A rectal ulcer is an open sore that develops in the lining of the rectum, which is the final section of the large intestine connecting the colon to the anus. This muscular tube temporarily stores stool before it is passed out of the body. Rectal ulcers are generally manageable with appropriate diagnosis and care.
Causes of Rectal Ulcers
Rectal ulcers often arise from Solitary Rectal Ulcer Syndrome (SRUS), a condition frequently associated with chronic constipation and excessive straining during bowel movements. This straining can lead to trauma or injury to the rectal lining, or cause conditions like rectal prolapse where the rectum protrudes. Uncoordinated pelvic floor muscle contractions can also reduce blood flow to the rectum, contributing to ulcer formation.
Inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis are common causes of rectal ulcers. These inflammatory conditions affect the gastrointestinal tract, potentially leading to multiple ulcers that impact both the mucous membrane and deeper tissue layers.
Infections (bacterial, viral, or fungal) can also cause rectal ulcers. These may stem from a compromised immune system, exposure to specific microbes, or sexually transmitted infections (STIs). Radiation therapy (radiation proctitis) can injure rectal tissue and lead to ulcer development. Poor blood flow to the area (ischemia) or side effects from certain medications, such as some anti-anginal drugs, can also contribute to these sores.
Common Symptoms
Rectal ulcers often manifest with noticeable signs affecting bowel movements and general comfort. Rectal bleeding, typically bright red, is a frequently observed symptom and can range from minor to significant amounts.
Mucus discharge from the rectum is another common sign. Individuals may also experience rectal pain or a sensation of fullness in the pelvic area. Tenesmus, an urgent and often painful feeling of needing to pass stool even when the bowel is empty, is a distinct symptom. A persistent sensation of incomplete evacuation after a bowel movement is also reported.
How Rectal Ulcers Are Diagnosed
Diagnosis typically begins with a thorough review of the patient’s medical history, including symptoms and their duration. A physical examination, which may involve a digital rectal exam, helps assess the area.
The primary diagnostic approach involves endoscopic procedures like flexible sigmoidoscopy or colonoscopy. During these procedures, a thin, flexible tube with a camera is inserted into the rectum, allowing direct visualization of the rectal lining and a portion of the colon to identify sores or lesions.
If an ulcer or suspicious area is found, a biopsy is often performed. This involves taking a small tissue sample during the endoscopy. The sample is then sent to a laboratory for microscopic examination, which confirms the ulcer and helps determine its underlying cause, distinguishing it from other conditions.
Available Treatment Options
Treatment for rectal ulcers often begins with lifestyle and dietary adjustments to promote healing and reduce irritation. Increasing daily fiber intake and ensuring adequate fluid consumption can soften stools and prevent straining during bowel movements. Avoiding prolonged sitting and incorporating regular exercise may also support bowel regularity.
Medical treatments aim to reduce inflammation and support ulcer healing. Topical medications, such as sucralfate enemas or corticosteroid creams, can be applied directly to the affected area to soothe inflammation and encourage tissue repair. Oral medications may be prescribed to manage underlying conditions like inflammatory bowel disease or to treat specific infections, if present.
For conditions like Solitary Rectal Ulcer Syndrome linked to pelvic floor dysfunction, behavioral therapy, specifically biofeedback, can be beneficial. This therapy teaches individuals to retrain their pelvic muscles to relax during defecation, reducing strain and allowing for easier bowel movements.
Surgical intervention is considered when conservative and medical therapies have not provided sufficient relief, particularly if the ulcer is associated with a rectal prolapse or severe, persistent bleeding. Procedures like rectopexy can be performed to reposition and secure the rectum in its proper anatomical place. In very severe and unresponsive cases, surgical removal of the rectum with a colostomy may be considered.