Rectal Ulcer: Causes, Symptoms, And Treatment

What Is a Rectal Ulcer?

A rectal ulcer is essentially a wound or lesion that forms on the delicate tissue lining your rectum. The most common form is known as solitary rectal ulcer syndrome (SRUS), which typically presents as a single ulcer but may occasionally involve multiple lesions. The condition occurs when the rectal tissue becomes damaged or inflamed, leading to the formation of an open sore. These ulcers can vary in size from small, shallow wounds to deeper, more extensive lesions.

Rectal ulcers can affect anyone, though they are most frequently diagnosed in adults aged 30 to 50. It’s important to understand that most rectal ulcers are non-cancerous (benign). However, they require proper medical evaluation to rule out other conditions and ensure appropriate treatment. The key is recognising the symptoms early and seeking professional medical guidance.

Causes of Rectal Ulcers

• Chronic straining during bowel movements: Excessive pressure from repeated straining damages the delicate rectal tissue.
• Severe constipation: Hard stools and infrequent bowel movements create trauma to the rectal lining.
• Rectal prolapse: When the rectum slips out of its normal position, it can lead to tissue damage and ulceration.
• Pelvic floor dysfunction: Abnormal muscle coordination affects normal bowel function and can cause tissue injury.
• Physical trauma: Manual stool removal, improper enema use, or insertion of foreign objects can damage rectal tissue.
• Inflammatory bowel disease: Conditions like Crohn's disease or ulcerative colitis can cause rectal inflammation and ulceration.
• Ischaemic injury: Reduced blood supply to rectal tissue can lead to tissue death and ulcer formation.
• Sexually transmitted infections: Certain STIs can cause rectal inflammation and subsequent ulceration.
• Frequent anal intercourse: Repeated trauma to the rectal area can result in tissue damage.

Common Risk Factors for Rectal Ulcers

Certain lifestyle factors and medical conditions can increase the risk of developing a rectal ulcer:

• Chronic constipation lasting months or years: Creates ongoing pressure and strain on rectal tissues.
• Low-fibre diet: Leads to hard stools that are difficult to pass and require excessive straining.
• Sedentary lifestyle: Prolonged sitting weakens pelvic floor muscles and affects bowel function.
• Dehydration: Insufficient fluid intake contributes to constipation and hard stools.
• Frequent use of laxatives: Can lead to dependency and abnormal bowel patterns.
• History of rectal prolapse: Previous prolapse increases the risk of tissue damage and ulceration.
• Pelvic surgery: Previous operations can affect muscle function and bowel habits.
• Advanced age: Older adults are more prone to constipation and pelvic floor weakness.
• Pregnancy: Increased pressure on pelvic organs can contribute to constipation and straining.

Symptoms of Rectal Ulcers

Recognising rectal ulcer symptoms is essential for early diagnosis and treatment. The symptoms can vary in severity and may develop gradually:

1. Rectal pain or discomfort: Often described as a dull ache or sharp pain, especially during bowel movements.
2. Blood in stool: Bright red blood on toilet paper or mixed with stool may indicate rectal bleeding.
3. Mucus discharge from the rectum: Thick, slimy discharge that may be clear, white, or blood-tinged.
4. Painful bowel movements: Significant discomfort or burning sensation during defecation.
5. Feeling of incomplete evacuation: Sensation that the bowel hasn't emptied completely after a bowel movement.
6. Chronic constipation: Difficulty passing stools or infrequent bowel movements.
7. Pelvic pressure or fullness: Uncomfortable sensation of pressure in the pelvic region.
8. Fecal incontinence: Difficulty controlling bowel movements or accidental leakage.

Some people with mild cases may experience minimal symptoms or none at all initially. However, as the condition progresses, rectal ulcer symptoms typically become more noticeable and bothersome. It's important to note that these symptoms can also indicate other serious conditions, making a proper medical evaluation essential.

Examination and Imaging Tests to Identify Rectal Ulcers

Several tests are used to differentiate rectal ulcers from other conditions such as hemorrhoids, anal fissures, or colorectal cancer. Your doctor will prescribe these based on your symptoms and physical examination.

• Digital rectal examination: Your doctor physically examines the rectum using a gloved finger to feel for abnormalities.
• Sigmoidoscopy: A flexible, lighted tube with a camera is used to examine the lower colon and rectum.
• Colonoscopy: A comprehensive examination of the entire colon using a flexible endoscope with a camera.
• Endoscopic biopsy: Small tissue samples are collected during endoscopy to confirm the diagnosis and rule out malignancy.
• Defecography: Special X-ray imaging that shows how your rectum functions during bowel movements.
• Anorectal manometry: Tests that measure muscle function and pressure in the anal and rectal areas.
• MRI of the pelvis: Detailed imaging to assess pelvic floor anatomy and identify structural problems.
• Anal ultrasound: Uses sound waves to produce detailed images of the anal and rectal structures.

How Are Rectal Ulcers Diagnosed?

The diagnosis of a rectal ulcer typically begins with a detailed medical history and physical examination. Your doctor will ask about your bowel habits, symptoms, and any factors that might contribute to the condition. They may ask questions about straining, constipation patterns, and any previous rectal problems.

A digital rectal examination is usually the first diagnostic step, allowing your doctor to feel for ulcers, masses, or other abnormalities. However, according to the National Institutes of Health (NIH), a definitive diagnosis requires direct visualisation through sigmoidoscopy or colonoscopy. These procedures allow your doctor to visualize the ulcer, assess its size and location, and obtain tissue samples if necessary.

During endoscopy, your doctor will look for the characteristic appearance of rectal ulcers, which often have a clean base with raised edges. They may also identify signs of solitary rectal ulcer syndrome, such as thickened rectal walls or abnormal tissue patterns. Additional tests like defecography or pelvic MRI may be needed to identify underlying causes such as rectal prolapse or pelvic floor dysfunction.

Treatment Options for Rectal Ulcers

Treatment for rectal ulcers depends on the severity of the condition and its underlying causes. Treatment options include:

• Stool softeners and laxatives: Medications like docusate or polyethylene glycol to ease bowel movements.
• Topical medications: Sucralfate enemas, corticosteroid suppositories, or mesalazine to promote healing.
• Biofeedback therapy: Training to improve pelvic floor muscle coordination and bowel habits.
• Pelvic floor physiotherapy: Specialised exercises to strengthen and coordinate pelvic muscles.
• Behavioural modifications: Learning proper toileting posture and avoiding excessive straining.
• Surgical interventions: Procedures like rectopexy for rectal prolapse or ulcer excision for severe cases.
• Botulinum toxin injections: Used in selected cases to relax overactive pelvic floor muscles.

Home Remedies and Lifestyle Changes

Supporting medical treatment with home remedies and lifestyle modifications can significantly improve outcomes:

• Increase dietary fibre gradually: Add 25-35 grams daily through natural sources like oats, beans, and vegetables.
• Stay well-hydrated: Drink at least 8-10 glasses of water daily to keep stools soft.
• Establish regular bowel habits: Try to have bowel movements at the same time daily, preferably after meals.
• Avoid prolonged straining: Limit toilet time to 5-10 minutes, and don't force bowel movements.
• Use proper toileting posture: Keep feet flat on the floor or a footstool, and lean slightly forward.
• Practice stress management: Chronic stress can worsen digestive symptoms and delay healing.
• Exercise regularly: Walking, swimming, or yoga can improve bowel function and pelvic floor strength.
• Apply warm compresses: Gentle heat can help relieve discomfort and improve blood flow to the area.

Prevention of Rectal Ulcers

Preventing rectal ulcers focuses on maintaining healthy bowel habits and avoiding risk factors:

• Maintain a high-fibre diet consistently: Include plenty of fruits, vegetables, whole grains, and legumes.
• Drink adequate fluids daily: Water, herbal teas, and clear broths help maintain soft stools.
• Exercise regularly: Regular physical activity supports healthy digestion and helps prevent constipation
• Respond promptly to bowel urges: Don't delay when you feel the need to have a bowel movement.
• Avoid excessive straining: Never force bowel movements or spend excessive time on the toilet.
• Practice good anal hygiene: Clean gently with soft toilet paper or moistened wipes.
• Manage underlying conditions: Treat inflammatory bowel disease, pelvic floor dysfunction, or other contributing factors.
• Limit anal trauma: Use adequate lubrication and communicate during intimate activities.
• Seek early treatment: Address constipation, rectal prolapse, or other bowel symptoms promptly.

When to See a Doctor

You should consult a doctor promptly if you experience persistent rectal pain, bleeding, or changes in bowel habits. Seek immediate medical attention if you notice signs of infection, like fever, or symptoms of bowel obstruction. Your doctor can properly evaluate your symptoms, perform necessary tests, and develop an appropriate treatment plan.

Conclusion

Understanding rectal ulcers empowers you to recognise symptoms early and seek appropriate care. While these conditions can be uncomfortable and concerning, the key to successful management lies in addressing underlying causes like chronic constipation, pelvic floor dysfunction, or abnormal bowel habits. Simple changes like increasing dietary fibre, staying hydrated, and avoiding excessive straining can make a significant difference in both treatment and prevention.

At Metropolis Healthcare, we understand the importance of accurate diagnosis and timely management in conditions like rectal ulcer syndrome. Our comprehensive portfolio of more than 4,000 tests includes specialised investigations that support your doctor's diagnostic process. With our network of 220+ laboratories and over 10,000 touchpoints across India, we make essential diagnostic services accessible when and where you need them. Our qualified technicians provide convenient at-home sample collection, ensuring comfort during your health journey.

FAQs

What causes rectal ulcers?

Rectal ulcers result from chronic straining during bowel movements, persistent constipation, rectal prolapse, pelvic floor dysfunction, trauma, inflammatory bowel disease, or sometimes unknown causes in solitary rectal ulcer syndrome.

How are rectal ulcers treated?

Treatment includes dietary changes, increased fibre intake, stool softeners, topical medications, biofeedback therapy, pelvic floor physiotherapy, and occasionally surgery for severe cases or underlying prolapse.

Can rectal ulcers heal on their own?

Some rectal ulcers may improve with lifestyle changes and conservative management, but most require medical treatment to heal completely and prevent complications or recurrence.

How do you prevent rectal ulcers?

• Eat a high-fibre diet with adequate fluids.
• Exercise regularly and maintain a healthy weight
• Avoid straining during bowel movements.

• Treat constipation promptly

• Practice good toilet habits

References
•    https://my.clevelandclinic.org/health/diseases/21189-rectal-ulcers
•    https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/symptoms-causes/syc-20377749
•    https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx
•    https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/
•    https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/