Solitary rectal ulcer

This is becoming a more commonly diagnosed problem. Classically, it takes the form of an ulcer on the anterior wall of the rectum. In this form it must be differentiated from a rectal carcinoma or inflammatory bowel disease, particularly Crohn’s disease. In recent years, it has been appreciated that the ulceration may heal, leaving a polypoid appearance. A variety of explanations as to its cause has been suggested, including persistent trauma by sexual malpractices. However, recent proctographic studies indicate that the cause may be due to a combination of internal intussusception or anterior rectal wall prolapse, and an increase in intrarectal pressure. This combination of factors is usually due to chronic straining as a result of constipation. The histological appearances confirm the diagnosis (Morson) and they are similar to the appearances of biopsies from a full-thickness overt rectal prolapse. The condition, although benign, is difficult to treat. Symptomatic relief from bleeding and discharge may some­times be achieved by preventing the internal prolapse by an abdominal rectopexy. In rare cases rectal excision may be required.