rectal intussusception can lead to localized vascular trauma and consequently the onset of solitary local ulceration.

• #3 Solitary Rectal Ulcer Syndrome – Clinical Tree

  https://clinicalpub.com/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome (SRUS) is a chronic benign disorder of the rectum and pelvic floor that produces ulcerated and polypoid areas in the rectal wall. […] Although poorly understood, the cause of SRUS is thought to be disordered rectal evacuation associated with straining. […] A degree of rectal prolapse or intussusception and outlet obstruction attributed either to the redundant rectal wall, paradoxical contraction of puborectalis, or both is common to patients diagnosed with SRUS. […] It is likely that the individual presentation of each affected patient is determined by the degree of prolapse, the redundancy of tissue, and the strength of straining as patients seek to defecate and satisfy the urge they are feeling. […] However, it is the combination of rectal prolapse and paradoxical contraction of the puborectalis that seems to generate the ulceration seen in persons with SRUS.

• #3 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the rectal mucosa (the lining of the rectum). […] The condition may be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation (anismus). […] The exact cause is unclear and the condition is not fully understood. […] There are thought to be multiple factors which simultaneously cause the condition. […] Long term injury to the rectal mucosa and ischemic trauma (restriction in blood supply and oxygen to tissues) are thought to be the main mechanisms. […] In a report of 36 patients with SRUS, the underlying cause was internal rectal prolapse (internal intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients.

• #3 Solitary rectal ulcer syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/solitary-rectal-ulcer-syndrome-1?lang=us

  Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder characterized by the presence of an abnormality of the rectum in persons who have a long history of straining during defecation. […] Two functional disorders of defecation have been recognized: Rectal intussusception and Spastic pelvic floor syndrome. […] The rectal wall invaginates into the distal portion of the rectal lumen or the anal canal. Invagination of the rectal wall causes stretching of submucosal vessels, ischemia, and ulceration. […] There is an association with proctitis cystica profunda.

• #3 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  Solitary rectal ulcer syndrome (SRUS) is rarely seen in the pediatric population and is encountered more frequently in adolescent children. The etiology of SRUS is unclear. In healthy individuals, the puborectalis muscle relaxes during defecation, allowing the rectum to flatten and empty. On the other hand, this relaxation does not occur in patients with SRUS, who show tertiary contractions. Rectal hypersensitivity, which causes the feelings of a constant need to defecate and incomplete excretion, results in trauma, ischemia, and ulceration of the mucosa because of the inappropriate contraction of the puborectalis muscle and rectal mucosal prolapse. The diagnosis is based on the clinical findings, detection of an ulcer on the anterior wall of the rectum by colonoscopy, and characteristic histopathological changes. Although suggestive of a single ulcer, lesions may be multiple and of different shapes and sizes (ulcerative, polypoidal/nodular, or erythematous mucosa only). The histopathological findings distinguishing these lesions from other rectal diseases are fibromuscular obliteration of the lamina propria and the disorientation of muscle fibers.

• #3 Solitary Rectal Ulcer Syndrome – Birmingham Pelvic Floor Clinic

  https://birminghampelvicfloorclinic.com/conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome is not very common. Patients have inflammation and thickening in the rectum sometimes this is associated with an internal rectal prolapse (intusseception). […] The causes are uncertain, but a number of factors have been implicated. Excessive straining can cause a degree of internal prolapse. If this happens and the prolapse telescopes down into the anus it can be rubbed, causing it to become inflamed and ulcerated. Some patients use a finger in the anus to help open their bowel and this may be a cause of inflammation.

• #3 A Rare Cause of Occult Gastrointestinal Bleeding: Solitary Rectal Ulcer Syndrome – Caucasian Medical Journal

  https://caucasianmedj.com/articles/a-rare-cause-of-occult-gastrointestinal-bleeding-solitary-rectal-ulcer-syndrome/doi/cmj.galenos.2024.77486

  Occult gastrointestinal (GI) bleeding is defined as iron deficiency anemia or positive fecal guaiac test results without obvious bleeding. […] Despite its rarity, solitary rectal ulcer syndrome (SRUS) can result in occult bleeding. […] Although a solitary rectal ulcer usually causes rectal pain and obvious GI bleeding, it can sometimes cause occult GI bleeding. […] Multiple factors may play a role in the underlying etiology, although it is not fully understood. Direct trauma or local ischemia is the most widely accepted theories. It has been suggested that excessive straining during defecation can lead to trauma and compression of the anterior rectal wall on the upper anal canal, which can cause ischemic damage. […] Studies have shown that 82% of patients with SRUS may have dyssynergic defecation.

• #3 Coexistence of Solitary Rectal Ulcer Syndrome and Ulcerative Colitis: A Case Report and Literature Review

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2014.12.1.70

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. […] Its pathogenesis is probably multifactorial, and most accepted causes implicate direct trauma by repetitive self-digitation and ischemic injury to the rectal mucosa. […] SRUS is diagnosed by a combination of clinical aspects, endoscopic presentations, and histologic findings. […] SRUS is an uncommon benign disorder of defecation and is difficult to distinguish from malignancy and IBD because of variable clinical and endoscopic manifestations. […] Misdiagnosis of SRUS as malignancy can lead to unnecessary surgery. […] SRUS accompanied by IBD is extremely rare, and an accurate differential diagnosis is difficult to achieve.

• #3 Coexistence of Solitary Rectal Ulcer Syndrome and Ulcerative Colitis: A Case Report and Literature Review

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2014.12.1.70

  The characteristic histological findings in all three cases were fibromuscular obliteration of the lamina propria, thickening of the muscularis mucosa, and elongation and distortion of the crypt. […] No known mechanism can link UC to the development of SRUS. […] However, the development of the solitary rectal ulcer near the UC lesion indicates a possible sequential relationship between SRUS and UC.

• #4 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  The cause of ischemia may also be related to fibroblasts replacing blood vessels, and pressure by the anal sphincter. […] Self-digitation maneuver to reduce rectal prolapse or to evacuate an impacted stool may also cause direct trauma of the mucosa and ulceration. […] Although this hypothesis seems plausible, it remains unproven because rectal mucosal intussusception is common even in healthy subjects, but rectal prolapse and SRUS are rare. […] In children, secondary to chronic mechanical and ischemic trauma, inflammation by hard stools, and intussusceptions of the rectal mucosa, some histological features of SRUS can be seen, such as fibromuscular obliteration of the lamina propria and disorientation of muscle fibers.

• #4 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Solitary rectal ulcer syndrome (SRUS) is a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] The etiology is not known but may involve a number of mechanisms. For example, ischemic injury from pressure of impacted stools and local trauma due to repeated self-digitation may be contributing factors. […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. The most accepted theories are related to direct trauma or local ischemia as causes. […] It has been suggested that descent of the perineum and abnormal contraction of the puborectalis muscle during straining on defecation or defecation in the squatting position result in trauma and compression of the anterior rectal wall on the upper anal canal, and internal intussusceptions or prolapsed rectum.

• #4 Solitary rectal ulcer syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/solitary-rectal-ulcer-syndrome-1?embed_domain=external.radpair.com%2525252527%252525255B0%252525255D%2525252527%252525255B0%252525255D&lang=us

  Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder characterized by the presence of an abnormality of the rectum in persons who have a long history of straining during defecation. It is a misnomer because only a third of patients have a solitary ulcer, some have multiple ulcers and many have no ulcers at all. […] Two functional disorders of defecation have been recognized: Rectal intussusception and Spastic pelvic floor syndrome. The rectal wall invaginates into the distal portion of the rectal lumen or the anal canal. Invagination of the rectal wall causes stretching of submucosal vessels, ischemia, and ulceration. […] There is an association with proctitis cystica profunda.

• #4 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  It is thought that this self-induced trauma is one possible mechanism of SRUS. […] Prolonged straining may cause direct trauma to the rectal mucosa. […] The excessive pressure caused by straining (i.e. dyssynergic defecation and constipation) may in the long term lead to development of the spectrum of rectal prolapse conditions (mucosal versus full-thickness prolapse, internal versus external rectal prolapse). […] Psychological factors are also thought to be involved, since patients with SRUS sometimes have psychological disorders such as obsessive-compulsive disorder.

• #5 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Mucosal prolapse, overt or occult, is the most common underlying pathogenetic mechanism in SRUS. […] The cause of ischemia may also be related to fibroblasts replacing blood vessels, and pressure by the anal sphincter. […] Self-digitation maneuver to reduce rectal prolapse or to evacuate an impacted stool may also cause direct trauma of the mucosa and ulceration. […] The cause of SRUS is unknown. […] The clinical presentation varies, therefore, early diagnosis requires a high index of suspicion from both the surgeon and the pathologist, especially because the term solitary rectal ulcer is a misnomer and only a quarter of the adults with SRUS have a true rectal ulcer, and the lesion is not necessarily solitary or ulcerated.

• #5 Solitary Rectal Ulcer Syndrome – Clinical Tree

  https://clinicalpub.com/solitary-rectal-ulcer-syndrome/

  Persistent and prolonged straining pushes the prolapsing rectum against a closed pelvic floor and results in mucosal ischemia, trauma, and ulceration through compressive and shear forces. […] More straining may exacerbate the prolapse, which then worsens the feeling of incomplete emptying, thus producing further straining in a vicious cycle.

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