Overview
The rectum is the last part of the large bowel, where stool is held before it leaves the body. In solitary rectal ulcer syndrome (SRUS) the lining of the rectum becomes inflamed, thickened or ulcerated (an ulcer is a sore on the lining). The ulcer is usually on the front wall, a few centimetres from the anus. It is a benign condition, which means it is not cancer, although it can look worrying and a biopsy is often needed to be sure.
Symptoms
Straining a lot to pass stool, often for a long time
Passing blood or mucus (slimy discharge) from the rectum
A feeling of not having emptied the bowel fully
Frequent urges to go to the toilet, sometimes with only mucus passing
Pain or discomfort in the rectum or lower belly
Constipation or, in some people, a feeling of a blockage or a lump in the rectum
Some people have no symptoms and the ulcer is found by chance
Self-Care Tips
Keeping good toilet habits long term helps prevent relapse
Be patient: improvement can take weeks to months
Report any new bleeding or change in symptoms to your doctor
When to See a Doctor
Seek medical care promptly if you notice: Heavy rectal bleeding, passing clots, or feeling dizzy or faint; New rectal bleeding or a change in bowel habit that lasts, especially after age 45 or with a family history of bowel cancer; Severe or worsening rectal pain, fever, or a swollen, painful belly; Unable to pass stool or wind, with vomiting and a swollen belly; Rectum or tissue protruding from the anus that cannot be pushed back, or is painful and dark.
Why it happens
It is thought to result from repeated straining, from the rectum folding into itself (rectal prolapse, including a hidden or internal form), and from the pelvic floor muscles failing to relax while passing stool. This causes pressure and reduced blood flow to the rectal lining, which is damaged by friction. Some people also use fingers to help stool out, which can injure the lining. It is not contagious and is not caused by cancer.
How common it is
It is an uncommon condition. It affects mainly young and middle-aged adults and can occur in both men and women, and it is often diagnosed late because the symptoms resemble those of other conditions such as haemorrhoids or inflammatory bowel disease.
How it is diagnosed
Diagnosis needs a look inside the rectum: a flexible sigmoidoscopy or colonoscopy (a thin camera passed through the anus), during which biopsies are taken. The pathologist looks for the typical changes and excludes inflammatory bowel disease, infection and cancer. Because the cause is a problem with how the rectum and pelvic floor work, tests such as defecography (an X-ray or MRI video taken while passing stool) and anorectal physiology tests (which measure muscle function) may be done. The doctor decides which are needed.
Lifestyle and daily habits
Changing how you use the toilet is the most important treatment.
• Do not strain; if nothing passes within a few minutes, get up and try again later
• Limit time on the toilet and avoid reading or using the phone there
• Place a small footstool under your feet so your knees are higher than your hips
• Avoid using fingers to help stool out
• Go when you feel the urge instead of delaying
• Biofeedback therapy, guided by a trained therapist, retrains pelvic muscles to relax and is often recommended
Diet
The aim is soft, easy-to-pass stools.
• Increase fibre gradually with vegetables, fruit, whole grains and legumes
• Drink enough fluids throughout the day
• Add fibre slowly to avoid gas and bloating
Medicines
Medicines mainly treat constipation and inflammation. Your doctor decides which suit you.
• Fibre supplements or osmotic laxatives to keep stools soft
• Avoid long-term use of stimulant laxatives unless your doctor advises
• Medicated enemas or suppositories for inflammation, if prescribed
• Do not use medicines you buy without checking, as some irritate the rectum
Procedures and surgery
Procedures are for people who do not improve with habit changes and medicines.
• Biofeedback and pelvic floor retraining
• Local treatments applied during endoscopy in selected cases
• Surgery to repair rectal prolapse if this is the underlying cause and other treatments have failed
• Your surgeon will explain benefits and limits, as results vary
Outlook
The condition is benign and many people improve, particularly when they stop straining and treat constipation. It can take time, and symptoms may come and go. Bleeding and pain usually ease with the right treatment. Surgery is considered only for a small group with prolapse who do not improve with other measures.
Questions to ask your doctor
• Has cancer been ruled out by my biopsy?
• Do I have a rectal prolapse or a problem with relaxing my pelvic floor?
• Would biofeedback help me and where can I get it?
• Which laxatives or fibre are best for me?
• When would surgery be considered?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is Solitary Rectal Ulcer Syndrome?
How is Solitary Rectal Ulcer Syndrome diagnosed?
What is the outlook for Solitary Rectal Ulcer Syndrome?
When should I see a doctor about Solitary Rectal Ulcer Syndrome?
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