Materiały źródłowe

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

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

  Several treatment options have been used for SRUS, ranging from conservative treatment (i.e., diet and bulking agents), medical therapy, biofeedback and surgery. The choice of treatment depends upon the severity of symptoms and whether there is a rectal prolapse. […] Patient education and behavioral modification are the first steps in the treatment of SRUS. In particular, asymptomatic patients may not require any treatment other than behavioral modifications. Other suggestions for the treatment include reassurance of the patient that the lesion is benign, encouragement of a high-fiber diet, avoidance of straining, regulation of toilet habits, and attempt to discuss any psychosocial factors. […] The use of a high-fiber diet, in combination with stool softeners and bulking laxatives, and avoidance of straining have had varying responses. These dietary and behavioral modifications are especially effective in patients with mild to moderate symptoms and with absence of significant mucosal prolapse.

• #1 Solitary rectal ulcer syndrome | Altru Health System

  https://www.altru.org/health-library/conditions/solitary-rectal-ulcer-syndrome

  Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief through lifestyle changes, while people with more severe signs and symptoms may require medical or surgical treatment. […] Dietary changes. To relieve constipation, you may be given tips on increasing fiber in your diet. […] Behavior therapy. You may strain during bowel movements out of habit. Behavior therapy can help you learn to relax your pelvic muscles during bowel movements. […] In one behavioral technique, called biofeedback, a specialist teaches you to control certain involuntary body responses, such as the tightening of your anus or pelvic floor muscles, during defecation. Biofeedback may make you more aware of your straining and help you to control it.

• #1

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

  At the time of diagnosis, patients should be advised to use a high-fiber diet and bulk laxatives. They also need to be trained for prevention of straining and anal digitation. The toilet habits (time spent in the toilet) should be adjusted and defecation training should be noted. It is noteworthy that dietary and behavioral changes, especially in patients with mild to moderate symptoms, can be dramatically effective in the absence of mucosal prolapse, which can help in the improvement and prevention of disease progression. […] Conservative treatment may be no longer effective if the disease is more advanced, especially in cases where there is a high degree of intussusception in rectum, and, fibrosis, or external prolapse. In these cases, the resistance to conservative treatment may occur; subsequently, biofeedback can be promising in these patients for improving symptoms. Biofeedback is known as a variety of behavioral changes that are effective in reducing excessive straining with defecation through correction of abnormal pelvic floor behavior and stopping the use of suppositories and laxatives.

• #1 Solitary Rectal Ulcer Syndrome: Symptoms, Tests & Treatment

  https://my.clevelandclinic.org/health/diseases/21189-rectal-ulcers

  Try a laxative. Your provider may recommend taking a stool softener or bulking laxative to make stools easier to pass. […] Try medications that treat ulcers: A corticosteroid cream or suppository (such as hydrocortisone) can reduce inflammation, relieve pain and help the ulcers heal. […] If these treatments arent providing relief, your provider may recommend biofeedback therapy. […] If rectal prolapse or intussusception is causing your rectal ulcers, you may need a surgical procedure called a rectopexy to repair your rectum and place it into position. […] The good news is that there are treatments that heal sores and help manage solitary rectal ulcer syndrome.

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

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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] 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 was started with toilet training, a high-fiber diet, and laxatives. The patients were followed up every three months, and 5-Aminosalicylic acid (5-ASA) enema was added to the treatment in 11 (50%) patients who had no clinical improvement during the follow-up. A glucocorticoid enema was added in five (18.1%) patients who did not show improvement despite the initial treatment.

• #1 Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow | Gut

  https://gut.bmj.com/content/53/3/368

  Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow […] Biofeedback resulted in a significant improvement in rectal mucosal blood flow in subjects who felt subjectively better after biofeedback (p=0.001), from 165 (30) FU to 190 (40) FU. […] Gut directed biofeedback is an effective behavioural treatment for the majority of patients with SRUS. Mucosal blood flow is reduced to a similar level seen in normal transit constipation, suggesting similar impaired extrinsic autonomic cholinergic nerve activity. Successful outcome following biofeedback is associated with increased rectal mucosal blood flow, suggesting that improved extrinsic innervation to the gut may be partially responsible for the response to treatment.

• #1

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

  Studies have suggested that biofeedback is an appropriate and useful treatment for most patients with SRUS and an appropriate result has been achieved as a result of increased rectal mucosal blood flow. […] However, problems have also been addressed for this treatment. Of these problems, the lower number of patients who can be treated with this type of treatment can be noted, which leads to failure of treatment. In addition, over time, the effects of this type of treatment may be reduced in some patients. In fact, its short-term effects are beneficial because it is not effective in the long term. […] Topical therapy has been reported to be effective in some cases. Sucralfate enema, corticosteroids, and sulfasalazine enemas have been reported to be effective in improving the symptom in uncontrolled case series; however, their long-term effectiveness needs further evaluation.

• #1 Long term conservative approach in a young male with solitary rectal ulcer syndrome – MedCrave online

  https://medcraveonline.com/MOJCR/long-term-conservative-approach-in-a-young-male-with-solitary-rectal-ulcer-syndrome.html

  The solitary rectal ulcer syndrome is a rare entity commonly occurring in young patients. […] The patient was treated with combined sucralfate and prednisolone enema for one week. This was followed with only sucralfate enema for further two weeks. Bulk laxative ispgoal husk was given with fresh yoghurt and biofeedback therapy given continuously to this patient as long term conservative approach. […] So long term conservative therapy is recommended in all patients with solitary rectal ulcer syndrome. […] Conservative treatment consists of different types of enemas, bulk laxatives and biofeedback. […] The various treatment modalities for treatment of SRUS are bulk formers, laxatives, sucralfate enema, biofeedback and surgery in some cases. […] Both conservative and operative management have limitations.

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

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

  However, it would appear that conservative approaches are less useful when SRUS is associated with an advanced grade of rectal intussusception, extensive inflammation, established fibrosis and/or reducible external prolapse. […] Therefore, in patients whose symptoms are resistant to those conservative measures, a more organized form of behavioral therapy such as biofeedback appears promising. […] Topical treatments, including sucralfate, salicylate, corticosteroids, sulfasalazine, mesalazine and topical fibrin sealant, have been reported to be effective with various responses and improvement of symptoms. […] Surgery remains an option for patients not responsive to conservative measures and biofeedback. […] Surgical treatments include excision of the ulcer, treatment of internal or overt rectal prolapse, and defunctioning colostomy.

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

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

  However, it would appear that conservative approaches are less useful when SRUS is associated with an advanced grade of rectal intussusception, extensive inflammation, established fibrosis and/or reducible external prolapse. […] Therefore, in patients whose symptoms are resistant to those conservative measures, a more organized form of behavioral therapy such as biofeedback appears promising. […] Topical treatments, including sucralfate, salicylate, corticosteroids, sulfasalazine, mesalazine and topical fibrin sealant, have been reported to be effective with various responses and improvement of symptoms. […] Surgery remains an option for patients not responsive to conservative measures and biofeedback. Surgery is warranted in almost one-third of adults with associated rectal prolapse; in children this has only been described in case reports.

• #1 Long term conservative approach in a young male with solitary rectal ulcer syndrome – MedCrave online

  https://medcraveonline.com/MOJCR/long-term-conservative-approach-in-a-young-male-with-solitary-rectal-ulcer-syndrome.html

  Patients response to conservative treatment may vary from complete remission to no response. […] Bio feedback therapy or behavioural modification includes bowel habit training, avoid excessive straining on defecation and normalization of pelvic floor coordination can improve symptoms and healing SRUS. […] Long term remission of SRUS is possible using by continuous bio feedback therapy. […] Sucralfate retention enema given twice daily 2gm of sucralfate suspended in 30ml of tap water for 6-8weeks may result in healing of ulcer. […] The bulk laxatives with fresh yoghurt containing lactobacillus and biofeedback therapy can be used as long term maintenance therapy in preventing recurrence of the solitary rectal ulcer syndrome.

• #1 Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case | Scientific Reports

  https://www.nature.com/articles/s41598-025-86324-0

  The management of SRUS requires a multidisciplinary approach, beginning with conservative measures, such as dietary modification, bowel training, and biofeedback therapy aimed at correcting defecatory dysfunction. For patients who do not respond to these initial interventions, surgical options including rectopexy, mucosal resection, and fecal diversion may be necessary in severe cases. […] Thirty patients were administered rectal mesalamine at a dose of 1 g twice daily for 15 days. At the 6-month follow-up, among the 23 patients who returned for evaluation, 19 showed no evidence of SRUS lesions, while persistent lesions were observed in 4 patients. Additionally, two patients presenting with rectal bleeding were treated with argon plasma coagulation (APC), achieving complete remission in both cases. Four patients received rectal steroid suppositories. Furthermore, all patients were advised to adopt a high-fiber diet to support bowel health and improve symptom management. This additional information provides a comprehensive overview of treatment strategies and observed outcomes, thereby enhancing the understanding of SRUS management.

• #1 Solitary rectal ulcer syndrome | Altru Health System

  https://www.altru.org/health-library/conditions/solitary-rectal-ulcer-syndrome

  Medications. Certain treatments such as topical steroids, sulfasalazine enemas and onabotulinumtoxinA (Botox) may help ease your rectal ulcer symptoms. However, these treatments don’t work for everyone, and some are still considered experimental. […] Surgical procedures used to treat solitary rectal ulcer syndrome include: Rectal prolapse surgery. If you have a rectal prolapse that’s causing symptoms, your doctor may recommend a rectopexy procedure. Rectopexy secures the rectum in its anatomically correct position. […] Surgery to remove the rectum. An operation to remove the rectum may be an option if you have severe signs and symptoms that haven’t been helped by other treatments. The surgeon may connect the colon to an opening in the abdomen for waste to leave the body (colostomy). If you have a colostomy, a pouch or bag is then attached to your abdomen to collect waste.

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

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

  Many rectal ulcers go away without medical treatment when you make diet or lifestyle changes. […] Here are some common medical treatments for rectal ulcers: laxatives to reduce how much you have to strain on the toilet, stool softeners to reduce the chance of hard stools damaging your rectum, topical medications like hydrocortisone to reduce swelling and relieve pain, antibiotics for bacterial infections, especially if they’re caused by an STI. […] You may require surgery if you have a rectal ulcer that is caused by injury or rectal prolapse. […] Severe bleeding ulcers are treated with an endoscopic surgery that involves inserting a camera and surgical tools into the rectum to remove them manually. […] The treatment for rectal prolapse is rectopexy. This surgery is done by inserting surgical tools into your abdomen to pull the rectum back up into place. Depending on how severe your prolapse is, the procedure can be done with only a few small incisions (laparoscopic surgery) or by opening the skin above the rectum (open surgery). […] A systematic review and meta-analysis of the efficacy of medical treatments for the management of solitary rectal ulcer syndrome.

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

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

  Surgical intervention: Surgery is rarely required for SRUS and is typically considered only when conventional treatments have failed or have severe, persistent symptoms. Surgical options for SRUS may include procedures such as rectal advancement flap or rectopexy, which aim to repair the rectal wall and promote the healing of the ulcers. […] Yes, solitary rectal ulcer syndrome (SRUS) is treatable. Treatment options include dietary modifications, medications (such as laxatives or topical creams), biofeedback therapy, and, in rare cases, surgical intervention.

• #1 Effective treatment of solitary rectal ulcer syndrome using argon plasma coagulation

  https://www.termedia.pl/Effective-treatment-of-solitary-rectal-ulcer-syndrome-using-argon-plasma-coagulation,41,23487,1,1.html

  Effective treatment of solitary rectal ulcer syndrome using argon plasma coagulation. […] Treating SRUS is difficult and includes a variety of strategies, starting with conservative methods up to various surgery techniques. […] The aim of the study is to present an effective treatment of solitary rectal ulcer syndrome without proctoptosis with the pioneering use of argon plasma coagulation (APC). […] The local ulcer treatment by argon plasma coagulation with demonstrative appliance by ERBE Erbotom ICC 200 with an APC attachment was suggested to the patient. […] Six APC sessions were done during colonoscopy every 2 days, with the result of ulceration decrease and no bleeding after the fifth session. […] The APC therapy was effective in stopping the bleeding in our case and other authors cases. […] It seems to be effective also in healing solitary rectal ulcer syndrome. […] The APC therapy in treating SRUS without rectum prolapse could become a crucial method of bleeding treatment in solitary ulcers and an important method (basic and complementary) among the means of SRUS treatment.

• #1 Lamotrigine in the Treatment of Refractory Solitary Rectal Ulcer in an Adolescent Patient | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n6/06-elnagar-lamotrigine/

  Solitary rectal ulcer syndrome (SRUS), an uncommon benign condition, is characterized by the presence of bleeding rectal ulcers. Treatment options and responses vary. Approaches include enemas with sucralfate, salicylate, corticosteroids, sulfasalazine, mesalamine, and topical fibrin sealant, as well as behavior modification therapy. Surgical options such as botulinum toxin injection into the puborectalis, argon beam coagulation (APC) of bleeding ulcers, rectopexy, and proctectomy are reserved for refractory ulcers. […] Conservative management, including fiber supplementation, laxatives, and bowel retraining, is the first-line approach for SRUS. Different treatments like enemas containing sucralfate, salicylate, corticosteroid, sulfasalazine, mesalamine, and topical fibrin sealant have been used with variable efficacy. […] Lamotrigine may have a therapeutic effect on SRUS, but further prospective studies and long-term follow-up are required to establish the effect of the medication on SRUS. […] This case report highlights a successful application of lamotrigine therapy in a child with refractory SRUS.

• #1

  https://journals.lww.com/ajg/fulltext/2006/09001/rifaximin_in_the_treatment_of_refractory_solitary.764.aspx

  Solitary rectal ulcer is a chronic condition of multifactorial origin linked with rectal mucosal prolapse and disordered defecation. […] This is the first report of refractory solitary rectal ulcer that responded to treatment with rifaximin. […] Rifaximin 400 mg b.i.d., was then initiated and the patient experienced marked decrease in abdominal cramping and constipation. […] After 4 months of rifaximin therapy, colonoscopy showed significant healing with only a residual 12 cm rectal ulcer. […] In this patient with a solitary rectal ulcer, treatment with rifaximin 400 mg b.i.d. was associated with ulcer healing and relief of constipation. […] Rifaximin use for treatment of solitary rectal ulcer, as well as rectal prolapse and disordered defecation, warrants further study.

• #1 Modified Tong Xie Yao Fang relieves solitary rectal ulcer syndrome: A case report

  https://www.wjgnet.com/2307-8960/full/v7/i15/2058.htm

  Modified Tong Xie Yao Fang relieves solitary rectal ulcer syndrome: A case report. […] The treatment of SRUS includes local medication, improvement of bowel defecation habits, biofeedback, and surgical operation. […] The patient was treated with Chinese medicine therapy, with administration of Tong Xie Yao Fang. After 3 wk of treatment, the symptoms improved significantly. […] Chinese medicine therapy represents a potential treatment of SRUS with predominant rectal bleeding, mucinous discharge, and anal swelling pain. […] Following our success of treatment with modified Tong Xie Yao Fang, we discuss how this traditional Chinese medicine prescription might be an effective treatment strategy for SRUS with this symptom profile. […] Treatment of modified Tong Xie Yao Fang (TXYF) was administered to soothe the qi, fortify the spleen, quiet the heart, astringe the intestines, regulate the diarrhea, and relieve the pain. […] The improvement of rectal symptoms in this patient should be attributed to the role of the 21 herbs administered. […] The case described herein demonstrates that Chinese formulas, specifically modified TXYF, can be effective in relieving the symptoms of SRUS.

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

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

  Surgical treatments include excision of the ulcer, treatment of internal or overt rectal prolapse, and defunctioning colostomy. […] The indication for surgery is failure of conservative treatment to control severe symptoms, and the aim is to avoid formation of colostomy as a primary operation. […] When the above measures fail, mucosal-sleeve resection with coloanal pull-through or a diverting colostomy should be considered. The evidence regarding which approach is first-line for SRUS is unclear. However, open rectopexy and mucosal resection seem popular with a success rate of 42%-100%.

• #1 Solitary rectal ulcer syndrome – Wikipedia

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

  A systematic review reported that SRUS improved in 77% of patients who underwent any type of surgery. […] There are multiple different surgical procedures which have been reported for SRUS, including: Local excision (removing the area of ulceration). […] Rectopexy is a surgery for rectal prolapse. […] The stapled transanal rectal resection (STARR) procedure has been used both as an alternative to ventral mesh rectopexy and as a secondary procedure when ventral mesh rectopexy failed to completely resolve the condition.

• #1

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

  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. […] Long-term results of antiprolapse surgery have been reported to substantially improve the resolution of symptoms in patients with resistant SRUS to medical treatment. In general, antiprolapsal surgery has led to a promising long-term outcome of about 60% of patients undergoing surgery.

• #1

  https://link.springer.com/article/10.1007/s11938-002-0043-9

  We outline a reasonable approach to the management of SRUS. Histologic confirmation of SRUS should prompt a discussion of the presumed pathogenic mechanisms with the patient. Conservative therapy with dietary fiber, bowel retraining, and bulk laxatives should be employed. If symptoms persist, the patient should receive a trial of sucralfate enemas for 6 weeks. Individuals who respond should continue conservative therapy. However, if symptoms persist, defecography can be done to assess for inappropriate puborectalis contraction and occult rectal mucosal prolapse. Patients with inappropriate contraction of the puborectalis can be offered biofeedback. Patients with occult rectal mucosal prolapse can be considered for surgery. However, the risks, benefits, and success rates of surgery should be discussed at length, prior to any procedure being performed. Rectopexy or Delormes procedure offer the best success rates to date; however, the choice of surgical procedure must take into account the experience of the surgeon and wishes of the patient.

• #1 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. […] Although a solitary rectal ulcer usually causes rectal pain and obvious GI bleeding, it can sometimes cause occult GI bleeding. […] The patient was administered behavioral therapy. Fiber diet, fluid intake, and topical sucralfate treatment were recommended as first-line treatment. […] The first step for treating SRUS is patient education. In particular, asymptomatic patients may not require any treatment except for behavioral changes. Other suggestions for treatment include encouraging a high-fiber diet, avoiding straining, regulating toilet habits, and improving psychosocial factors. Biofeedback therapy is recommended for patients with dyssynergic defecation who do not respond to treatment. For symptomatic ulcers, topical treatments, including sucralfate, salicylates, corticosteroids, and mesalazine, have been reported to be effective in improving symptoms.

• #1 Solitary Rectal Ulcer | Proctology Clinic DRHC Dubai | Hemorrhoid

  https://www.drhc.ae/dubai-proctology-clinic/solitary-rectal-ulcer

  If SRUS is linked to an underlying condition, such as rectal prolapse or chronic constipation, addressing the root cause is essential for long-term symptom relief. […] After treatment for SRUS, ongoing care, and management are crucial to prevent recurrence and ensure long-term relief: […] Our approach focuses on the individual needs of each patient, with customized treatment plans that address both symptoms and underlying causes.

• #1

  https://www.omjournal.org/articleDetails.aspx?coType=1&aId=160

  We recommend 2-3 years duration of conservative management before surgical interventions. […] Following transrectal resection, patients should continue eating a high-fiber diet and avoid constipation to avoid recurrence. […] Treatment is initially conservative, but, if that fails, transrectal resection followed by a high-fiber diet is usually curative.

• #1 Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

  https://www.gutnliver.org/journal/view.html?volume=7&number=6&spage=752

  Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. […] The diagnosis of the syndrome is based on clinical symptoms and endoscopic and histological findings. […] Current treatment includes bulking agents (lactulose), enemas (steroid and mesalamine), oral 5-ASA, sucralfate, bowel retraining with or without biofeedback, endoscopical steroid injection and surgery (rectopexy, excision of ulcer) in refractory cases not responding to conservative treatments. Local sucralfate, sulfasalazine or steroid enemas have been reported to be effective. […] Application of sucralfate enema is a suitable initial medical treatment for children with SRUS, enemas, laxatives, and surgical approaches have been used more frequently than biofeedback therapy in most reported pediatric case series.

• #1

  https://theprofesional.com/index.php/tpmj/article/view/7168

  To evaluate the effectiveness of adding hydrocortisone enema in the traditional management of Solitary rectal ulcers (SRU) in pediatric patients. […] It was found that 14/25 (56.0%) children in Group-A reported complete resolution of symptoms in comparison to 20/24 (83.3%) in Group-B (p=0.0380) at 2-months post treatment follow up. […] In children with SRUS, hydrocortisone enemas along with conventional treatment were found to be significantly more useful in resolution of pretreatment symptoms in comparison to conventional treatment alone.

• #1 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] Diagnosis is made based on clinical symptoms, colonoscopy findings, and histologic finding of fibromuscular obliteration of the lamina propria. Inflammatory bowel disease (IBD) and tumors are differentiated from SRUS with histopathology findings: SRUS shows lamina propria scarring and mild inflammatory infiltrate and muscular hyperplasia. […] Both pediatric and adult literature of SRUS strive to follow the same stepwise pattern of treatments that begin with conservative methods, such as patient education in behavioral and diet changes, then to topical therapy such as sucralfate enema, corticosteroids, and sulfasalazine, and at last resort, surgical intervention.

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

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

  Several treatment options have been used for SRUS, ranging from conservative treatment (i.e., diet and bulking agents), medical therapy, biofeedback and surgery. The choice of treatment depends upon the severity of symptoms and whether there is a rectal prolapse. […] Patient education and behavioral modification are the first steps in the treatment of SRUS. In particular, asymptomatic patients may not require any treatment other than behavioral modifications. Other suggestions for the treatment include reassurance of the patient that the lesion is benign, encouragement of a high-fiber diet, avoidance of straining, regulation of toilet habits, and attempt to discuss any psychosocial factors. […] The use of a high-fiber diet, in combination with stool softeners and bulking laxatives, and avoidance of straining have had varying responses.

• #2

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

  Solitary rectal ulcer (SRUS) may mislead the inflammatory bowel disease (IBD) or rectal polyps, which may reduce the actual prevalence of it. Various treatments for SRUS have been described that can be referred to therapeutic strategies such as biofeedback, enema of corticosteroid, topical therapy, and rectal mucosectomy. Nevertheless, biofeedback should be considered as the first stage of treatment, while surgical procedures have been offered for those who do not respond to conservative management and biofeedback or those who have total rectal prolapse and rectal full-thickness. […] Treatment for SRUS is based on its symptoms (the severity of the disease) and presence of rectal prolapse. Asymptomatic patients may usually require behavioral changes, and other types of treatment may not be considered. It should be noted that a conservative, stepwise, patient education, and behavioral modification approach are the first proposed strategies. Patients who are asymptomatic or minimally symptomatic may be treated with bulk laxatives, bowel retraining, and reassurance.

• #2 Solitary Rectal Ulcer Syndrome: Symptoms, Tests & Treatment

  https://my.clevelandclinic.org/health/diseases/21189-rectal-ulcers

  Solitary rectal ulcer syndrome involves having one or more benign (noncancerous) sores inside your rectum. Treatments include lifestyle changes that allow you to pass stools more easily, prescription medications, biofeedback and surgery. […] Treatment for solitary rectal ulcer syndrome depends on the severity of your symptoms and whats causing them. Many people with mild to moderate symptoms find relief by changing their eating habits and bowel habits to relieve constipation. […] Your provider may recommend that you: Drink plenty of water. Dehydration can make stools hard, dry and more difficult to pass. […] Eat a fiber-rich diet. Fiber-rich foods can relieve constipation. Fiber softens stool and helps it pass through your intestines faster. […] Avoid straining during bowel movements. Straining or pushing too hard when pooping can damage your rectum and cause ulcers.

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

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

  Medications: Depending on the severity of the signs, Dr. Vikrant Kale Dr. Samrat Jankar may prescribe medications to alleviate pain, decrease inflammation, and promote healing of the rectal ulcer. They will carefully determine the appropriate medications and dosage for your specific condition. […] Biofeedback therapy: This technique helps retrain the pelvic floor muscles and improve their coordination. It involves using sensors and exercises to improve muscle control, which can improve rectal muscle function, enhance rectal sensation, and promote proper bowel movements. […] Rectal irrigation or enemas: In some cases, rectal irrigation or enemas may be recommended to aid cleanse the rectal area and improve signs. This can be especially helpful if constipation and fecal impaction are contributing to SRUS.

• #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&

  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. Similar to the literature, the treatment was started with toilet training, high fiber diet, and lactulose at the first stage, and a 5-ASA enema was added to the treatment in those who did not respond. Oral 5-ASA was added to the treatment in patients who did not improve clinically in the follow-up, and a glucocorticoid enema was added to the treatment in patients whose complaints did not regress despite this.

• #2

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

  At the time of diagnosis, patients should be advised to use a high-fiber diet and bulk laxatives. They also need to be trained for prevention of straining and anal digitation. The toilet habits (time spent in the toilet) should be adjusted and defecation training should be noted. It is noteworthy that dietary and behavioral changes, especially in patients with mild to moderate symptoms, can be dramatically effective in the absence of mucosal prolapse, which can help in the improvement and prevention of disease progression. […] Conservative treatment may be no longer effective if the disease is more advanced, especially in cases where there is a high degree of intussusception in rectum, and, fibrosis, or external prolapse. In these cases, the resistance to conservative treatment may occur; subsequently, biofeedback can be promising in these patients for improving symptoms. Biofeedback is known as a variety of behavioral changes that are effective in reducing excessive straining with defecation through correction of abnormal pelvic floor behavior and stopping the use of suppositories and laxatives.

• #2 Solitary rectal ulcer syndrome

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20377737

  Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief through lifestyle changes, while people with more severe signs and symptoms may require medical or surgical treatment. […] Dietary changes. To relieve constipation, you may be given tips on increasing fiber in your diet. […] Behavior therapy. You may strain during bowel movements out of habit. Behavior therapy can help you learn to relax your pelvic muscles during bowel movements. In one behavioral technique, called biofeedback, a specialist teaches you to control certain involuntary body responses, such as the tightening of your anus or pelvic floor muscles, during defecation. Biofeedback may make you more aware of your straining and help you to control it.

• #2

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

  Studies have suggested that biofeedback is an appropriate and useful treatment for most patients with SRUS and an appropriate result has been achieved as a result of increased rectal mucosal blood flow. […] However, problems have also been addressed for this treatment. Of these problems, the lower number of patients who can be treated with this type of treatment can be noted, which leads to failure of treatment. In addition, over time, the effects of this type of treatment may be reduced in some patients. In fact, its short-term effects are beneficial because it is not effective in the long term. […] Topical therapy has been reported to be effective in some cases. Sucralfate enema, corticosteroids, and sulfasalazine enemas have been reported to be effective in improving the symptom in uncontrolled case series; however, their long-term effectiveness needs further evaluation.

• #2 Long term conservative approach in a young male with solitary rectal ulcer syndrome – MedCrave online

  https://medcraveonline.com/MOJCR/long-term-conservative-approach-in-a-young-male-with-solitary-rectal-ulcer-syndrome.html

  Patients response to conservative treatment may vary from complete remission to no response. […] Bio feedback therapy or behavioural modification includes bowel habit training, avoid excessive straining on defecation and normalization of pelvic floor coordination can improve symptoms and healing SRUS. […] Long term remission of SRUS is possible using by continuous bio feedback therapy. […] Sucralfate retention enema given twice daily 2gm of sucralfate suspended in 30ml of tap water for 6-8weeks may result in healing of ulcer. […] The bulk laxatives with fresh yoghurt containing lactobacillus and biofeedback therapy can be used as long term maintenance therapy in preventing recurrence of the solitary rectal ulcer syndrome.

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

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

  However, it would appear that conservative approaches are less useful when SRUS is associated with an advanced grade of rectal intussusception, extensive inflammation, established fibrosis and/or reducible external prolapse. […] Therefore, in patients whose symptoms are resistant to those conservative measures, a more organized form of behavioral therapy such as biofeedback appears promising. […] Topical treatments, including sucralfate, salicylate, corticosteroids, sulfasalazine, mesalazine and topical fibrin sealant, have been reported to be effective with various responses and improvement of symptoms. […] Surgery remains an option for patients not responsive to conservative measures and biofeedback. […] Surgical treatments include excision of the ulcer, treatment of internal or overt rectal prolapse, and defunctioning colostomy.

• #2 Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case | Scientific Reports

  https://www.nature.com/articles/s41598-025-86324-0

  In our study, the significant age differences among the symptom groups indicated that older patients were more likely to present with hematochezia. This may be attributed to age-related vascular fragility and comorbid conditions, which increase the risk of bleeding. The variation in biopsy results across different symptom groups suggests that the clinical presentation of SRUS is heterogeneous and may influence the histopathological findings. The lack of statistically significant differences in hemoglobin and hematocrit levels across the biopsy groups implies that anemia may not be directly correlated with the histopathological severity of SRUS. These findings highlight the importance of patient age and symptomatology in the diagnosis and management of SRUS. […] Our findings on rectal mesalamines effectiveness in SRUS align with those of AlGhulayqah et al., who observed a significant improvement in 85% of SRUS patients treated with mesalamine and a high-fiber diet. In our study, 82.6% of the patients showed complete lesion resolution with rectal mesalamine at the six-month follow-up, supporting its role as an effective therapy. Additionally, we applied APC in two cases with active rectal bleeding, both achieving complete remission, similar to Shah et al., who reported 100% bleeding control and 71% ulcer healing in APC-treated refractory SRUS patients. This suggests that combining mesalamine and APC may offer dual benefits: mesalamine for inflammation reduction and APC for immediate bleeding control. These findings underscore the potential of mesalamine and APC as effective complementary options for SRUS management, particularly for patients with persistent symptoms or active bleeding.

• #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&

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] 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 was started with toilet training, a high-fiber diet, and laxatives. The patients were followed up every three months, and 5-Aminosalicylic acid (5-ASA) enema was added to the treatment in 11 (50%) patients who had no clinical improvement during the follow-up. A glucocorticoid enema was added in five (18.1%) patients who did not show improvement despite the initial treatment.

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

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

  The indication for surgery is failure of conservative treatment to control severe symptoms, and the aim is to avoid formation of colostomy as a primary operation. […] When the above measures fail, mucosal-sleeve resection with coloanal pull-through or a diverting colostomy should be considered. […] The evidence regarding which approach is first-line for SRUS is unclear. However, open rectopexy and mucosal resection seem popular with a success rate of 42%-100%.

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

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

  Surgical intervention: Surgery is rarely required for SRUS and is typically considered only when conventional treatments have failed or have severe, persistent symptoms. Surgical options for SRUS may include procedures such as rectal advancement flap or rectopexy, which aim to repair the rectal wall and promote the healing of the ulcers. […] Yes, solitary rectal ulcer syndrome (SRUS) is treatable. Treatment options include dietary modifications, medications (such as laxatives or topical creams), biofeedback therapy, and, in rare cases, surgical intervention.

• #2

  https://link.springer.com/article/10.1007/s11938-002-0043-9

  The treatment of solitary rectal ulcer syndrome (SRUS) remains problematic and is less than ideal. Prospective, well-designed studies assessing the efficacy of treatment for SRUS are few; most of the knowledge imparted for treating SRUS is experiential. As such, firm treatment recommendations can not be made. Rather, a conservative, stepwise, individualized approach must be employed. Diagnostic modalities should be incorporated in the management scheme to direct treatment when indicated. […] Management must include patient reassurance that the underlying lesion is benign, because complete cures are uncommon in those with SRUS. The goals of therapy should be discussed with the patient prior to initiating treatment. Although the ultimate goal is macroscopic and microscopic healing, a realistic goal is cessation or minimization of symptoms.

• #2 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

  In conclusion, patient history is crucial when investigating patients for occult GI bleeding. SRUS should be considered in patients with a history compatible with dyssynergic defecation. Patient education is the initial step in managing SRUS. In symptomatic cases, sucralfate and salicylate treatment can be used.

• #2 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  A conservative treatment plan for SRUS is directed towards patients with mild to moderate symptoms with no significant prolapse. It includes education of the patient to avoid straining, minimize the amount of time spent on the commode, and increased consumption of a high-fiber diet and bulk laxatives. Furthermore, topical treatments such as sucralfate, salicylates, corticosteroids, sulfasalazine, mesalazine, and topical fibrin sealent have been shown to improve symptoms. […] If symptoms persist, gut directed biofeedback or behavioral therapy can be used, which helps reduce excessive straining associated with defecating. If neither a conservative method nor biofeedback is therapeutic, and if patients have a rectal prolapse or intussusception, surgical intervention may be considered such as ulcer excision or treatment of the rectal prolapse or rectal intussusception. If patients do not have a rectal prolapse or intussusception, but neither a conservative method nor biofeedback is therapeutic, local excision may be considered for symptomatic relief. […] Both SRUS cases followed a conservative treatment plan where the former was treated with mesalamine, docusate, and increasing fiber intake. The latter was treated with mesalamine and docusate. Both treatments are ongoing and will be reassessed at the next follow-up visit.

• #3 Solitary rectal ulcer syndrome – Wikipedia

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

  A systematic review reported that SRUS improved in 77% of patients who underwent any type of surgery. […] There are multiple different surgical procedures which have been reported for SRUS, including: Local excision (removing the area of ulceration). […] Rectopexy is a surgery for rectal prolapse. […] The stapled transanal rectal resection (STARR) procedure has been used both as an alternative to ventral mesh rectopexy and as a secondary procedure when ventral mesh rectopexy failed to completely resolve the condition.

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