What Is a Rectal Ulcer?

A rectal ulcer is a break or injury in the mucous membrane that lines the rectum. While these ulcers are most often linked to a rare condition called solitary rectal ulcer syndrome (SRUS), there are other causes, too.

The rectum is the final 4- to 5-inch section of your large intestine, or colon. The primary function of the rectum is to hold feces and help control defecation and bowel continence. The rectum is made up of five layers consisting of both mucosal tissue and muscle. An ulcer—an injury to the mucosal tissue that is slow to heal or keeps returning—can be caused by injury or disease.

This article will explore common types of rectal ulcers, how they are diagnosed, and how they can be treated.

Types of Rectal Ulcer

Any injury that leads to tissue loss and is slow to heal can be considered an ulcer. Because of the types of material that pass through this system, like stool and digestive enzymes, the tissues within the digestive tract are more susceptible to irritation. This means that any kind of injury or inflammation can lead to a slow-healing wound or ulcer.

"Rectal ulcer" is a generic term for these injuries. In some cases, rectal ulcers may be the only diagnosis, but they typically are a symptom or complication of another disease or injury.

Rectal Ulcer Symptoms

The primary symptoms associated with rectal ulcers include:

• Abdominal pain
• Cramping
• Bleeding from the anus
• Blood in your stools
• Dark or tarry stools
• Mucus in your stools
• Diarrhea
• Constipation
• Pain during bowel movements
• Stool leakage (fecal incontinence)

These symptoms can be related to a number of issues within your digestive tract, so your healthcare provider will most likely have to perform a comprehensive exam before the cause of your symptoms can be identified.

Causes

Rectal ulcers can develop on their own in some cases, especially with SRUS. This rare disease is considered a benign (noncancerous) condition. Rectal ulcers are commonly misdiagnosed, because symptoms like rectal bleeding and abdominal pain can appear with many other diseases that affect the digestive tract.

In people with SRUS, about 40% have multiple ulcers, 20% have just one ulcer, and the remainder have some other form of lesion or irritation. The exact cause of this condition is unknown, and for many people it can be the result of several issues, including:

• Straining during bowel movements due to constipation
• Trauma caused by the act of trying to remove impacted stool digitally or with an enema
• Uncoordinated muscle movements between the rectum and anus
• Rectal prolapse (when part of the rectum slips or falls outside the anus)

Other conditions that may be associated with the formation of rectal ulcers include:

• Prolonged constipation (stercoral colitis)
• Ulcerative colitis
• Crohn's disease
• Ulcerative proctitis
• Acute hemorrhagic rectal ulcer (AHRU)
• Human immunodeficiency virus (HIV) infection
• Rectal injury or trauma
• Ischemia
• Infection
• Rectal or colon cancer
• Diverticulitis
  

Diagnosis

Your healthcare provider may be able to make some guesses based on your symptoms, but an accurate diagnosis of rectal ulcers—or any of the conditions that can cause this problem—usually involves a more invasive procedure.

Imaging studies like X-ray, ultrasound, and magnetic resonance imaging (MRI) may sometimes be used, as well as a digital rectal exam. However, direct visualization of the colon with a flexible sigmoidoscopy or colonoscopy can provide the most accurate information for diagnosis.

During this procedure, your healthcare provider will use a thin, lighted tube with a camera on the end to inspect the tissues in your rectum. Special tools are then used to remove small pieces of tissue for further analysis (biopsy).

Treatment

If your rectal ulcers are caused by a gastrointestinal disease like inflammatory bowel disease (IBD), including ulcerative colitis, your treatments will be tailored to that specific condition. When ulcers develop as a complication of another condition, controlling the underlying disease should allow existing ulcers to heal and prevent new ones from forming.

If SRUS is the cause of your rectal ulcers, treatment will depend on your specific symptoms and how severe the issue is. A small number of people with this condition have no symptoms at all, and treatment may be limited to behavioral changes to reduce constipation or relieve fecal impaction (buildup of feces in the rectum) with less irritating methods. For people with minor symptoms, laxatives, bowel training, and education about bowel management can be helpful.

For more severe cases, enemas, topical treatments, and steroids can help, but surgery may be required—especially when ulcers lead to complications like rectal prolapse. Surgical options can vary from a limited removal of the ulcer itself to complete removal of the entire rectum (proctectomy).

Prognosis

Conservative treatment is the first choice when it comes to rectal ulcers. Education, behavioral changes, dietary changes, and other strategies that rely on biofeedback are the first line of treatment in most cases. Studies suggest that 50%–75% of people with rectal ulcers find relief with these therapies.

Surgery is usually reserved for the limited number of people who experience severe bleeding or other complications from rectal ulcers. When surgery is required for SRUS, 42%–100% of procedures are successful.

When rectal ulcers are caused by other conditions, the overall prognosis will depend on how well the underlying condition—like cancer, for example—can be treated or controlled.

Coping

Dietary changes and behavior modification usually are effective when it comes to managing rectal ulcers and other digestive problems—but these therapies can take time. Dealing with the symptoms of rectal ulcers, particularly things like rectal bleeding or fecal incontinence, can be uncomfortable and embarrassing.

Your healthcare provider will be able to suggest ways to manage your fecal incontinence while your condition is addressed. This might include using products like disposable undergarments or absorbent pads. You may also want to ask about support groups or other services that can help you cope with the emotional toll of your diagnosis.

It's also important to take care of your skin if you experience fecal leaking, incontinence, or rectal bleeding. Problems like bed sores and moisture-associated skin damage are common in people who experience all types of incontinence, and strict hygiene and preventive care can help. Absorbent products can actually make skin damage worse if wet products are left in contact with your skin for long periods of time.

If you experience fecal incontinence or other leaking due to your rectal ulcers be sure to:

• Clean your skin as soon as possible after a bowel movement.
• Clean with a mild soap, rinse well, and pat dry.
• Use moisturizers.
• Avoid products or soaps that can dry the skin.
• Add a moisture barrier or skin sealant to prevent damage.
  

Summary

Rectal ulcers can develop as a complication of several conditions or as an isolated problem. If you experience problems like fecal incontinence or rectal bleeding, you should make an appointment with a healthcare provider so that an accurate diagnosis can be made.

A Word From Verywell

Rectal ulcers are small wounds that develop in the lining of your large intestine. These injuries can be caused by certain diseases, and even trauma from constipation or enemas. In many cases, these ulcers can be treated, but managing incontinence or bleeding while you are healing can be challenging. Talk to your healthcare team about the best way to manage incontinence and bleeding while you treat the underlying cause of your ulcers.