Going to the bathroom can be a very difficult thing at times, right? It's normal to feel scared, especially if you see a little blood in your stool, or if you have to strain to defecate. It can be a little embarrassing to talk about these things with others. But these are very important health-related things. Today we are going to talk about a rare condition that can cause these symptoms, but not many people have heard of it. That is Solitary Rectal Ulcer Syndrome (SRUS) .
What is Solitary Rectal Ulcer Syndrome (SRUS)?
Simply put, SRUS is a long-term, non-cancerous condition that causes one or more ulcers to form inside our rectum. Now you might be wondering, "What is this rectum?" The rectum is the last part of our large intestine (colon), where stool temporarily stays before it leaves our body.
But this name can be a bit misleading. Despite the word "solitary," sometimes there can be more than one ulcer. Also, these are not always ulcers. Sometimes they can just be inflamed, red tissue. Sometimes this condition can even be seen in a part of the colon just above the anus.
Doctors and researchers are still learning a lot about this condition. Research is still being conducted into its causes and the best treatments.
How common is this condition?
SRUS is actually a very rare condition. It affects about one in 100,000 people. It is most common in people between the ages of 30 and 40. However, it can also occur in young children and the elderly.
Is this situation serious? Should we be afraid?
This may be the first question that comes to your mind. The good news is that these lesions are usually not serious. That means they do not become cancerous.
However, the important thing here is that the underlying problem causing these lesions may be something that needs attention. That's why it's essential to see a doctor for an accurate diagnosis if you have these symptoms.
You should never ignore a symptom like this. It's not a good idea to just assume, "It'll go away in a few days." Because rectal bleeding can be caused by more serious conditions than SRUS.
What are the symptoms of SRUS?
These symptoms usually appear gradually. They can make going to the bathroom a very uncomfortable experience. Let's take a look at the main symptoms.
| Symptom | Simply put... |
|---|---|
| Rectal Bleeding | Bright red, fresh blood coming out with the stool or after going to the toilet. Sometimes the tissue paper may be stained with blood. |
| Mucus-like discharge with stool | A feeling of mucus-like discharge, either with or without stool. |
| Straining to defecate (Straining) | It takes a long time, a lot of effort, and a lot of straining to pass stool. |
| Incomplete bowel movement | Feeling like there is still stool after going to the toilet, like "I'm not done yet." |
| Anal pain or discomfort | Feeling pain or discomfort in the anus and surrounding area, especially when going to the toilet. |
| Pelvic Fullness | Feeling of heaviness and fullness in the lower abdomen. |
Surprisingly, about one in four people (25%) with SRUS do not have any symptoms. It is discovered incidentally during testing for another reason.
Why does this situation occur?
The exact cause of this condition is not yet known. However, doctors believe that it is related to several conditions that can damage the inner wall of the rectum. This means that these lesions may be caused by another underlying medical condition.
There are several conditions that are commonly seen with SRUS:
- Rectal Prolapse: This is when the rectum protrudes through the anus. Think of it like turning a sock inside out. The friction and pressure that occurs as the tissue comes out can cause sores.
- Rectal Intussusception: This is when one part of the rectum pushes into another part of the rectum, like a telescope. This can also cause tissue damage.
- Chronic Constipation: When we have difficulty passing stool, we strain for a long time. This excessive pressure can damage the delicate tissues of the rectum. Some people try to remove stool with their fingers when it becomes stuck. This is also a major cause of rectal injuries.
- Fecal incontinence: Problems with the rectum can also occur in situations where you cannot control your bowel movements.
One of the main theories is that when our pelvic floor muscles, which help us pass stool, do not work properly, the process of passing stool becomes irregular and injuries like this occur.
How do you find this, Doctor?
When you see a doctor with the symptoms you mentioned above, he or she will first ask you about your symptoms and your toilet habits (e.g., do you take a long time to defecate?). Then, they will do some tests to confirm whether you have these lesions.
Main tests
- Endoscopy: This is the most common test. In this test, a thin, flexible tube with a camera attached is inserted through the anus to view any lesions or other changes inside on a screen. There are several types of this test:
- Anoscopy: Examines the anus and the last part of the rectum.
- Flexible Sigmoidoscopy: Examines the rectum and lower part of the colon.
- Colonoscopy: Examines the entire colon.
Other important tests
Your doctor may recommend several other tests to make sure you don't have other serious conditions (e.g., Inflammatory Bowel Disease (IBD) or Colon Cancer ) that cause symptoms similar to SRUS.
- Transrectal Ultrasound: A small probe is inserted into the rectum and sound waves are used to produce clear images of the inside walls of the rectum.
- Defecography: This is a special test. The process of passing stool is recorded using an X-ray or MRI machine. This helps to accurately determine if there is a condition such as rectal prolapse.
- Anorectal Manometry: A test that measures the function and pressure of the muscles in and around the anus. This can help determine whether the muscles involved in defecation are working properly.
- Biopsy: During the endoscopy, a very small piece of tissue is taken from the lesion and sent to the laboratory for examination under a microscope. This test is essential to be 100% sure that this is not cancer.
What are the treatments for this?
Treatment depends on the severity of your symptoms and the underlying cause of the condition. In most cases, simple changes to your lifestyle and toilet habits can help.
| Treatment method | Description |
|---|---|
| Diet and lifestyle changes |
|
| Medicines |
|
| Biofeedback Therapy | This is a behavioral therapy method. It involves recognizing the pelvic floor muscles that tighten during bowel movements and practicing relaxing them instead of tightening them. This is very helpful in breaking the habit of straining. |
| Surgery | If these injuries are caused by a condition such as rectal prolapse, a surgery called rectopexy may be required to correct the condition. |
When is the best time to see a doctor?
This is very important. There are some symptoms that we should never ignore.
If you are bleeding from your rectum, passing blood or mucus in your stool, or have persistent pain when going to the bathroom, please don't ignore it, thinking "it will go away in a day." Be sure to see your doctor to find out exactly what is causing it.
Take-Home Message
- Solitary Rectal Ulcer Syndrome (SRUS) is a rare, non-cancerous condition, but the discomfort it causes can be life-threatening.
- Bleeding from the rectum is never normal. If you notice it, be sure to see a doctor.
- Often, it is more important to treat the underlying cause of these sores (e.g., constipation, rectal prolapse) than to treat the actual sores themselves.
- Simple things like drinking plenty of water, eating a diet high in fiber, and avoiding straining in the bathroom can go a long way in controlling this condition.
- Follow your doctor's instructions exactly. Get the necessary tests and receive the appropriate treatment. If you treat it patiently, you can manage this condition well.
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