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Solitary rectal ulcer syndrome

David J Kim, MD
Peter A L Bonis, MD
Section Editor
Lawrence S Friedman, MD
Deputy Editor
Shilpa Grover, MD, MPH


Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with bleeding, passage of mucus, straining during defecation, and a sense of incomplete evacuation. The lesion was first reported in 1829 [1], but its clinical manifestations and histopathology were not described until 1969 [2]. Because it is rare, its incidence is uncertain, but has been estimated in one study to be 1 in 100,000 [3]. In one retrospective study of 80 patients, the median age was 48 years with a range of 14 to 76 years [4]. Men and women appear to be affected equally although gender differences have been suggested in various reports.


The name of the syndrome is misleading, since patients can often present with lesions that are neither solitary nor ulcerated. The lesions are located in the anterior rectal wall within 10 cm of the anal verge in the majority of patients [4].

Endoscopic and radiologic findings vary and can include mucosal ulcerations, polypoid and mass lesions (mimicking rectal cancer [5]), or simply erythema. As a result, misdiagnosis is common. In one study, as many as 26 percent of patients had been initially diagnosed incorrectly, most commonly as having a nonspecific ulcer, inflammatory bowel disease, or adenomatous changes [6].

Symptoms are variable or may be absent [6-8]. In an illustrative series the most common symptoms were rectal bleeding (56 percent), straining (28 percent), and pelvic fullness (23 percent) [6]. Mucous discharge, incontinence, tenesmus, and pain were less frequently described.


The pathogenesis of the solitary rectal ulcer is incompletely understood. However, a number of factors appeared to have a causative role in individual reports. It is possible that different etiologies may contribute to the development of the final lesion.


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Literature review current through: Mar 2015. | This topic last updated: Apr 23, 2014.
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