Doctors sometimes struggle to diagnose a rare condition called solitary rectal ulcer syndrome (SRUS) because it looks like other more serious diseases. This case study describes a 60-year-old man who had SRUS along with a narrowing of his rectum, which made diagnosis even trickier. The good news is that doctors used several tests to figure out what was really going on, and then treated him successfully with diet changes, laxatives, special therapy, and a procedure to widen the narrowed area. Understanding this condition better helps doctors catch it earlier and treat patients more effectively.

The Quick Take

  • What they studied: A rare condition where a sore develops in the rectum (the last part of your large intestine) and causes narrowing, which doctors often mistake for cancer or inflammatory bowel disease.
  • Who participated: One 60-year-old male patient with symptoms of rectal ulcer syndrome and narrowing of the rectum.
  • Key finding: Using multiple diagnostic tests including camera examination, pressure testing, special imaging, and tissue samples helped doctors correctly identify this rare condition and treat it successfully without surgery.
  • What it means for you: If you have persistent rectal symptoms, doctors should consider this rare condition and do proper testing to confirm diagnosis before starting treatment. Early and correct diagnosis leads to better outcomes.

The Research Details

This is a case report, which means doctors documented the medical story of one patient with an unusual condition. The patient underwent several diagnostic procedures: a colonoscopy (camera examination of the rectum), anorectal manometry (a test measuring muscle pressure), magnetic resonance defecography (special imaging of the rectum), and a tissue biopsy (taking a small sample to examine under a microscope). These tests helped doctors understand what was causing the patient’s symptoms and rule out more serious conditions like cancer or inflammatory bowel disease.

The patient was then treated with a combination approach: eating more fiber, taking laxatives (stool softeners), undergoing biofeedback therapy (learning to relax muscles properly), having argon plasma coagulation (a procedure using special energy to treat the ulcer), and stricture dilation (gently stretching the narrowed area). Doctors tracked how well these treatments worked.

This case is important because solitary rectal ulcer syndrome is very rare and often gets misdiagnosed. By documenting this unusual presentation with narrowing, doctors help other physicians recognize similar cases earlier. The combination of diagnostic tests used here provides a roadmap for how to properly identify this condition, which is critical because it can look like cancer or serious inflammatory disease.

This is a single case report, which is the lowest level of scientific evidence. It describes what happened with one patient but cannot prove cause-and-effect or be applied to everyone. However, case reports are valuable for describing rare conditions and unusual presentations. The strength of this report is that multiple diagnostic tests were used to confirm the diagnosis, and tissue examination (histopathology) provided definitive proof. The main limitation is that we cannot know if this treatment approach works for all patients with this condition.

What the Results Show

The 60-year-old patient presented with symptoms suggesting a serious rectal problem. Initial examination might have suggested cancer or inflammatory bowel disease, but multiple tests revealed the true diagnosis: solitary rectal ulcer syndrome with rectal narrowing. The tissue biopsy was crucial—it showed the characteristic changes of SRUS rather than cancer or other serious conditions.

After treatment with the combination approach (high-fiber diet, laxatives, biofeedback therapy, argon plasma coagulation, and stricture dilation), the patient’s condition improved significantly. He did not require surgery, which is important because surgery carries more risks and longer recovery time.

This case demonstrates that even when a condition looks scary on initial examination, proper diagnostic testing can identify the true cause and lead to effective non-surgical treatment. The patient’s improvement shows that conservative (non-surgical) management can work well for this condition.

The case highlights that solitary rectal ulcer syndrome typically develops from chronic straining during bowel movements, repeated manual manipulation of the rectum, or rectal prolapse (when the rectum drops down). The condition causes damage to the rectal lining through several mechanisms: squeezing of the rectal wall, reduced blood flow to the area, ongoing inflammation, and repeated mechanical injury. In rare cases like this one, the chronic damage leads to scarring and narrowing (stricture formation).

Solitary rectal ulcer syndrome is known to be rare and often misdiagnosed. This case adds to the medical literature by showing an unusual presentation with stricture formation. Most cases of SRUS respond to conservative treatment, but the addition of stricture makes diagnosis more challenging because narrowing of the rectum is more commonly associated with cancer or inflammatory bowel disease. This case reinforces that histopathological examination (tissue biopsy) is essential for accurate diagnosis.

This is a single case report, so we cannot determine how common this presentation is or whether the same treatment approach works for all patients. We don’t have long-term follow-up information about whether the patient remained symptom-free. The case doesn’t compare different treatment approaches to see which works best. Additionally, because only one patient is described, we cannot make general recommendations that apply to everyone with this condition.

The Bottom Line

If you have persistent rectal symptoms (bleeding, pain, difficulty with bowel movements, or feeling of incomplete evacuation), ask your doctor to consider solitary rectal ulcer syndrome in the differential diagnosis. Insist on proper diagnostic testing including colonoscopy and tissue biopsy rather than assuming it’s cancer or inflammatory bowel disease. Conservative treatment with dietary changes, stool softeners, and behavioral therapy should be tried first before considering more invasive procedures. (Confidence level: Moderate—based on this single case and general medical knowledge about the condition.)

This information is relevant for people experiencing chronic rectal symptoms, especially those who strain frequently during bowel movements or have a history of rectal problems. It’s also important for healthcare providers who may encounter patients with rectal symptoms, as it reminds them to consider rare diagnoses. People with inflammatory bowel disease should be aware this condition exists as a possible alternative diagnosis. Those with a history of rectal prolapse or chronic constipation should pay attention to new or worsening symptoms.

If this condition is properly diagnosed and treated, improvement may be seen within weeks to a few months with conservative management. However, this is based on one case, so individual results may vary. Some patients may need several months of consistent treatment before seeing significant improvement. If conservative treatment doesn’t work after 3-6 months, more advanced procedures may be needed.

Want to Apply This Research?

  • Track daily bowel movement symptoms including: presence of blood, pain level (1-10 scale), feeling of incomplete evacuation, and straining effort. Also note dietary fiber intake and water consumption. This data helps identify patterns and shows whether treatment is working.
  • Implement gradual dietary changes to increase fiber intake (aiming for 25-30 grams daily), increase water consumption to 8+ glasses daily, and practice relaxation techniques during bowel movements to reduce straining. Use the app to set reminders for taking prescribed laxatives and to log compliance with biofeedback exercises if recommended by your doctor.
  • Use the app to create a symptom diary tracking rectal symptoms weekly. Set monthly check-in reminders to review trends and share data with your healthcare provider. Monitor whether symptoms improve, stay the same, or worsen over 3-month periods to assess treatment effectiveness and guide decisions about whether to continue or modify the current approach.

This article describes a single case of a rare medical condition and should not be used for self-diagnosis. Rectal symptoms can have many different causes, some serious. If you experience rectal bleeding, pain, or changes in bowel habits lasting more than a few weeks, consult a healthcare provider for proper evaluation and diagnosis. This information is educational and does not replace professional medical advice. Always work with your doctor to determine the cause of your symptoms and develop an appropriate treatment plan.