Nonsurgical therapy for solitary rectal ulcer syndrome

Abstract

The treatment of solitary rectal ulcer syndrome (SRUS) remains problematic and is less than ideal. Prospective, well-designed studies assessing the efficacy of treatment for SRUS are few; most of the knowledge imparted for treating SRUS is experiential. As such, firm treatment recommendations can not be made. Rather, a conservative, stepwise, individualized approach must be employed. Diagnostic modalities should be incorporated in the management scheme to direct treatment when indicated. Management must include patient reassurance that the underlying lesion is benign, because complete "cures" are uncommon in those with SRUS. The goals of therapy should be discussed with the patient prior to initiating treatment. Although the ultimate goal is macroscopic and microscopic healing, a realistic goal is cessation or minimization of symptoms. We outline a reasonable approach to the management of SRUS. Histologic confirmation of SRUS should prompt a discussion of the presumed pathogenic mechanisms with the patient. Conservative therapy with dietary fiber, bowel retraining, and bulk laxatives should be employed. If symptoms persist, the patient should receive a trial of sucralfate enemas for 6 weeks. Individuals who respond should continue conservative therapy. However, if symptoms persist, defecography can be done to assess for inappropriate puborectalis contraction and occult rectal mucosal prolapse. Patients with inappropriate contraction of the puborectalis can be offered biofeedback. Patients with occult rectal mucosal prolapse can be considered for surgery. However, the risks, benefits, and success rates of surgery should be discussed at length, prior to any procedure being performed. Rectopexy or Delorme's procedure offer the best success rates to date; however, the choice of surgical procedure must take into account the experience of the surgeon and wishes of the patient.

Long Term Conservative Approach in a Young Male with Solitary Rectal Ulcer Syndrome

“…Only a few patients with occult rectal mucosa will require surgery as next step. However success of surgical procedure should be discussed with patient and choice of surgical procedure should be according to experience of surgeon [18]. Sucralfate retention enema given twice daily 2 gm of sucralfate suspended in 30 ml of tap water for 6-8 weeks may result in healing of ulcer.…”

A report of 112 cases of solitary rectal ulcer syndrome from Iran

“…In a recent study from Italy, treatment of mucosal prolapse with PPH (procedure for prolapse and hemorrhoids) showed good results [8]. In addition, intra-anal Delorme's surgery indicated good results in a few studies [14][15][16][17].…”

“…However, biofeedback should be the main treatment, while for those who do not respond to regular treatments or those with total rectal prolapse, surgery should be considered [8]. In the present study, clinical features of SRUS among Iranian patients have been evaluated to help determine the prominent criteria that differentiate this syndrome from IBD.…”

Rektumda Polipoid-Malign Gorunumlu Lezyonla Basvuran Soliter Rektal Ulser Olgusu

“…Pelvik taban disfonksiyonu olan hastalarda diğer tedavi yöntemlerinden fayda görmeyenlere ve özellikle konstipe olanlara biofeed back uygulaması denenebilir. Bu tedavinin amacı defekasyon sırasında pelvik taban kaslarını ve anal sfinkteri gevşeterek rektoanal koordinasyonu sağlamak ve normal defekasyon dinamiğini gerçekleştirmektir (9,10). Davranışsal tedaviler ile semptomlarda belirgin düzelmelerin sağlandığı rapor edilmiştir (11,12).…”