title: Solitary rectal ulcer syndrome.
abstract: BACKGROUND
  Solitary rectal ulcer syndrome is a rare disorder characterized by erythema or ulceration of the rectal wall, associated with typical histological features, and disturbed defaecatory behaviour with the passage of blood and mucus.
  
  
  METHODS
  This is a review based on a literature search using a computer database (Medline) and manual cross-referencing.
  
  
  RESULTS
  The pathogenesis is likely to vary in different patients; it includes trauma from straining, direct digital trauma and possibly primary neuromuscular pathology. The histological findings of extension of the muscularis mucosa between crypts and muscularis propria disorganization on full-thickness specimens are characteristic. Biofeedback defaecation retraining, including habit training, can lead to symptom improvement and return to work in a majority of patients. Abdominal rectopexy offers long-term symptom improvement in approximately 50 per cent of patients. Rectal ulceration may persist after any treatment, even if symptoms improve.
  
  
  CONCLUSIONS
  Behavioural therapy and carefully considered operations offer the best treatment results. Further work on psychological factors and neuromuscular and vascular pathology is required.
authors.affiliation: Middlesex Hospital, London, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Vaizey
authors.forename: J B
authors.initials: JB
authors.lastname: van den Bogaerde
authors.forename: A V
authors.initials: AV
authors.lastname: Emmanuel
authors.forename: I C
authors.initials: IC
authors.lastname: Talbot
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
mesh_terms: D006801:Humans; D012002:Rectal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013577:Syndrome; D014456:Ulcer / Q000175:diagnosis / Q000209:etiology / Q000628:therapy