saudigastro.com/patients/solitary-rectal-ulcer-syndrome
Category
Chronic
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
The rectum is the last part of the large bowel, where stool is held before it leaves the body. In solitary rectal ulcer syndrome (SRUS) the lining of the rectum becomes inflamed, thickened or ulcerated (an ulcer is a sore on the lining). The ulcer is usually on the front wall, a few centimetres from the anus. It is a benign condition, which means it is not cancer, although it can look worrying and a biopsy is often needed to be sure.
How common is it?
It is an uncommon condition. It affects mainly young and middle-aged adults and can occur in both men and women, and it is often diagnosed late because the symptoms resemble those of other conditions such as haemorrhoids or inflammatory bowel disease.
Why does it happen?
It is thought to result from repeated straining, from the rectum folding into itself (rectal prolapse, including a hidden or internal form), and from the pelvic floor muscles failing to relax while passing stool. This causes pressure and reduced blood flow to the rectal lining, which is damaged by friction. Some people also use fingers to help stool out, which can injure the lining. It is not contagious and is not caused by cancer.
Symptoms
- Straining a lot to pass stool, often for a long time
- Passing blood or mucus (slimy discharge) from the rectum
- A feeling of not having emptied the bowel fully
- Frequent urges to go to the toilet, sometimes with only mucus passing
- Pain or discomfort in the rectum or lower belly
- Constipation or, in some people, a feeling of a blockage or a lump in the rectum
- Some people have no symptoms and the ulcer is found by chance
Red flags — seek urgent medical care
Heavy rectal bleeding, passing clots, or feeling dizzy or faint
Significant blood loss can occur. Go to the emergency department now.
New rectal bleeding or a change in bowel habit that lasts, especially after age 45 or with a family history of bowel cancer
Bleeding should not be put down to this condition without examination. See a doctor to rule out other causes.
Severe or worsening rectal pain, fever, or a swollen, painful belly
Rarely, an ulcer can lead to infection or a hole in the bowel wall. Seek emergency care.
Unable to pass stool or wind, with vomiting and a swollen belly
May indicate a blockage. This is an emergency.
Rectum or tissue protruding from the anus that cannot be pushed back, or is painful and dark
Tissue may be trapped with poor blood supply. Go to the emergency department.
How is it diagnosed?
Diagnosis needs a look inside the rectum: a flexible sigmoidoscopy or colonoscopy (a thin camera passed through the anus), during which biopsies are taken. The pathologist looks for the typical changes and excludes inflammatory bowel disease, infection and cancer. Because the cause is a problem with how the rectum and pelvic floor work, tests such as defecography (an X-ray or MRI video taken while passing stool) and anorectal physiology tests (which measure muscle function) may be done. The doctor decides which are needed.
Outlook — what to expect
The condition is benign and many people improve, particularly when they stop straining and treat constipation. It can take time, and symptoms may come and go. Bleeding and pain usually ease with the right treatment. Surgery is considered only for a small group with prolapse who do not improve with other measures.
Treatment
Habits & Lifestyle
Changing how you use the toilet is the most important treatment.
- Do not strain; if nothing passes within a few minutes, get up and try again later
- Limit time on the toilet and avoid reading or using the phone there
- Place a small footstool under your feet so your knees are higher than your hips
- Avoid using fingers to help stool out
- Go when you feel the urge instead of delaying
- Biofeedback therapy, guided by a trained therapist, retrains pelvic muscles to relax and is often recommended
Diet
The aim is soft, easy-to-pass stools.
- Increase fibre gradually with vegetables, fruit, whole grains and legumes
- Drink enough fluids throughout the day
- Add fibre slowly to avoid gas and bloating
Medications
Medicines mainly treat constipation and inflammation. Your doctor decides which suit you.
- Fibre supplements or osmotic laxatives to keep stools soft
- Avoid long-term use of stimulant laxatives unless your doctor advises
- Medicated enemas or suppositories for inflammation, if prescribed
- Do not use medicines you buy without checking, as some irritate the rectum
Procedures & Surgery
Procedures are for people who do not improve with habit changes and medicines.
- Biofeedback and pelvic floor retraining
- Local treatments applied during endoscopy in selected cases
- Surgery to repair rectal prolapse if this is the underlying cause and other treatments have failed
- Your surgeon will explain benefits and limits, as results vary
Living with the condition
- Keeping good toilet habits long term helps prevent relapse
- Be patient: improvement can take weeks to months
- Report any new bleeding or change in symptoms to your doctor
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Has cancer been ruled out by my biopsy?
- Do I have a rectal prolapse or a problem with relaxing my pelvic floor?
- Would biofeedback help me and where can I get it?
- Which laxatives or fibre are best for me?
- When would surgery be considered?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide