A recent restrospective review of 140 pediatric cases (median age 12 years) of solitary rectal ulcer syndrome (SRUS) (U Poddar et al. JPGN 2020; 71: 29-33) highlights the fact that in many, there are multiple ulcerations and in some there are none.

Key findings:

• Most had dsynergic defecation with prolonged sitting on the toilet (94%), excessive straining (98%), feeling of incomplete evacuation (93%) or “rectal digitation” (51%)
• Rectal bleeding was presenting feature in 94%
• Colonoscopy showed in 72% (n=101); a single ulcer was noted in (60%) (n=84)  -thus in those with an ulcer, 83% were solitary.
• Of the 113 with adequate followup, 63% had clinical improvement and healing of ulcer was documented in 36/82 (44%)
• The most common treatment was hydrocortisone enema with bulk laxative (n=73) with “improvement” in 52, “better” in 16, and no response in 5 (8.2%).  Other frequent treatments: sulfasalazine enema with bulk laxative (n=12), and bulk laxative alone (n=22)
• Most children (95/140) were older than 10 years; only 2 were ≤5 years

My take: Asking carefully about dysnergic bowel habits will make this diagnosis much easier.  Many children with SRUS have erythema and not a solitary ulcer; in addition, lesions can be ulcerative or polypoid.

Related blog post: One more cause of rectal bleeding