Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the
rectal mucosa
The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the le ...
(the lining of the rectum).
It commonly occurs with varying degrees of
rectal prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...
. The condition is thought to be caused by different factors, such as long term
constipation
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...
, straining during defecation, and
dyssynergic defecation
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...
. Treatment is by normalization of bowel habits,
biofeedback
Biofeedback is the process of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate t ...
, and other conservative measures. In more severe cases various surgical procedures may be indicated. The condition is relatively rare, affecting approximately 1 in 100,000 people per year. It affects mainly adults aged 30–50. Females are affected slightly more often than males. The disorder can be confused clinically with
rectal cancer
Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of th ...
or other conditions such as
inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...
, even when a
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
is done.
Signs and symptoms
The signs and symptoms are variable, and in up to 25% of patients there may be no symptoms.
The most common symptoms and signs are bleeding, which can vary from minor to severe, rectal prolapse and incomplete evacuation (35%-76% of cases).
According to one report, constipation is present in about 55% of cases, but diarrhea is present in 20%–40% of cases.
Reported symptoms are:
*
Hematochezia
Haematochezia is the passage of fresh blood through the anus path, usually in or with stools (contrast with melena). The term is from Greek αἷμα ("blood") and χέζειν ("to defaecate"). Hematochezia is commonly associated with lower gastro ...
(lower gastrointestinal bleeding).
which can vary from minor to severe.
* Rectal pain.
* Pelvic discomfort.
* Tenesmus.
* Sensation of incomplete evacuation of stool.
* Mucous rectal discharge.
* Constipation, which may be chronic and severe.
* Straining during defecation.
*
Rectal prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...
or other
pelvic floor disorders.
* Repeated use of laxatives.
*
Fecal incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred ...
.
Causes
The exact cause is unclear and the condition is not fully understood.
There are thought to be multiple factors which simultaneously cause the condition.
Long term injury to the rectal mucosa and ischemic trauma are thought to be the main mechanisms.
In a report of 36 patients with SRUS, the underlying cause was internal prolapse (intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients.
Direct trauma
Self-digitation is when patients experiencing constipation resort to inserting a finger into the rectum in order to "hook out" fecal pellets, or to apply pressure to an obstructing lesion (see:
obstructed defecation
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...
). The rectal mucosa is fragile and vulnerable to trauma when such manoeuvres are performed chronically. It is thought that this self-induced trauma is one possible mechanism of SRUS.
However, since sometimes the location of SRUS lesion(s) is much further than a finger could reach means that this cannot be the only cause.
In constipation, the stools may be very hard and this is another possible mechanism of trauma.
Excessive straining: chronic constipation, dyssynergic defecation
People with constipation or certain anatomical anomalies are more likely to end up using excessive straining during defecation attempts.
Prolonged straining may cause direct trauma to the rectal mucosa.
Most patients with SRUS have
dyssynergic defecation
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...
(previously termed anismus).
This is a failure of relaxation (or paradoxical contraction) of the
puborectalis muscle
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
during defecation attempts. This pelvic floor muscle is normally supposed to relax, thereby straightening the anorectal angle and allowing rectal contents to be evacuated. Dyssynergic defecation causes high pressure in the rectum and in the anal canal,
which causes lengthening
and compression of the rectal tissues, which in turn leads to ischema of the mucosa.
There is also a shearing movement of the rectum against the pelvic floor muscles.
In the long term this leads to repeated mucosal damage.
Inappropriate contraction of puborectalis in the squatting position causes traumatic compression of the rectal wall against the anal canal.
Also, it is reported that individuals with SRUS have not only increased pressure when squeezing, but also higher resting pressure compared to normal controls.
Rectal prolapse and ischemic injury
SRUS is usually accompanied by prolapse (e.g. external prolapse or rectoanal intussusception/internal prolapse) or other pelvic-floor disorders.
This is association is common, but not always present.
Some state that if SRUS is not treated, it would always tend to progress to rectal prolapse.
The relationship of SRUS with
rectal prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...
and rectal cystitis profunda is debated.
Some see SRUS and prolapse as synonymous, while others see them as separate entities,
and state that they do not share the same physiology.
For example the mucosal changes that occur with external rectal prolapse can be separated from the mucosal changes seen in SRUS.
The excessive pressure caused by straining (dyssynergic defecation and constipation) may in the long term lead to development of the spectrum of rectal prolapse conditions (mucosal versus full-thickness prolapse, internal versus external rectal prolapse).
These conditions create chronic vascular trauma (ischemia/hypoperfusion) in the rectal mucosa,
which predisposes it to ulceration,
and pressure necrosis.
Even the initial small areas of an intussusception can lead to vascular injury and reduce blood supply to the region.
This is the first stage of ulcer development.
Other factors
Psychological factors are also thought to be involved, since patients with SRUS sometimes psychological disorders such as
obsessive-compulsive disorder.
Also, some unknown factors may also be involved such as hormonal factors related to pregnancy.
Other possible factors are rectal hypersensitivity,
and impaired rectal evacuation of stool.
Diagnosis
Diagnosis is difficult because of rarity of the condition and variability of the symptoms and the histologic appearance.
The condition is sometimes misdiagnosed.
Diagnosis may be delayed by many years as a result.
Differential diagnosis
The
differential diagnosis
In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
is as follows:
*
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...
(IBD).
*
rectal neoplasms (bowel cancer).
* Chronic vascular insufficiency (
Ischaemic colitis
Ischemic colitis (also spelled ischaemic colitis) is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater ...
).
* Infectious diseases (e.g.
amebiasis
Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba ''Entamoeba histolytica''. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include lethargy, loss of weight, colonic ulc ...
,
lymphogranuloma venereum
Lymphogranuloma venereum (LGV; also known as climatic bubo, Durand–Nicolas–Favre disease, poradenitis inguinale, lymphogranuloma inguinale, and strumous bubo) is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a, L2 ...
,
syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...
).
*
Rectal endometriosis
Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, fall ...
.
* Drugs.
*
Colitis cystica profunda
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...
.
* Drug induced ulcer.
* Pressure ulcer.
* Trauma.
* Idiopathic (i.e. unknown cause).
Investigations
Investigations used in the diagnosis of SRUS include
defecography
Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visuali ...
,
endoanal ultrasound
Endoanal ultrasound is a type of medical investigation which images the structures of the anal canal.
It is used in the investigation of some anorectal symptoms, e.g. fecal incontinence or obstructed defecation.
See also
* Medical ultrasonography ...
colonoscopy
Colonoscopy () or coloscopy () is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis (''e. ...
and histological examination of a
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
.
Colonoscopy
The macroscopic appearance of SRUS is very variable.
Indeed, the condition has been referred to as “the three-lies disease”,
because the name of the condition is sometimes misleading. In reality, there may be more than one lesion, which may not be
ulcer
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...
ative,
and the condition may appear in different parts of the gastrointestinal tract (i.e. other than the
rectum
The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...
).
Classically, there is a solitary ulcer. But only 20% of patients have a single ulcer whereas in other cases there may be multiple lesions.
The size of the ulcers is usually 0.5–4 cm.
The lesion is most often located on the anterior (front) or lateral (side) rectal wall, centered on a rectal fold,
usually 10 cm from the anal verge.
Less commonly there may be ulcers in the
anal canal
The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segment ...
or even in the
sigmoid colon
The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus ''s ...
.
The nature of the tissue changes can vary from simple
erythema
Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not assoc ...
(redness) /
hyperaemia
Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation. Clinically, ...
(increased blood flow) of the mucosa 18% of cases,
to a chronic-appearing, small shallow ulcer with nodular margins and a white or sloughing base.
In up to 33% of cases there is no ulceration but instead one or more well-developed polyps or mass lesions.
There is usually mild
proctitis
Proctitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.
Signs and symptoms
A common symptom is a continual urge to have a bowel movement—the rectum could feel full or have const ...
(inflammation of the rectal mucosa) surrounding the ulcer.
Defecography
Conventional defecography or magnetic resonance defecography may be used.
Between 50-100% of patients with SRUS will have abnormal defecography results.
Defecography findings in SRUS may include:
* Evidence of dyssynergic defecation (anismus),
82% of patients with SRUS had dssynergic defecation in one report.
* Rectal intussusception (the most common finding in one report).
* Anterior (front) or posterior (back)
rectocele
In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pel ...
.
* Prolonged retention of
contrast media
A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radio ...
.
*
Megarectum
Megarectum is a large rectum as a result of underlying nerve supply abnormalities or muscle dysfunction, which remains after disimpaction of the rectum.
The Principles of Surgery textbook describes any rectum that can hold more than 1500cc of flu ...
.
Endoanal ultrasound
Endoanal ultrasound
Endoanal ultrasound is a type of medical investigation which images the structures of the anal canal.
It is used in the investigation of some anorectal symptoms, e.g. fecal incontinence or obstructed defecation.
See also
* Medical ultrasonography ...
can determine the depth of the ulcer and structure of the external and internal anal sphincters.
Endoanal ultrasound findings in SRUS include:
* Lack of distinction between the mucusa and the
muscularis propria
The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
.
* Thickening of the rectal wall.
* Thickening
muscularis propria
The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
.
* Thickening of
internal anal sphincter
The internal anal sphincter, IAS, (or sphincter ani internus) is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal; its inferior border is in contact with, but quite separate from, the external anal sphincter. It is ...
.
* Thickening of
external anal sphincter
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.
Anatomy
The external anal sphincter measures about 8 ...
.
* Thickening of
submucosal layer.
* Intussusception.
* Multiple submucosal cysts.
* Hyperechogenic bands of fibrosis in the submucosa layer.
* Regional lymph node infiltration.
Biopsy
The histological appearance is as follows:
* Segmental and superficial (shallow) ulceration.
* Obliteration of the lamina propria with fibromuscular / collagen infiltration.
This feature differentiates SRUS from
inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...
, and is the landmark diagnostic feature for SRUS.
* Hypertrophy and disruption of muscularis mucosa layer.
* Hyperplasia and distortion of crypt structure.
* Chronic inflammatory cell infiltration.
* No evidence of malignancy
(unless as very rarely happens the two conditions occur together).
If the biopsy includes polypoid lesions, there are villiform structures visible.
Gland entrapment in the submucosa is sometimes seen, which is termed
colitis cystica profunda
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...
.
Management
Treatment of SRUS is difficult and there is a lack of evidence-based guidelines for treatment of SRUS.
The treatment is based on the pathophysiology of SRUS,
and the main aim is restoration of a normal pattern of defecation.
The exact treatment depends on the severity of the symptoms, the severity/type of SRUS and whether rectal prolapse is present or absent.
Conservative measures are the first line treatment for patients with no symptoms, or only mild to moderate symptoms, and who have no significant anatomical defect.
Conservative measures by themselves may improve symptoms and prevent the condition getting worse.
Where conservative measures fail, or with severe disease and symptoms, or with significant anatomical defects, surgical options may be indicated.
Improvement in symptoms does not always equate to healing of the ulcer as seen on endoscopy.
Conservative (non-surgical)
Conservative management is focussed on education of the patient and behaviour modification. Where indicated, conservative management may also involve treatment of psychological problems,
and avoidance of anal-receptive sex (to prevent trauma to the rectum).
Modification of bowel habit
* Regular bathroom visits,
for a limited period of time.
* Avoidance of excessive straining. This can improve symptoms in up to 67% of cases and allow some degree of healing of the ulcer in about 30% of cases.
* Use of a stool to elevate the legs during defecation,
thereby straightening the anorectal angle and allowing for less effort during defecation. Alternatively, a squatting position can be used.
* Avoidance of any kind of rectal manipulation (digitation, enemas, suppositories).
Dietary measures
* A high-
fiber
Fiber or fibre (from la, fibra, links=no) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often incorporate ...
diet may help, but by itself is insufficient treatment. Improvement with high-fiber diet varies between 19% and 70%.
*
Bulk forming laxatives,
e.g.
psyllium
Psyllium , or ispaghula , is the common name used for several members of the plant genus ''Plantago'' whose seeds are used commercially for the production of mucilage. Psyllium is mainly used as a dietary fiber to relieve symptoms of both constip ...
powder.
*
Stool softener
Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation.
Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubri ...
s.
* Adequate intake of water (non-carbonated and caffeine-free drinks) during the day.
Biofeedback
Biofeedback targets pelvic floor behaviours and enables a reprogramming of autonomic nerologic pathways associated with defecation.
The treatment is particularly helpful for dyssynergic defecation. Research studies have shown that there is improved blood flow to the rectal mucosa after biofeedback therapy.
The overall rate of complete resolution of both symptoms and ulceration varies at 50-75%.
Stool frequency and straining effort decrease after this treatment.
In about 56% of cases biofeedback treatment stops rectal bleeding.
Some patients are able to cease relying on digitation.
Biofeedback is more effective in children with SRUS compared to adults.
Topical agents
Several different topical treatments (i.e. substances applied directly to the ulcer) have been reported, with variable outcomes.
They are usually administered by enema and may be helpful for short term management of acute symptoms in SRUS.
They are thought to work by reducing inflammation and physically forming a barrier over the surface of the ulcer to protect it from irritants and allowing it to heal.
However the long term efficacy is unknown. According to a systematic review, 57% of SRUS patients receiving medical treatment had resolution of ulceration.
Topical agents which have been used for SRUS include:
*
Glucocorticoid
Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebr ...
steroids.
*
Sucralfate
Sucralfate, sold under various brand names, is a medication used to treat stomach ulcers, gastroesophageal reflux disease (GERD), radiation proctitis, and stomach inflammation and to prevent stress ulcers. Its usefulness in people infected by ' ...
.
*
Salicylate
Salicylic acid is an organic compound with the formula HOC6H4CO2H. A colorless, bitter-tasting solid, it is a precursor to and a metabolite of aspirin (acetylsalicylic acid). It is a plant hormone, and has been listed by the EPA Toxic Substance ...
s.
*
Sulfasalazine
Sulfasalazine, sold under the brand name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease. It is considered by some to be a first-line treatment in rheumatoid arthritis. It is ...
.
*
Mesalamine
Mesalazine, also known as mesalamine or 5-aminosalicylic acid (5-ASA), is a medication used to treat inflammatory bowel disease, including ulcerative colitis and Crohn's disease. It is generally used for mildly to moderately severe disease. It ...
(5-aminosalicylic acid).
Surgery
Surgery may be indicated for severe cases of SRUS (either severe symptoms, severe ulceration, or significant associated anatomical defect such as prolapse), or when conservative measures fail.
Some authors state that most patients do not benefit from surgery.
Overall, up to 33% of SRUS patients end up requiring surgery.
A systematic review reported that SRUS improved in 77% of patients who underwent any type of surgery,
however 52% of cases developed a later recurrence of the condition.
It has been suggested that any treatment which only addresses the ulcer without correcting the underlying causes will typically lead to recurrence.
There are multiple different surgical procedures which have been reported for SRUS,
including:
* Local excision (removing the area of ulceration).
* Local therapies (usually injection of different agents into the rectal wall).
* Delorme procedure.
* Perineal proctectomy (Altemeier procedure).
* Rectopexy.
* Stapled transanal local excision (STARR) (has been used for SRUS with internal prolapse).
* Diversion colostomy.
* Transanal mucosal sleeve resection along with coloanal pull-through.
Local therapies
Various local treatments for SRUS have been reported. According to one report, such measures have generally unfavorable results, and sometimes the ulcer returns deeper and larger than before the treatment.
* Injection of steroid 100 mg diluted in 10 ml water into the rectal wall around the ulcer.
* Argon plasma coagulation (APC). This procedure uses high frequency monopolar current directed by ionised argon gas to coagulate tissues and mucosal ulcers, aiming to promote healing through re-epithelializion.
*
Sclerotherapy
Sclerotherapy (the word reflects the Greek ''skleros'', meaning ''hard'')
is a procedure used to treat blood vessel malformations (vascular malformations) and also malformations of the lymphatic system. A medicine is injected into the vessels, wh ...
: injection into the submucosal layer or
retro rectal space with 5% phenol, 30% hypertonic saline or 25% glucose and perianal
cerclage.
* Human
fibrin glue
Fibrin glue (also called fibrin sealant) is a surgical formulation used to create a fibrin clot for hemostasis, cartilage repair surgeries or wound healing. It contains separately packaged human fibrinogen and human thrombin.
Medical uses
This g ...
sealant applied endoscopically.
* Injection of
botulinum toxin
Botulinum toxin, or botulinum neurotoxin (BoNT), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromusc ...
injection into the external anal sphincter.
Local excision
Excision (removal) of the ulcer and suturing the resulting defect with surrounding healthy mucosa has been reported. However, the may not be any long-term benefit.
Ulcers in the upper part of the rectum may be accessible to local excision using a transanal minimally invasive approach (TAMIS).
Excision with neodymium yttrium-aluminiumgarnet laser has also been reported.
Rectopexy
Rectopexy is a surgery for rectal prolapse.
A newer version of the procedure is termed ventral mesh rectopexy, which has also been used for SRUS.
It may be performed with or without anterior resection (removal of a portion of the front wall of the rectum).
It may be used with or without mesh to reinforce the anterior rectal wall.
It can be done as an open procedure or with a laparoscopic abdominal approach.
Some authors state rectopexy is suitable in highly select cases,
while others say it is the procedure of choice,
since it directly addresses the most likely cause.
There is also more evidence to support the use of rectopexy in SRUS compared to other surgical procedures.
Approximately 55-83% of patients with SRUS get reduced symptoms after rectopexy,
and these benefits appear to be long term.
Other options
The following "last resort" surgical procedures (which may have significant consequences) have been reported in severe, persistent or recurrent cases of SRUS:
*
Lower anterior resection
A lower anterior resection, formally known as anterior resection of the rectum and colon and anterior excision of the rectum or simply anterior resection (less precise), is a common surgery for rectal cancer and occasionally is performed to remove ...
with coloanal anastomosis/reconstruction.
*
Fecal diversion (can be a temporary measure).
Epidemiology
The condition is relatively rare, but the exact prevalence is not known.
Prevalence has been estimated as 1 in 100,000 people per year.
SRUS can occur at any age, but it is most common in adults aged between 30-50.
Males and females are affected almost equally.
or slightly more in females.
Misdiagnosis
A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, i ...
as
inflammatory bowel disease
Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...
(IBD) or
rectal polyps
A colorectal polyp is a polyp (fleshy growth) occurring on the lining of the colon or rectum. Untreated colorectal polyps can develop into colorectal cancer.
Colorectal polyps are often classified by their behaviour (i.e. benign vs. malignant) ...
may hide the true prevalence of SRUS.
References
External links
{{Gastroenterology
Colorectal surgery
Rectum