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Dr QM Leong
Dr QM Leong

Ulcers In Rectum: Causes, Treatment, Symptoms, And More 

Ulcers in the rectum are a medical condition that often represents a complex and multifaceted issue within the gastrointestinal tract. They are defined as sores or lesions on the rectal wall’s lining. The presence of these ulcers may be associated with various underlying conditions, including solitary rectal ulcer syndrome (SRUS), inflammatory bowel disease, or ischemic trauma.

Although the prevalence of an ulcer in the rectum is relatively rare, its impact on overall health should not be underestimated. Solitary rectal ulcer syndrome, for example, is a benign disorder that can cause significant discomfort and disruption to daily life.

Rectal bleeding, rectal pain, and alterations in bowel habits are common signs and symptoms that necessitate proper medical attention.

Understanding this condition is vital, not only for those suffering from the symptoms but also for medical professionals who may encounter rectal ulcers in their practice.

This recognition may lead to early diagnosis, crucial in managing and treating the underlying causes, whether chronic constipation, pelvic floor disorders, or conditions like ulcerative colitis and Crohn’s disease.

 

Symptoms Of Ulcer In Rectum

The presence of an ulcer in the rectum can manifest through various symptoms. Recognising these signs earlier can be crucial in diagnosing and treating the underlying condition. Here’s what one should look out for:

Pain Or Discomfort

An ulcer in the rectum often leads to localised pain or discomfort, especially during a bowel movement. The inflammation or irritation of the rectal mucosa can cause persistent sensations of unease, which can be particularly bothersome for some individuals.

Blood In Stool

Bleeding is one of the most noticeable rectal ulcer symptoms. Fresh blood or dark, tarry stools might indicate damage to the anterior rectal wall or a solitary ulcer. It’s essential to consult a healthcare provider if such symptoms occur, as they may require endoscopic findings or a histological examination for a proper differential diagnosis.

Mucous Discharge

When the inner lining of the rectum produces more mucus or becomes red and swollen, it might be due to sores (ulcers). These changes can be signs of conditions like Rectal Ulcer Syndrome (SRUS) or a problem with blood flow to the colon called ischemic colitis.

Urgency In Bowel Movements

Rectal hypersensitivity may lead to a frequent or urgent need to pass stool. This urgency can be associated with rectal intussusception or incomplete evacuation, a feeling that the stool is not entirely passed. Such a sensation could be linked to pelvic floor disorders or overt rectal prolapse.

 

Causes Of Ulcer In The Rectum

Understanding the underlying causes of an ulcer in the rectum is fundamental to the appropriate diagnosis and management of this condition. Here is an overview of both common and rare factors that may contribute to the development of a rectal ulcer:

Inflammatory Bowel Disease (IBD)

IBD, encompassing conditions like Crohn’s disease and ulcerative colitis, significantly contributes to ulcers in the rectal region. These chronic inflammatory conditions affect the gastrointestinal tract and can lead to multiple ulcers, impacting the mucous membrane and deeper layers.

Infections

Various bacterial, viral, or fungal infections can cause ulcers in the rectum. These infections may result from a compromised immune system or exposure to specific pathogens. The infected tissues can lead to abdominal pain, rectal bleeding, and other severe symptoms.

Chronic Use Of Certain Medications

Some medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the gastrointestinal tract and result in ulcers. Chronic use or misuse of these drugs can disrupt the protective lining, leading to ulceration in the anterior rectal wall or other areas.

Radiation Therapy

Patients undergoing radiation therapy for cancers in the pelvic area may experience side effects, including the formation of ulcers in the rectum. The radiation can cause damage to the rectal mucosa, leading to moderate symptoms or more severe cases of ulceration.

Rare Conditions And Diseases

Some less common causes include rare diseases or disorders affecting the anal canal and surrounding regions. Conditions such as SRUS, ischemic colitis, or disorders related to pelvic floor muscles and rectal prolapse can manifest in ulceration.

Thorough differential diagnosis and clinical features examination are essential to identify the underlying cause.

Direct Trauma And Lifestyle Factors

Physical injury or direct trauma to the rectal area, excessive straining during bowel movements, or unhealthy lifestyle habits may also contribute to the development of ulcers. Adequate conservative measures, including dietary changes, may be part of the prevention and treatment strategies.

 

Diagnosis

Diagnosing an ulcer in the rectum requires a comprehensive approach, requiring careful examination and several diagnostic tools. Early detection and accurate diagnosis can lead to more effective treatment strategies, helping to relieve discomfort and prevent complications. Here are the key stages in the diagnostic process:

Physical Examination

Initially, a thorough physical examination of the anal canal is performed. It includes checking for signs of rectal prolapse, anal fissure, or external anal sphincter dysfunction. This examination may reveal information about the clinical features of the condition and guide further evaluation.

Endoscopy Or Colonoscopy

These procedures allow direct visualisation of the gastrointestinal tract, including the rectal ulcer and any multiple lesions. Colonoscopy screenings provide a more detailed view, allowing for an assessment of multiple factors such as mucous membrane abnormalities, lamina propria involvement, or evidence of paradoxical contraction.

Biopsy

A biopsy may be conducted during an endoscopy or colonoscopy to take a small tissue sample from the affected area. This can help identify the ulcer’s specific characteristics, distinguishing it from other rare disorders, and confirming the diagnosis.

Blood Tests

Blood tests can assess overall health and may reveal underlying conditions that could be contributing to the ulcer, such as inflammatory bowel disease. In severe cases, blood tests may show signs of infection or anaemia related to chronic rectal bleeding.

Imaging Studies

Techniques like MRI or CT scans may be used to evaluate the pelvic floor muscles and other structures, especially if rectal prolapse or full-thickness prolapse is suspected. These imaging studies provide valuable insights into the anatomy and might reveal underlying issues, such as direct trauma, contributing to the symptoms.

 

Treatment Options For Ulcer In Rectum

To treat an ulcer in the rectum, you need a mix of treatments. This can include medicine and changes to your daily habits. These treatment options must be tailored to the patient’s symptoms, underlying causes, and overall health.

Here are some of the essential strategies for treating rectal ulcers:

Medication

Anti-Inflammatories: These are used for ulcers caused by inflammation, especially in conditions like IBD. They work by reducing swelling and can help with moderate symptoms.

Examples include Mesalamine (Asacol, Lialda) and Sulfasalazine (Azulfidine). These drugs not only reduce inflammation but also help in repairing the lining of the intestine.

Antibiotics: If the ulcer is due to an infection, antibiotics can help by targeting the specific bacteria or other microbes causing the problem. For instance, doctors commonly prescribe Metronidazole (Flagyl) and Ciprofloxacin (Cipro) for bacterial infections in the gut.

Topical Medication: These are applied directly to the affected area, usually in creams, ointments, or suppositories. They can be beneficial if there are multiple ulcers. Topical medication also relieves severe symptoms and abdominal pain. An example is Hydrocortisone cream, which can reduce itching and inflammation.

Dietary Changes

Altering one’s diet to include more fibre and fluids can aid in regulating bowel movements and relieve constipation. This, in turn, helps reduce excessive straining and pressure on the anal canal, promoting the healing of the ulcer.

Conservative Measures: These may include avoiding foods that irritate the digestive system, like:

  • Spicy Foods: Hot peppers, curries, and some spicy sauces can worsen symptoms.
  • Acidic Foods: Tomatoes, citrus fruits (like oranges and lemons), and beverages like coffee and sodas can irritate the digestive lining.
  • Dairy Products: For some people, especially those who are lactose intolerant, dairy can be problematic. This includes milk, cheese, and ice cream.
  • Fatty and Fried Foods: Foods high in fat, especially deep-fried items, can be harder to digest and may worsen symptoms.
  • Alcohol and Caffeine: Both can irritate the digestive system and should be consumed in moderation or avoided.
  • Processed Foods: Items with many additives, preservatives, and artificial ingredients can be harder on the digestive system.

Surgical Interventions

In persistent or severe cases, surgical procedures may be required to remove the ulcer or correct underlying structural issues such as rectal prolapse.

Various surgical treatments are available, and the choice depends on factors like the location of the ulcer, size, and associated conditions such as a rare disorder.

Lifestyle Adjustments

Lifestyle Changes: This may include avoiding or reducing activities that might aggravate the condition like heavy lifting or excessive straining during stool passes.

Pelvic Floor Exercises: These exercises can help strengthen the pelvic floor muscles, reducing symptoms and supporting overall anorectal physiology. Examples of such exercises include Kegel exercises, where one tightens and relaxes the pelvic muscles repeatedly, deep squats which engage the pelvic and gluteal muscles, bridge poses that target the pelvic region, and wall sits that help in toning the pelvic floor.

 

Prevention And Self-Care

Addressing an ulcer in the rectum does not end with medical interventions and treatment alone. Prevention and self-care are vital aspects of managing this condition, both in avoiding recurrence and in enhancing overall well-being. Here’s a closer look at the importance of these facets:

Importance Of Early Diagnosis:

Early detection is critical in preventing the progression of the condition. Recognising symptoms such as abdominal pain, rectal bleeding, or changes in bowel movements can lead to prompt medical intervention, potentially preventing severe complications or chronic issues.

Regular screenings and awareness of personal risk factors are key components in early diagnosis.

Tips For At-Home Care:

Avoid Excessive Straining: During bowel movements or physical activities, being mindful of pressure on the anal canal and pelvic floor can prevent exacerbation.

Monitor Symptoms: Regularly checking for changes in symptoms can benefit ongoing management. Look for signs like blood in the stool or persistent discomfort.

Apply Topical Treatments: Over-the-counter creams or prescribed topical medication may be part of the home care routine, depending on the underlying condition.

When To Seek Medical Attention:

If self-care measures are not providing relief or severe symptoms are present, it is crucial to seek professional medical help. Delays in medical attention can lead to unnecessary suffering and potential complications.

Regular follow-ups and adherence to prescribed treatments ensure ongoing medical oversight and prevention, even in the absence of symptoms.

 

Conclusion About Ulcers In The Rectum

Dealing with a rectal ulcer is not merely a medical challenge but a holistic one, requiring awareness, timely intervention, and lifestyle adjustments.

By understanding the condition and actively engaging with prevention and self-care strategies, individuals can alleviate the distress associated with rectal ulcers and significantly reduce their risk of occurrence.

If you need treatment for ulcerations in your rectum, contact a professional colorectal surgeon in Singapore — Dr Leong. His fields of expertise lie in diagnosing a wide array of colorectal issues. Schedule a consultation today.

 

Frequently Asked Questions About Ulcers In The Rectum

What Are The Common Risk Factors For Developing A Rectal Ulcer?

The risk factors for developing a rectal ulcer can vary based on underlying causes and individual health conditions.

They may include chronic gastrointestinal disorders, a history of radiation therapy to the pelvic area, long-term use of specific medications like NSAIDs, or infections that impact the gastrointestinal tract.

Lifestyle factors such as a low-fibre diet or chronic constipation may also contribute. Consulting with a healthcare provider for a personal risk assessment is advised.

How Long Does It Typically Take For Treatment To Alleviate Symptoms?

Treatment response times for rectal ulcers can differ widely, depending on the underlying cause, severity of the condition, and the treatment method used.

Some may experience relief within a few weeks of medical or lifestyle interventions, while others might require ongoing management for chronic conditions. Regular follow-up with healthcare providers ensures appropriate monitoring and treatment adjustments.

Is It Possible To Mistake The Symptoms For Another Condition?

Yes, the symptoms of a rectal ulcer, such as abdominal pain, blood in the stool, and changes in bowel movements, can be similar to other gastrointestinal issues like haemorrhoids, diverticulitis, or colorectal cancer.

Therefore, proper diagnosis through physical examination, imaging studies, or endoscopy is essential to distinguish the specific condition and apply the correct treatment.

Can Children And Adolescents Develop Rectal Ulcers, And How Is It Managed?

While rectal ulcers are more common in adults, they can occur in children and adolescents. The management in younger populations might be similar to adults but may require additional growth, development, and family involvement considerations.

Paediatric specialists often oversee the care, providing tailored treatment strategies, including dietary modifications, medications, or surgical interventions if needed, always aligning with the child’s overall health and developmental needs.