Solitary rectal ulcer syndrome

Background Solitary rectal ulcer syndrome is a rare disorder characterized by erythema or ulceration of the rectal wall, associated with typical histo logical features, and disturbed defaecatory behaviour with the passage of b lood and mucus. Methods This is a review based on a literature search using a computer data base (Medline) and manual cross-referencing. Results The pathogenesis is likely to vary in different patients; it includ es trauma from straining, direct digital trauma and possibly primary neurom uscular pathology. The histological findings of extension of the muscularis mucosa between crypts and muscularis propria disorganization on full-thick ness specimens are characteristic. Biofeedback defaecation retraining, incl uding habit training, can lead to symptom improvement and return to work in a majority of patients. Abdominal rectopexy offers long-term symptom impro vement in approximately 50 per cent of patients. Rectal ulceration may pers ist after any treatment, even if symptoms improve. Conclusion Behavioural therapy and carefully considered operations offer th e best treatment results. Further work on psychological factors and neuromu scular and vascular pathology is required.