Materiały źródłowe

• #1 Rectal Ulcer: Overview and More

  https://www.verywellhealth.com/rectal-ulcer-overview-and-more-5216265

  The primary symptoms associated with rectal ulcers include: […] Rectal ulcers can develop on their own in some cases, especially with SRUS. This rare disease is considered a benign (noncancerous) condition. […] In people with SRUS, about 40% have multiple ulcers, 20% have just one ulcer, and the remainder have some other form of lesion or irritation. […] When rectal ulcers are caused by other conditions, the overall prognosis will depend on how well the underlying conditionlike cancer, for examplecan be treated or controlled.

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

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

  Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. […] SRUS is an infrequent disease that is easily underdiagnosed, with an estimated annual prevalence of one in 100,000 persons. It occurs most commonly in the third decade in men and in the fourth decade in women. Patients mainly exhibit intestinal symptoms, such as constipation, feelings of incomplete defecation, bloody or purulent stools, discomfort with a falling anus and rectal ulcers. […] The clinical symptoms include abdominal pain, bleeding, mucus discharge, and chronic and severe constipation, among others. […] Not all SRUS cases present ulcers. Patients with typical symptoms and nonulcerated rectal lesions should be differentiated from those with superficial rectal cancer.

• #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 syndrome is characterized by painful and difficult defecation, a sense of incomplete evacuation, and sometimes lower gastrointestinal bleeding. […] Solitary rectal ulcer syndrome (SRUS) may typically present with anal pain, rectal bleeding and constipation. Accompanying symptoms also include tenesmus, excessive straining during defecation, mucus discharge, pelvic discomfort and incomplete evacuation. […] The most common symptom is rectal bleeding, the amount of which is different according to patients condition. Hematochezia may range from blood streaks over stool to a gross hemorrhage requiring transfusion or emergency diagnostic workup.

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

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

  Anorectal physiology studies have shown that 25%-82% of patients with SRUS may have dyssynergia with paradoxical anal contraction. Studies have confirmed that uncoordinated defecation with excessive straining over time play a key role in SRUS. […] 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. […] 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.

• #1 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. Signs and symptoms include bright red blood in your stool, anal or rectal pain and painful bowel movements. Symptoms of a rectal ulcer usually develop gradually and involve unpleasant bathroom visits. Signs and symptoms of a rectal ulcer include: Rectal bleeding (blood is usually bright red), Mucus or blood in your stool, Straining to poop or having too few bowel movements, Feeling the frequent urge to poop but being unable to empty your bowels, Anal discomfort, especially when pooping, A feeling of fullness in your pelvis. Up to 25% of people with solitary rectal ulcer syndrome dont have symptoms. Rectal ulcers are benign and dont cause serious long-term medical problems. Still, they can cause pain and ongoing unpleasant symptoms without proper treatment.

• #1

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  Solitary rectal ulcer syndrome (SRUS) is a chronic and benign rectal disorder affecting all age groups and usually presents with rectal bleeding or mucoid secretion from the rectum, chronic constipation, abdominal pain, straining, and sensation of incomplete evacuation. […] The most common symptom was bleeding per rectum affecting 77 (83%) patients followed by constipation (47%), straining on stool (31.5%), mucus passage per rectum (28.8%), pain abdomen (27.2%), and diarrhea in 25% of patients. […] Rectal bleeding was the most common symptom and ulcerative lesions the most common endoscopic finding. […] The endoscopic findings in the present study revealed ulcerative lesion in 87% of patients with solitary lesion in only 44 %, hence the term SRUS is misleading. […] The most common presenting symptoms of SRUS in the present study were rectal bleeding and constipation.

• #1 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. […] The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). […] The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

• #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). Symptoms are variable. There may be bleeding, obstructed defecation, or no symptoms at all. Very often but not always SRUS occurs in association with varying degrees of rectal prolapse. The signs and symptoms are variable, and in up to 25% of patients there may be no symptoms. The most common signs and symptoms are bleeding, which can vary from minor to severe, rectal prolapse and incomplete evacuation (35%-76% of cases). According to one report, constipation is present in about 55% of cases, but diarrhea is present in 20%-40% of cases. 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). Some state that if SRUS is not treated, it would always tend to progress to rectal prolapse. The relationship of SRUS with rectal prolapse and rectal cystitis profunda is debated.

• #1 Solitary rectal ulcer syndrome | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20377737/

  Solitary rectal ulcer syndrome can cause rectal bleeding and straining during bowel movements. […] Signs and symptoms of solitary rectal ulcer syndrome include: Constipation, Rectal bleeding, Straining during bowel movements, Pain or a feeling of fullness in your pelvis, A feeling of incomplete passing of stool, Passing mucus from your rectum, Fecal incontinence, Rectal pain. […] However, some people with solitary rectal ulcer syndrome may experience no symptoms.

• #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. […] 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. […] The occurrence of symptoms affects the probability of the disease, and its diagnosis is by direct examination of the lesion by colonoscopy and histological study of lesion. […] Patients typically complain of rectal pain, rectal prolapse, bleeding, pain, tenesmus, mucus, chronic and severe constipation, lengthened straining on defecation, pelvic discomfort as well as a sense of incomplete evacuation.

• #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. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] The amount of blood varies from a little fresh blood to severe hemorrhage that requires blood transfusion. Some children present with apparent diarrhea (because of prolonged visits to the bathroom), and associated bleeding, abdominal pain, and tenesmus suggest to clinicians the presence of inflammatory bowel disease. However, it is unusual that a child may present with recurrent rectal bleeding and anemia requiring blood transfusion.

• #1

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

  The most common clinical symptom is reported to be rectal bleeding. […] Severe rectal hemorrhage, which requires emergency endoscopy to diagnose the underlying cause, is rarely reported. […] The history of repeated use of laxatives has been reported in many patients. […] Self-induced trauma has been reported in people who have been trying to remove stools by rectal digitation. […] The pathogenesis of SRUS is not well known; various factors may be involved in its creation and development, which should be considered. […] 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 is noteworthy that conservative management, patient education, fiber consumption, and behavioral modification are the first strategies that can be applied at an early stage.

• #1 Solitary Rectal Ulcer Syndrome: A Narrative Review

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

  Remained untreated, rectal prolapse would be the final presenting symptom. […] SRUS, as the name would express, is usually acknowledged as a single rectal ulcer but the lesion may actually vary from an erythematous patch to multiple well-developed polyps. […] The diagnosis of solitary rectal ulcer syndrome is based on clinical, endoscopic and histopathologic aspects. […] The endoscopic findings vary from simple mucosal erythematous patch to a solitary or multiple ulcers. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse. […] Patient education and behavior modification are the first and main steps in the treatment of SRUS. […] Asymptomatic patients benefit from BFT and lifestyle changes. These may include high-fiber diet, drinking enough water (non-carbonated and caffeine-free beverages) during the day, regulation of toilet time, treatment of psychological problems and prevention of straining and anal digitation.

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

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm14030

  Solitary rectal ulcer syndrome (SRUS) is a disorder affecting all ages and presents with rectal bleeding, mucorrhea, tenesmus and feeling of incomplete evacuation. […] Patients with SRUS more often had fecal evacuation disorder (FED) than healthy controls, as shown by weight needed to expel the balloon, a trend towards abnormal balloon expulsion test (BET) and impaired anal relaxation. […] Most patients with SRUS reported having chronic constipation in spite of having normal and diarrheal stool forms. […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. […] Those with abnormal BET had thicker internal anal sphincter on endoscopic ultrasonography than those without.

• #1 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  The average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 11.2 mo. […] The first clinical finding in all patients except one was rectal bleeding. […] The most common presenting clinical symptoms of the patients was rectal bleeding (n = 54; 98.2%) and then straining during defecation or forceful defecation (n = 50; 90.9%). […] The main causes of this disorder are still unknown. […] In the present study, the most common findings in the colonoscopic examination of the patients were ulcer (67.3%), polypoid lesions (12.7%), and mucosal redness and erythema (10.9%). […] During the follow-up, the symptoms of 69.8% of patients were recovered.

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

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

  The most common signs and symptoms of an ulcer in your rectum include: abdominal pain or cramps, cramps near your anus, bleeding from your rectum, diarrhea, constipation, bloody stool, pain during a bowel movement, changes in stool color, mucus in your stool, stool leaking from your anus. […] 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 you’ll have rectal ulcers without any other symptoms like pain or changes in your stool. […] If it’s treated, a rectal ulcer can heal in about 24 weeks. A rectal ulcer where a rectal biopsy is performed heals in about 4 weeks. […] Untreated rectal ulcers that become severe may last for weeks or months until they’re treated, especially if they result from another condition like IBD.

• #1 Solitary Rectal Ulcer Syndrome: A Narrative Review

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

  Improvement of clinical symptoms do not mean endoscopic healing. […] People with more severe signs and symptoms may require medical or surgical treatment. […] Surgery is recommended for refractory cases of SRUS despite lifestyle changes and medical treatment or for the patient with full thickness rectal mucosal prolapse.

• #1 Solitary rectal ulcer syndrome – wikidoc

  https://www.wikidoc.org/index.php/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS, SRU), is a disorder of the rectum and anal canal, caused by straining and increased pressure during defecation. This increased pressure causes the anterior portion of the rectal lining to be forced into the anal canal (an internal rectal intussusception). The lining of the rectum is repeatedly damaged by this friction, resulting in ulceration. SRUS can therefore considered to be a consequence of internal intussusception (a sub type of rectal prolapse), which can be demonstrated in 94% of cases. It may be asymptomatic, but it can cause rectal pain, rectal bleeding, rectal malodor, incomplete evacuation and obstructed defecation (rectal outlet obstruction). […] Symptoms include: Straining during defecation, Mucous rectal discharge, Rectal bleeding, Sensation of incomplete evacuation (tenesmus), constipation, or more rarely diarrhea, fecal incontinence (rarely). […] Complications are uncommon, but include massive rectal bleeding, ulceration into the prostate gland or formation of a stricture. Very rarely, cancer can arise on the section of prolapsed rectal lining. […] Ulceration may persist even when symptoms resolve.

• #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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The common complaints are prolonged straining, tenesmus, and perineal pain, accompanied by rectal bleeding and mucous in the stool. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] The median time to diagnosis was 24 months. […] All the patients complained of rectal bleeding, mucous stool, constipation, and difficult defecation at admission. […] The treatment was started with toilet training, a high-fiber diet, and laxatives. […] The time to diagnosis was significantly shorter in those in remission than in those not in remission (p=0.04). […] Increasing the awareness of this condition will result in the identification of more cases in Trkiye. […] The treatment of SRUS varies according to the severity of symptoms. […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04).

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

  https://www.jnmjournal.org/journal/view.html?uid=878&vmd=Full

  Solitary rectal ulcer syndrome (SRUS) is a disorder affecting all ages and presents with rectal bleeding, mucorrhea, tenesmus and feeling of incomplete evacuation. […] Patients with SRUS more often had fecal evacuation disorder (FED) than healthy controls (HC) as shown by weight needed to expel the balloon, a trend towards abnormal balloon expulsion test (BET) and impaired anal relaxation. […] Most patients with SRUS reported having chronic constipation in spite of having normal and diarrheal stool forms. […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on endoscopic ultrasonography than those without. […] The present study showed that patients with SRUS more often had chronic constipation by the Rome III criteria, had FED as compared to HC as documented by BET and impaired anal relaxation, more than half of patients with SRU had abnormal defecography, about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and those with abnormal BET had thicker internal anal sphincter than those without. […] 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://link.springer.com/article/10.1007/BF02555506

  We report 33 patients with the solitary rectal ulcer syndrome seen between 1975 and 1982. Twenty-four were women and the median age was 32 years. The principal symptoms were bleeding (89 per cent), chronic constipation (64 per cent), rectal pain (42 per cent), tenesmus (42 per cent), and mucous discharge (45 per cent). Twenty-eight patients gave a history of straining (85 per cent). A full-thickness rectal prolapse was present in six patients, an anterior rectal prolapse was observed in 11, and 12 patients had clinical evidence of perineal descent. Defecation was only possible by digital evacuation in six women, and three male patients were passive homosexuals. Manometric studies were performed on 16 patients; eight patients were unable to tolerate rectal distension with 200 cc of air and impaired rectal sensation was present in two. Rectal distention was associated with bursts of involuntary external sphincter activity in three patients, and the distention reflex was absent in six, despite normal ganglia on rectal biopsy. In only four patients was there electromyographic evidence of contraction of the puborectalis during attempted defecation. Fourteen patients were treated by rectopexy; healing of the ulcer occurred in five of six with a full-thickness prolapse compared with only two of eight without a complete prolapse.

• #1

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

  Behavioral modification or biofeedback treatment has been shown to be effective in improving both rectal blood flow and symptoms. […] Surgical treatment is recommended for patients with certain symptoms who have complete prolapse or full-thickness or those who do not respond to conservative and biofeedback.

• #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 symptoms of solitary rectal ulcer syndrome (SRUS) can differ from person to person, but the most common symptoms include: Pain or a sense of fullness in your pelvis, A sense of incomplete passing of stool, Mucus discharge from your rectum, Fecal incontinence, Rectal pain or discomfort, Constipation, Rectal bleeding, Difficulty with bowel movements, Straining during bowel movements. […] SRUS is a chronic condition, but it can be managed and symptoms can be relieved with appropriate treatment. However, a complete cure for SRUS is rare. […] Yes, Solitary Rectal Ulcer Syndrome (SRUS) can cause rectal pain or discomfort. […] Solitary rectal ulcer syndrome (SRUS) is considered a rare disease. It is estimated to occur in less than 1% of the general population.

• #1 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose 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. […] 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. […] 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. […] 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.

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

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

  Twelve of 16 patients (75%) reported subjective symptomatic improvement after treatment. […] 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 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

  Most patients with SRUS present without any manifestation of anorectal disease, bowel habit alteration, and even abdominal symptoms. […] A disturbance in bowel habits was reported as constipation or diarrhea. […] Anorectal physiological studies performed in patients with SRUS have given inconsistent results. […] The etiology of SRUS still remains not fully understood. […] The treatment of SRUS remains problematic and several options have been used in the management of SRUS, ranging from behavioral modification to topical treatment, biofeedback and surgery. […] Symptoms may be improved by treatment but it is uncommon to achieve endoscopic and histological normality. […] Solitary rectal ulcer syndrome however may be resistant to conservative treatment.

• #1 The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-72

  Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. […] The most common symptom was bleeding per rectum affecting 95 (82%) patients followed by abdominal pain (49%), constipation (23%), diarrhea (22%) and mucus per rectum (17%). […] SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. […] The clinical presentation and endoscopic findings are summarized in Tables1 and 2 respectively. […] Present study reveals that the rectal bleeding, abdominal pain and constipation were the most common symptoms encountered in patients with SRUS. Ulcerative lesions remain the most common observation on endoscopy but lesions other than ulcerative including polypoidal/nodular and erythematous mucosa were also present. […] A high index of suspicion is therefore required to diagnose potentially serious disease by repeated examinations and biopsies for histopathology.

• #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

  The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] Histological examination is the gold standard for establishing the diagnosis of SRUS. […] Anemia is not consistently present in SRUS. […] Rectal prolapse, either occult or overt is well documented in SRUS. […] Therapeutic experience in children with SRUS is limited, with variable treatment protocols and clinical outcomes. 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. […] In conclusion, physicians must have a high index of suspicion for SRUS in patients who present with rectal discharge of blood and mucus and previous disorders of evacuation or in whom clinical improvement is not achieved with conservative treatments given.

• #1 Solitary Rectal Ulcer Syndrome – Causes, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/solitary-rectal-ulcer-syndrome-causes-symptoms-and-treatment

  Solitary rectal ulcer syndrome is a rare medical condition that you develop when you get one or more ulcers in your rectum. […] The common symptoms are: Rectal bleeding, Constipation, Rectal pain, Passing mucus from your rectum, Strain while passing stool, Pain in your pelvic region, Fecal incontinence. […] In some cases, you may not experience any symptoms. […] In most cases, solitary rectal ulcer syndrome shows symptoms similar to other medical conditions. However, it is recommended that you consult with a doctor as soon as you start experiencing mild symptoms to avoid complications.

• #2 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. […] SRUS usually presents with a symptom complex consisting of rectal bleeding, passage of mucus, straining on defecation, tenesmus, perineal and abdominal pain, incomplete evacuation sensation, constipation, and rectal prolapse. […] Despite the name „solitary rectal ulcer syndrome,” ulcers are only present in around 40% of patients. […] The pathophysiology of SRUS remains unclear, but a leading theory suggests it is secondary to paradoxical contraction of the pelvic floor during defecation trauma and subsequent ischemia to the rectal mucosa. […] SRUS can be difficult to treat and presents a management challenge due to its high recurrence rate. […] A previously healthy 12-year-old female presented to our emergency department with a two-month history of intermittent rectal bleeding, tenesmus, and supra-pubic pain.

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

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

  Although the passage of blood during defecation is the hallmark, up to 26% of patients can be asymptomatic, discovered incidentally when investigating other diseases. […] 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. […] Anorectal physiology studies have shown that 25%-82% of patients with SRUS may have dyssynergia with paradoxical anal contraction. Studies have confirmed that uncoordinated defecation with excessive straining over time play a key role in SRUS. […] The diagnosis can be made clinically, endoscopically, and histologically. Symptoms may resolve spontaneously or may require treatment. A variety of therapies have been tried. Several therapies thought to be beneficial include topical medication, behavior modification supplemented by fiber and biofeedback, and surgery.

• #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). Symptoms are variable. There may be bleeding, obstructed defecation, or no symptoms at all. Very often but not always SRUS occurs in association with varying degrees of rectal prolapse. The signs and symptoms are variable, and in up to 25% of patients there may be no symptoms. The most common signs and symptoms are bleeding, which can vary from minor to severe, rectal prolapse and incomplete evacuation (35%-76% of cases). According to one report, constipation is present in about 55% of cases, but diarrhea is present in 20%-40% of cases. 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). Some state that if SRUS is not treated, it would always tend to progress to rectal prolapse. The relationship of SRUS with rectal prolapse and rectal cystitis profunda is debated.

• #2 The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-72

  Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. […] The most common symptom was bleeding per rectum affecting 95 (82%) patients followed by abdominal pain (49%), constipation (23%), diarrhea (22%) and mucus per rectum (17%). […] SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. […] The clinical presentation and endoscopic findings are summarized in Tables1 and 2 respectively. […] Present study reveals that the rectal bleeding, abdominal pain and constipation were the most common symptoms encountered in patients with SRUS. Ulcerative lesions remain the most common observation on endoscopy but lesions other than ulcerative including polypoidal/nodular and erythematous mucosa were also present. […] A high index of suspicion is therefore required to diagnose potentially serious disease by repeated examinations and biopsies for histopathology.

• #2

  https://link.springer.com/article/10.1007/BF02555506

  We report 33 patients with the solitary rectal ulcer syndrome seen between 1975 and 1982. Twenty-four were women and the median age was 32 years. The principal symptoms were bleeding (89 per cent), chronic constipation (64 per cent), rectal pain (42 per cent), tenesmus (42 per cent), and mucous discharge (45 per cent). Twenty-eight patients gave a history of straining (85 per cent). A full-thickness rectal prolapse was present in six patients, an anterior rectal prolapse was observed in 11, and 12 patients had clinical evidence of perineal descent. Defecation was only possible by digital evacuation in six women, and three male patients were passive homosexuals. Manometric studies were performed on 16 patients; eight patients were unable to tolerate rectal distension with 200 cc of air and impaired rectal sensation was present in two. Rectal distention was associated with bursts of involuntary external sphincter activity in three patients, and the distention reflex was absent in six, despite normal ganglia on rectal biopsy. In only four patients was there electromyographic evidence of contraction of the puborectalis during attempted defecation. Fourteen patients were treated by rectopexy; healing of the ulcer occurred in five of six with a full-thickness prolapse compared with only two of eight without a complete prolapse.

• #2 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 syndrome is characterized by painful and difficult defecation, a sense of incomplete evacuation, and sometimes lower gastrointestinal bleeding. […] Solitary rectal ulcer syndrome (SRUS) may typically present with anal pain, rectal bleeding and constipation. Accompanying symptoms also include tenesmus, excessive straining during defecation, mucus discharge, pelvic discomfort and incomplete evacuation. […] The most common symptom is rectal bleeding, the amount of which is different according to patients condition. Hematochezia may range from blood streaks over stool to a gross hemorrhage requiring transfusion or emergency diagnostic workup.

• #2 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. […] The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). […] The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

• #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. Signs and symptoms include bright red blood in your stool, anal or rectal pain and painful bowel movements. Symptoms of a rectal ulcer usually develop gradually and involve unpleasant bathroom visits. Signs and symptoms of a rectal ulcer include: Rectal bleeding (blood is usually bright red), Mucus or blood in your stool, Straining to poop or having too few bowel movements, Feeling the frequent urge to poop but being unable to empty your bowels, Anal discomfort, especially when pooping, A feeling of fullness in your pelvis. Up to 25% of people with solitary rectal ulcer syndrome dont have symptoms. Rectal ulcers are benign and dont cause serious long-term medical problems. Still, they can cause pain and ongoing unpleasant symptoms without proper treatment.

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

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

  The most common signs and symptoms of an ulcer in your rectum include: abdominal pain or cramps, cramps near your anus, bleeding from your rectum, diarrhea, constipation, bloody stool, pain during a bowel movement, changes in stool color, mucus in your stool, stool leaking from your anus. […] 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 you’ll have rectal ulcers without any other symptoms like pain or changes in your stool. […] If it’s treated, a rectal ulcer can heal in about 24 weeks. A rectal ulcer where a rectal biopsy is performed heals in about 4 weeks. […] Untreated rectal ulcers that become severe may last for weeks or months until they’re treated, especially if they result from another condition like IBD.

• #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

  Solitary rectal ulcer syndrome (SRUS) is the term used to describe a wide spectrum of abnormalities affecting mainly young adults with varied clinical presentation, protean endoscopic appearance, yet characteristic histopathological findings. […] Most patients with SRUS, both adults and children, present with rectal bleeding, mucous discharge, straining, tenesmus, and rectal pain. […] A typical SRUS appears as isolated erythema or a shallow and solitary ulcerating lesion highlighted by erythematous mucosa, usually located on the anterior rectal wall, several centimeters from the anal verge. […] Rectal bleeding, mucus discharge, excessive straining, and rectal pain are consistent but not specific symptoms. Other common complaints are lower abdominal pain, increased frequency of defecation, self digitations, and fecal incontinence.

• #2

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  Solitary rectal ulcer syndrome (SRUS) is a chronic and benign rectal disorder affecting all age groups and usually presents with rectal bleeding or mucoid secretion from the rectum, chronic constipation, abdominal pain, straining, and sensation of incomplete evacuation. […] The most common symptom was bleeding per rectum affecting 77 (83%) patients followed by constipation (47%), straining on stool (31.5%), mucus passage per rectum (28.8%), pain abdomen (27.2%), and diarrhea in 25% of patients. […] Rectal bleeding was the most common symptom and ulcerative lesions the most common endoscopic finding. […] The endoscopic findings in the present study revealed ulcerative lesion in 87% of patients with solitary lesion in only 44 %, hence the term SRUS is misleading. […] The most common presenting symptoms of SRUS in the present study were rectal bleeding and constipation.

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

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

  SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. […] Although SRUS usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, and lower abdominal pain, some children present with apparent diarrhea and the associated bleeding and abdominal pain may suggest the presence of inflammatory bowel disease. […] The average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor.

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

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

  Twelve of 16 patients (75%) reported subjective symptomatic improvement after treatment. […] 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.

• #2 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose 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. […] 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. […] 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. […] 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.

• #3 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. […] The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). […] The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

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