Solitary Rectal Ulcer Syndrome – Diagnosis and Treatment
Diagnosis
Doctors use several methods to diagnose solitary rectal ulcer syndrome (SRUS). They often start with a review of medical history and symptoms.
Rectal bleeding, bloody stools, and changes in bowel habits are common complaints. Physical exams and tests help confirm the diagnosis and rule out other rectal diseases like inflammatory bowel disease or ulcerative colitis.
A flexible sigmoidoscopy usually allows the doctor to view the rectum and lower colon using a thin, camera-equipped tube. Sometimes, they see ulceration or abnormal tissue.
The doctor often collects a small tissue sample (biopsy) to look for signs such as mucosal ulceration and muscle fibers in the lamina propria during histological examination. Colonoscopy can provide a more complete look at the colon.
Imaging studies also play an important role. Rectal ultrasound helps detect changes in the rectal wall and differentiates SRUS from other conditions.
Defecation proctography or magnetic resonance defecography uses barium or MRI imaging to check for prolapse, problems with the external anal sphincter, and muscle coordination issues, which can contribute to the etiology and pathophysiology of SRUS.
Additional Diagnostic Details
Doctors gather further information from biopsy results. Histological findings usually show evidence of ulceration, distortion of the crypt architecture, and fibers from muscles in the affected tissue.
These findings help distinguish SRUS from ischemic changes or inflammatory conditions. If needed, doctors might order extra tests to rule out other causes of rectal bleeding or confirm whether the diagnosis of SRUS is accurate.
Treatment
For solitary rectal ulcer syndrome, doctors choose the plan for care based on how bad the symptoms are. Early steps often include changes in routine, but more severe problems may require medicine or different types of surgery.
Diet Adjustments
- Eating foods higher in fiber helps manage constipation, which is common with this condition.
- Drinking enough water and avoiding foods that make constipation worse can also be helpful.
- A simple table can help track fiber sources:
| Food Group | Examples |
|---|---|
| Fruits | Apples, pears |
| Vegetables | Broccoli, spinach |
| Grains | Oats, brown rice |
Behavior Changes and Therapy
- Behavioral therapy focuses on changing habits during bowel movements.
- Biofeedback therapy often helps patients learn to relax pelvic muscles and avoid straining.
- Sessions with a trained therapist or specialist can improve bathroom habits over time.
Medications
- Some people may use topical treatments, such as sucralfate, sulfasalazine enemas, or certain steroid medications.
- Doctors might recommend laxatives for easier bowel movements, but patients should use these as directed.
- Sometimes, medications like onabotulinumtoxinA (Botox) may be suggested, though results can vary.
Surgical and Other Procedures
- If someone has rectal prolapse or rectal intussusception that does not respond to other treatments, a surgeon may perform rectopexy.
- In severe cases, surgeons may remove the rectum and create a colostomy.
- Some clinics also use methods like argon plasma coagulation to treat bleeding or ulcers.
- Surgical approaches differ based on the patientโs specific needs and other related issues, such as rectocele.
Ways to Care for Yourself
Some lifestyle changes can make a difference for people with solitary rectal ulcer syndrome. Making certain choices each day helps with bowel function and may ease common issues such as constipation, tenesmus, and abdominal discomfort.
Increasing Fiber
Adding more fiber to meals can make stools bulkier. This helps the muscles in the intestines move stool along, which can lower straining during defecation and reduce pelvic floor pressure.
Good options for fiber include whole grain bread, oatmeal, bran cereals, vegetables, and fruits with the skin left on. For most people, a goal is 14 grams of fiber for every 1,000 calories eaten each day. Checking the nutrition label can help track this.
| Foods High in Fiber | Serving Suggestion |
|---|---|
| Whole wheat bread | 2 slices |
| Apples (with skin) | 1 medium |
| Broccoli | 1 cup, cooked |
| Oatmeal | 1 cup, cooked |
Bulk Laxatives and Stool Softeners
Sometimes, fiber alone is not enough. Bulk-forming laxatives add more volume to stool and can trigger the bowel to work better.
Patients should take these with enough water to avoid blockage. Stool softeners help mix fluid into the stool, making it less painful to pass. This can help with symptoms such as rectal pain, perineal pain, and excessive straining.
Staying Hydrated
Drinking plenty of water throughout the day makes bowel movements softer and easier to move. Noncarbonated, caffeine-free drinks and prune juice are good options. Prune juice may also help with mild diarrhea or constipation.
Monitoring these habits supports regular evacuation and may ease symptoms linked to solitary rectal ulcer syndrome, such as anemia, discomfort, or a feeling of incomplete emptying.
Getting Ready for Your Medical Visit
Steps You Can Take Before the Appointment
Patients who think they might have solitary rectal ulcer syndrome should take a few steps to make their visit more effective.
- Find out about any special instructions. Check with the clinic if you need to change your diet or stop any medicines before the visit.
- List important health details. Include any recent stresses, illnesses, or injuries, as well as family history, especially reports of lower abdominal pain or juvenile polyps in children and adolescents.
- Record all symptoms. Make notes about what symptoms you have noticed, even if they do not seem connected. This can include bleeding, pain, changes in bowel habits, or mucus.
- Make a medication log. Write down all prescriptions, vitamins, and supplements currently used.
- Prepare a set of questions. Asking clear questions helps you learn more about your condition and care.
- Bring any pediatric records. If the patient is a child or adolescent or if there is a history of pediatric gastroenterology visits, bring those documents.
Example Questions for Healthnile Doctors:
| Question | Example |
|---|---|
| What is the main cause of my symptoms? | “What could be causing my issues?” |
| Testing | “What tests do I need?” |
| Treatment | “Are there different treatments? What are the side effects?” |
| Other Conditions | “How will this affect my other health problems?” |
| Medicine Options | “Is there a generic version of the medicine?” |
What Your Healthcare Provider May Ask
Doctors often begin with questions to better understand the patientโs story, especially if there are unique cases, such as in children, or if past events like trauma or intussusception have occurred. Be ready to answer honestly.
- When did symptoms start?
- Are the symptoms always there or do they come and go?
- How strong is the pain or discomfort?
- Has there been constipation or recent trouble going to the bathroom?
- Has anything helped make symptoms better?
- Is there anything that makes things worse?
Doctors also ask about past family or personal cases, including pediatric or internal medicine case reports, particularly for young patients.
