What is a rectal ulcer?

A rectal ulcer is a rupture or injury to the bowel mucosa Rectal lining. While these ulcers are often associated with a rare disorder called solitary rectal ulcer syndrome (SRUS), there are other causes as well.

The rectum is the last 4 to 5 inches of the large intestine or colon. The main function of the rectum is to hold stool and help control bowel movements and bowel movements. The rectum consists of five layers, including mucosal tissue and muscle. Ulcers – damage to the mucosal tissue that heals slowly or constantly – can be caused by injury or disease.

This article will discuss common types of rectal ulcers, how to diagnose them, and how to treat them.

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Types of Rectal Ulcers

Any injury that results in tissue loss and slow healing can be considered an ulcer. Tissues within the digestive tract are more susceptible to irritation due to the types of substances that pass through this system, such as stool and digestive enzymes. This means that any type of injury or inflammation can lead to slow-healing wounds or ulcers.

A “rectal ulcer” is a general term for these injuries. In some cases, rectal ulcers may be the only diagnosis, but they are usually a symptom or complication of another disease or injury.

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Rectal Ulcer Symptoms

The main symptoms associated with rectal ulcers include:

  • stomach ache
  • cramp
  • anal bleeding
  • blood in stool
  • dark or tar-like stools
  • mucus in stool
  • diarrhea
  • constipate
  • pain during bowel movements
  • Leaky stools (fecal incontinence)

These symptoms can be related to a number of problems in the digestive tract, so your healthcare provider will likely have to do a full examination before determining the cause of the symptoms.


In some cases, rectal ulcers can develop on their own, especially SRUS.This rare disease is considered to be benign (non-cancerous) condition. Rectal ulcers are often misdiagnosed because symptoms such as rectal bleeding and abdominal pain can occur along with many other conditions that affect the digestive tract.

Among SRUS patients, approximately 40% have multiple ulcers, 20% have only one ulcer, and the remainder have other forms of injury or irritation. The exact cause of this condition is unknown, and for many, it may be the result of several problems, including:

  • straining during bowel movements due to constipation
  • Trauma caused by attempting to remove the affected stool digitally or with an enema
  • Uncoordinated muscle movement between the rectum and anus
  • Rectal prolapse (when part of the rectum slips off or out of the anus)
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How common are rectal ulcers?

There are many causes of rectal ulcers, so it is difficult to determine the true prevalence. However, SRUS is believed to affect approximately 1 in 100,000 people each year. Mostly seen in men in their 30s or women in their 40s.

Other conditions that may be associated with rectal ulceration include:

  • Long-term constipation (fecal enteritis)
  • ulcerative colitis
  • Crohn’s disease
  • ulcerative proctitis
  • Acute hemorrhagic rectal ulcer (AHRU)
  • Human Immunodeficiency Virus (HIV) Infection
  • rectal injury or trauma
  • ischemia
  • Infect
  • rectal or colon cancer
  • Diverticulitis

Digestive diseases and disorders (not IBD)


Your healthcare provider may be able to make some guesses based on your symptoms, but an accurate diagnosis of a rectal ulcer or any condition that can cause the problem often involves more invasive surgery.

Imaging studies such as X-rays, ultrasound, and magnetic resonance imaging (MRI), as well as a digital rectal exam, are sometimes available. However, direct visualization of the colon using a flexible sigmoidoscope or colonoscope provides the most accurate information for diagnosis.

During this procedure, your healthcare provider will use a thin light-emitting tube with a camera on the end to examine the tissue in your rectum. A special tool is then used to remove small pieces of tissue for further analysis (biopsy).

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

If SRUS is the cause of your rectal ulcer, treatment will depend on your specific symptoms and the severity of the problem. A small number of people with this disorder have no symptoms at all, and treatment may be limited to behavioral changes to reduce constipation or to relieve fecal impaction (a buildup of stool in the rectum) with less irritating methods. For people with mild symptoms, laxatives, bowel training, and bowel management education may help.

For more severe cases, enemas, topical treatments, and steroids can help, but surgery may be required—especially if the ulcer causes complications such as rectal prolapse. Surgical options can range from limited removal of the ulcer itself to complete removal of the entire rectum (proctectomy).

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For rectal ulcers, conservative treatment is the first choice. In most cases, education, behavioral changes, dietary changes, and other strategies that rely on biofeedback are first-line treatments. Studies show that 50%–75% of people with rectal ulcers experience remission with these treatments.

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

When rectal ulcers are caused by other diseases, the overall prognosis will depend on how well the underlying disease (such as cancer) is treated or controlled.

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Dietary and behavioral changes are often effective in treating rectal ulcers and other digestive problems—but these treatments can take time. Dealing with symptoms of a rectal ulcer, especially symptoms such as rectal bleeding or fecal incontinence, can be uncomfortable and embarrassing.

When your condition resolves, your healthcare provider will be able to recommend ways to manage your fecal incontinence. This may include using products such as disposable underwear 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 is also important to take care of your skin if you experience fecal leakage, incontinence, or rectal bleeding. Problems such as bedsores and moisture-related skin damage are common in people who experience various types of incontinence, and strict hygiene and preventative care can help. Absorbent products can actually make skin damage worse if wet products come into contact with the skin for prolonged periods of time.

If you have fecal incontinence or other leakage due to a rectal ulcer, be sure to:

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

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

VigorTip words

Rectal ulcers are small wounds that form in the lining of the large intestine. These injuries can be caused by certain medical conditions, or even trauma from constipation or enemas. In many cases, these ulcers are treatable, but managing incontinence or bleeding during the healing process can be challenging. Talk with your healthcare team about the best ways to manage incontinence and bleeding when treating the underlying cause of the ulcer.

Frequently Asked Questions

  • Are all rectal ulcers cancerous?

    While ulcers can develop in many conditions, including rectal cancer, these wounds are there for a reason. Constipation is a major factor.

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    Rectal Cancer Overview

  • Can enemas cause rectal ulcers?

    There are many things that can cause rectal ulcers, including certain diseases and even trauma. Tools or enemas used to remove stool from the bowel can lead to the development of rectal ulcers, but so can constipation, which enemas are designed to treat.

    understand more:

    Are enemas safe?

  • Do I need surgery to treat a rectal ulcer?

    In severe cases, rectal ulcers may require surgery. Surgery is usually required in cases of severe bleeding or rectal prolapse. Most of the time, however, rectal ulcers can be treated with more conservative measures such as diet and behavioral changes.

    understand more:

    Colorectal Surgery: An Overview