A rectal ulcer is a partially inflammatory mass in the area of the last section of the intestine, the rectum. It develops directly on the front wall of the rectum. The technical term "solitary rectal ulcer" is rather inappropriate. The rectal ulcer can occur in several places at the same time, depending on its severity.
A rectal ulcer most likely originates from an injury to the anal mucosa. This can occur through mechanical damage, e.g. when taking a temperature, or through tissue death, e.g. as a result of rectal prolapse.
Doctors call the latter process of rectal ulcer development pressure necrosis. Common causes of pressure necrosis include
If such tissue damage is caused by changes in the blood vessels, it is known as ischemic necrosis. This means that the tissue dies as a result of the lack of blood and oxygen supply.
In the early stages, rectal ulcers are usually asymptomatic. If the cause - such as excessively hard bowel movements - persists for a longer period of time, the ulcer increases in size. It can then become symptomatic.
The most common symptoms of a rectal ulcer include
To diagnose a rectal ulcer, the doctor will always start by taking a medical history. He will ask about important life circumstances and family backgrounds that are relevant to the patient's medical history.
This is followed by a physical examination. During this examination, the doctor collects important findings in the area of the rectum and anal opening. In addition to signs of a rectal ulcer, the bowel specialist often also finds hemorrhoids or even a rectal prolapse.
During the anamnesis interview, the doctor obtains important information about a possible disease
As is usual with inflammatory changes in the area of the bowel, the doctor confirms the diagnosis of "rectal ulcer" using imaging. The symptom complex of ulcerations, blood in the stool and chronic constipation could also indicate cancer. The doctor will therefore examine the rectum more closely using endoscopy (colonoscopy).
The doctor may also take a tissue sample (biopsy) from the affected ulcer area and characterize it histologically. The rectal ulcer is particularly noticeable due to its thickened mucosal layer (mucosa).
The reassuring answer first: yes, rectal ulcers are generally easy to treat. In most cases, it also responds to conservative therapies, which means that surgery can be avoided. Many patients suffer from recurrent constipation at the same time as this ulcer disease. This is why doctors prescribe laxatives to promote bowel movements .
If the rectal ulcer is caused by rectal prolapse, surgery may be necessary depending on the severity. The surgeon will primarily attempt to remove the rectal ulcer and at the same time correct its cause - in particular rectal prolapse.
The treatment of rectal ulcers can also be accompanied by lifestyle changes. It makes sense to reduce the frequency of bowel movements by adjusting the diet. At the same time, those affected should limit straining during bowel movements. Patients should also learn to avoid relapses by better controlling their straining. The technique of biofeedback may be well suited for this.
Specialists who primarily deal with the bowel and also the rectal area are the so-called specialists in proctology. However, dermatologists (skin specialists) and surgeons may also be involved in the differential diagnosis and treatment of rectal ulcers.
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