SOLITARY RECTAL ULCER SYNDROME - THE CLINICAL ENTITY AND ANORECTAL PHYSIOLOGICAL FINDINGS IN SINGAPORE

The clinical pattern and physiological abnormalities in solitary recta l ulcer syndrome (SRUS) occurring in Singapore, were investigated. Sin ce April 1989, 25 patients have presented with histologically proven S RUS. There were 13 males and 12 females (20 Chinese, 4 Malay and 1 Ind ian) with a mean age of 47.5 (+/- 3.1) years. Ninety-six per cent pres ented with rectal breeding, 92% strained at stools, 40% had mucus disc harge, 40% felt incomplete defecation and 32% digitated to defecate. F our had previous haemorrhoidectomies that did not cure their symptoms. The lesions were at a mean 6.8 (+/- 0.5) cm above the anal verge, usu ally anteriorly (64%) but one was circumferential. Anorectal physiolog y performed on 14 patients was compared with 13 age and gender matched normal controls. The measured mean resting perineum level in SRUS (1. 4 +/- 0.3 cm) was significantly lower than in normals (P < 0.01). The mean anal electrosensory threshold (2.5 +/- 0.52 mV) was also signific antly higher than in the controls (P < 0.05). Fifteen patients were su ccessfully treated with a high fibre diet and avoidance of straining. Three patients required surgery and the most recent seven patients hav e responded well to biofeedback treatment. Awareness of this uncommon anorectal condition is necessary for early diagnosis and appropriate m anagement. The physiological findings support a pelvic straining patho physiology resulting in perineal descent, with less sensitive rectal m ucosa prolapsing into, and raising, the anal canal electrosensory thre shold. Treatment strategies aimed at correcting the straining have usu ally been successful.