Other nonneoplastic

Solitary rectal ulcer syndrome

Deputy Editor-in-Chief: Catherine E. Hagen, M.D.
Raul S. Gonzalez, M.D.

Last author update: 28 October 2021
Last staff update: 5 May 2022

Copyright: 2003-2023,, Inc.

PubMed search: solitary rectal ulcer syndrome

Raul S. Gonzalez, M.D.
Page views in 2022: 33,302
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Cite this page: Gonzalez RS. Solitary rectal ulcer syndrome. website. Accessed February 8th, 2023.
Definition / general
  • Solitary or multiple ulcerated or polypoid lesions 4 - 10 cm from anal margin
Essential features
  • Not always solitary, not always rectal, not always ulcerated, not really a syndrome
  • Mucosal prolapse type change resulting in rectal lesions
  • Also called mucosal prolapse syndrome (may be a better term since not necessarily solitary, ulcerated or rectal)
  • Uncommon (incidence of 1 per 100,000 per year)
  • Usually third and fourth decade
  • More common in women
  • Rarely in children (Pediatrics 2002;110:e79)
  • Usually in rectosigmoid colon
  • Abnormal function of anal and pelvic floor musculature during defecation, causing rectal mucosal prolapse or intussusception
Clinical features
  • High fiber diet, laxatives, topical steroids
  • Possibly resection
Gross description
  • Well demarcated irregular ulcer(s) on rectal wall
  • Also polypoid, rough, erythematous lesions
  • Mucosal thickening
Microscopic (histologic) description
  • Superficial mucosal ulceration and villiform change
  • Crypt hyperplasia and elongation with focal dilation (some glands diamond shaped)
  • Fibromuscular hyperplasia of lamina propria
  • Thickened muscularis mucosae with splayed fibers
  • Ectatic capillaries
  • Minimal inflammation
  • May have inflammatory pseudomembranes
  • Late changes resemble colitis cystica profunda
Microscopic (histologic) images

Contributed by Andrey Bychkov, M.D., Ph.D. and Jian-Hua Qiao, M.D.

Polypoid shape

Solitary rectal ulcer

Crypt hyperplasia

Disarrayed muscularis mucosa

Haphazardly arranged benign colonic crypts

Distorted diamond shaped glands

Sample pathology report
  • Rectum, ulcer, biopsy:
    • Colonic mucosa with prolapse type change, mild acute inflammation and focal erosion (see comment)
    • Comment: The findings are compatible with so called solitary rectal ulcer syndrome.
Differential diagnosis
Board review style question #1

Solitary rectal ulcer syndrome most frequently occurs in what patient population?

  1. Elderly men
  2. Female infants
  3. Middle aged women
  4. Young adult men
Board review style answer #1
C. Middle aged women

Comment Here

Reference: Solitary rectal ulcer syndrome
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