Rectal Ulcer – Information on the Condition and Symptoms Affecting the Anus and Rectum

A rectal ulcer most likely develops as a result of an injury to the anal mucosa. This can be caused by mechanical damage—for example, during a temperature measurement—or by tissue necrosis, such as that resulting from a rectal prolapse.

Doctors refer to the latter process of rectal ulcer formation as pressure necrosis. 

Common causes of pressure necrosis include:

• rectal prolapse (the rectum protrudes from the anus)
• chronic constipation, as well as
• Manual evacuation during hard bowel movements

If such tissue damage results from changes in the blood vessels, however, it is classified as ischemic necrosis. This means that the tissue dies as a result of a lack of blood and oxygen supply.

In the early stages, a rectal ulcer is usually asymptomatic. If the underlying cause—such as hard stools—persists for an extended period, the ulcer continues to grow in size. 

The most common symptoms of a rectal ulcer include:

• A feeling of incomplete bowel movement
• Blood and discharge from the rectum
• Pain in the anal area
• General feeling of illness
• Increased tendency toward chronic constipation
• Anal fissure, abscess, or fistula

To diagnose a rectal ulcer, the primary care physician always begins by taking a medical history. During this process, the doctor asks about important lifestyle factors and family history that are relevant to the patient’s medical history.

This is followed by a physical examination. During this examination, the doctor assesses key findings in the area of the rectum, the sphincter muscle, and the anal opening. In addition to signs of a rectal ulcer, the colorectal specialist often finds other hemorrhoidal conditions or even a rectal prolapse. This is often associated with severe pain.

During the medical history interview, the doctor obtains important information about a possible condition @ Robert Kneschke

As is customary with inflammatory changes in the intestinal tract, the doctor confirms the diagnosis using imaging. Symptoms such as an ulcer, blood in the stool or on toilet paper, and chronic constipation could also indicate cancer. For this reason, the doctor performs a more detailed examination of the rectum using endoscopy (colonoscopy) to clarify the diagnosis. The medical diagnosis also includes chronic inflammatory bowel diseases, such as Crohn’s disease. 

In some cases, the doctor may also take a tissue sample (biopsy) from the affected ulcer area and analyze it histologically. A rectal ulcer is particularly characterized by a thickened mucosal layer.

First, the reassuring answer: Yes, a rectal ulcer is generally treatable. It responds to conservative therapies, meaning surgery is not necessary. Many patients also suffer from recurrent constipation. For this reason, the doctor prescribes laxatives to promote bowel movements. 

If the rectal ulcer is caused by a rectal prolapse, surgery may be necessary depending on the severity. During the procedure, the surgeon primarily aims to remove the rectal ulcer while simultaneously correcting the underlying cause (rectal prolapse).

In addition to treating the rectal ulcer, lifestyle changes are also recommended. Patients should reduce the frequency of bowel movements by adjusting their diet. 

At the same time, patients should limit straining during bowel movements. They should also learn to prevent relapses by better controlling their straining. Biofeedback may be a suitable technique for this purpose.

Specialists who focus primarily on the intestines and the rectal area are called proctologists. However, dermatologists (skin doctors) and surgeons may also be involved in the differential diagnosis and treatment of rectal ulcers.

What is a rectal ulcer, and what symptoms does it cause?

A rectal ulcer is a rare, inflammatory condition of the rectum in the area of the anus. Typical symptoms include pain during bowel movements, bleeding, anal itching, and a feeling of incomplete bowel emptying. 

How are rectal ulcers diagnosed and treated?

A colonoscopy is usually performed to make the diagnosis, as well as to rule out other infections and intestinal diseases. Treatment initially focuses on conservative measures; surgical procedures are rarely necessary. 

Can a rectal ulcer be cured, and how can a recurrence be prevented?

Yes—a rectal ulcer can usually be treated effectively. However, preventing a recurrence is very important: regular bowel movements without straining, a high-fiber diet, sufficient exercise, and adequate fluid intake. These measures help prevent complications and recurrence.