What Is a Rectal Ulcer? A Plain-Language Guide to Solitary Rectal Ulcer Syndrome, Its Signs, and Its Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: Rectal Ulcer at a Glance

A rectal ulcer is a rare condition in which one or more open sores form in the rectum, causing constipation, rectal bleeding, straining, pelvic pain and mucus, though some people have no symptoms [1]. It is thought to stem from rectal stress or injury, such as straining or prolapse, and mostly affects adults aged 30 to 40 [1]. Treatment depends on severity [2].

Feature	Details
What it is	A rare condition in which one or more open sores (ulcers) form in the rectum. Despite the name, more than one ulcer can develop [1].
What it feels like	Constipation, rectal bleeding, straining, pain or fullness in the pelvis or rectum, incomplete passing of stool, mucus, and sometimes fecal incontinence. Some people have no symptoms [1].
What causes it	Not always clear. Researchers believe stress or injury to the rectum, such as impacted stool, straining, rectal prolapse, pelvic floor tightening, manual stool removal, or intussusception [1].
Who gets it	Anyone, but adults between ages 30 and 40 are most affected [1].
Treatment	Depends on severity: fiber and fluids, bulk laxatives and stool softeners, behavior therapy with biofeedback, certain medicines, or surgery [2].

What the research says

• Medical treatment resolves the ulcers in a majority of people. A systematic review and meta-analysis of 9 studies (216 people with SRUS) found that 57% of those who received medical treatment, such as sucralfate, sulfasalazine, human fibrin, a high-fiber diet, or psyllium powder, had their ulcers resolve (95% CI 41% to 73%). The authors noted that few randomized trials compare medical treatments with other options. (Qari and Mosli, Saudi J Gastroenterol, 2020) [3]

• Surgery had the highest healing rate, and may help when other treatments fail. A network meta-analysis of 22 studies (911 people with SRUS) found that surgery had the highest ulcer healing rate, 70.5% (95% CI 57% to 83%), and was superior to medical therapies and biofeedback for ulcer healing. The authors suggest surgery has a role in cases that do not respond to medical treatment and biofeedback, and they call for more studies in similar groups of patients. (Gaj et al., Colorectal Dis, 2024) [4]

What Is a Rectal Ulcer?

Solitary rectal ulcer syndrome is a condition in which one or more open sores, called ulcers, form in the rectum [1]. The rectum is a muscular tube connected to the end of the colon [1]. Stool passes through the rectum on its way out of the body [1]. It is a rare and poorly understood disorder that can happen in people with long-lasting constipation [1].

Despite the name, sometimes more than one rectal ulcer develops [1]. "Solitary" means one, but in reality there can be more. SRUS may improve with simple lifestyle strategies, such as changing your diet and drinking more fluids [1]. In severe cases, however, surgery may be needed [1].

What Are the Symptoms of a Rectal Ulcer?

A rectal ulcer can cause constipation, rectal bleeding, straining, pain or fullness in the pelvis or rectum, and a feeling of incomplete passing [1].

Symptom	What you might notice
Constipation	Bowel movements that are hard, infrequent, or both.
Rectal bleeding	Blood with stool or from the rectum.
Straining	Pushing hard during bowel movements.
Pain or fullness	Discomfort or a feeling of fullness in the pelvis or rectum.
Incomplete passing	A feeling that stool was not fully passed.
Passing mucus	Mucus comes from the rectum.
Fecal incontinence	Not being able to control bowel movements [1].
No symptoms	Some people with SRUS have no symptoms at all [1].

When Should I See a Doctor?

Make an appointment with a healthcare professional if you notice any symptoms that worry you. Several other conditions may cause symptoms similar to those of SRUS, so your healthcare professional may recommend tests and procedures to identify or rule out causes other than SRUS [1].

What Causes a Rectal Ulcer?

The cause of a rectal ulcer is not always clear, but researchers believe stress or injury to the rectum may cause it to form. Researchers believe that stress or injury to the rectum may cause rectal ulcers to form [1]. Several things could injure the rectum:

Possible injury to the rectum	What it means
Constipation or impacted stool	Hardened stool in the rectum that is difficult to pass.
Straining	Pushing hard when passing stool.
Rectal prolapse	A stretched rectum that comes out of the anus.
Pelvic floor tightening	Tightening of the pelvic floor muscles that slows blood flow to the rectum [1].
Manual stool removal	Attempts to remove impacted stool by hand [1].
Intussusception	One part of the intestine sliding inside another part, a rare, serious condition.

Who Is Most Likely to Get a Rectal Ulcer?

Anyone can have SRUS, but adults between the ages of 30 and 40 are most affected [1]. It can happen in people with long-lasting constipation.

How Is a Rectal Ulcer Diagnosed?

A rectal ulcer, or solitary rectal ulcer syndrome, is diagnosed with one or more tests that look at the rectum.

Test	How it works	What it shows
Sigmoidoscopy	A thin, flexible tube with a tiny camera is inserted into the rectum to examine the rectum and part of the colon.	The ulcer itself. If a lesion is found, a tissue sample (biopsy) may be taken for laboratory testing [2].
Anorectal manometry	A flexible, tube-like device is inserted into the rectum, and the response of the anal and rectal muscles and nerves is measured.	How well bowel function and stool control are working. It is used for people with constipation, fecal incontinence, and similar problems [2].
Defecography	A soft paste made of barium is inserted into the rectum and passed in the stool while imaging is done.	Shows up on X-rays and may reveal a prolapse or problems with muscle function and coordination. MRI versions give a 3D image of the rectum [2].
Ultrasound	Uses sound waves to create pictures [2].	Helps tell SRUS apart from other conditions [2].

How Is a Rectal Ulcer Treated?

Treatment depends on the severity of the condition [2]. People with mild symptoms may find relief through lifestyle changes, while people with more severe symptoms may need medical or surgical treatment.

Treatment	What it does
Dietary changes	Increasing fiber helps relieve constipation.
Behavior therapy	Teaches you to relax your pelvic muscles when passing stool, to break the habit of straining.
Biofeedback	A specialist teaches you to control involuntary responses, such as tightening of the anus or pelvic floor muscles, to lessen straining.
Medicines	Topical steroids, sulfasalazine enemas, onabotulinumtoxinA (Botox), or argon plasma coagulation may help ease symptoms. They do not work for everyone, and some are still considered experimental [2].
Rectopexy	Rectal prolapse surgery that secures the rectum in its anatomically correct position [2].
Rectum removal with colostomy	For severe symptoms that have not been helped by other treatments. The colon is connected to an opening in the abdomen, with a pouch or bag to collect waste [2].

What Can I Do at Home?

At home, you can help a rectal ulcer by increasing the fiber in your diet and trying bulk laxatives and stool softeners.

• Increase the fiber in your diet. Fiber adds bulk to stool and helps push the contents of your intestines along [2]. Depending on your age and sex, you should get between 22 and 34 grams of fiber a day [2], so ask your healthcare team about the right amount for you. The best sources are fruits, vegetables, and whole grains. Eat fruits and vegetables with the skin on, and choose whole fruits and vegetables over juices [2].

• Try bulk laxatives and stool softeners. Bulk laxatives, such as psyllium husk and calcium polycarbophil, absorb fluid in the intestines and make stools bulkier. Take them with water, because they can cause obstruction [2]. Stool softeners, such as docusate, help mix fluid into stools, making them easier to pass [2].

• Drink water throughout the day. Aim for 64 ounces (about 2 liters) of fluid a day unless you have restrictions due to other health conditions [2]. Prune juice can help because it has a natural laxative effect [2].

How Should I Prepare for My Appointment?

For a possible rectal ulcer, start with your primary healthcare team, who may refer you to a gastroenterologist [2], and prepare by listing your symptoms, medicines and questions. If SRUS is suspected, you may be referred to a gastroenterologist, a doctor who specializes in the digestive system. To prepare:

• Ask about pre-appointment restrictions, such as restricting your diet.

• Write down your symptoms, including any that may seem unrelated, and key personal information such as major stresses or recent life changes.

• List all medicines, vitamins, and supplements you take.

• Write down your questions. For example: What is likely causing my symptoms, and what else could it be? What tests do I need? Is my condition likely temporary or long lasting? What are my treatment options? Do I need to follow any dietary or activity restrictions? Will I need follow-up visits, and how often?

Your doctor will likely ask when your symptoms began, whether they are continuous or occasional, how severe they are, whether you have had trouble with constipation, and what seems to improve or worsen them [2].

What is the bottom line on rectal ulcers?

A rectal ulcer, medically known as solitary rectal ulcer syndrome, is a rare, poorly understood condition in which one or more open sores form in the rectum [1]. It can bring rectal bleeding, pain, straining, a feeling of fullness, incomplete passing of stool, mucus, and trouble controlling bowel movements, though some people have no symptoms [1]. The cause is not always clear, but stress or injury to the rectum seems to play a role [1]. Mild cases often improve with simple steps: more fiber, bulk laxatives, stool softeners, and plenty of fluids, while behavior therapy with biofeedback helps retrain the pelvic muscles. More severe cases may call for certain medicines or surgery [2]. If you notice rectal bleeding or other worrying symptoms, see a healthcare professional, because several other conditions can look similar [1].

Want more digestive health guides? Explore more plain-language health information at Rinnit.com.

Frequently Asked Questions

What is a rectal ulcer?

A rectal ulcer is an open sore that forms in the rectum, the muscular tube connected to the end of the colon [1]. The condition is officially called solitary rectal ulcer syndrome, and despite the name, sometimes more than one rectal ulcer develops [1].

What are the symptoms of a rectal ulcer?

Constipation, rectal bleeding, straining during bowel movements, pain or a feeling of fullness in the pelvis or rectum, a feeling of incomplete passing of stool, passing mucus from the rectum, and not being able to control bowel movements (fecal incontinence). Some people have no symptoms [1].

What causes a rectal ulcer?

The cause of a rectal ulcer is not always clear. Researchers believe that stress or injury to the rectum may cause ulcers to form. Possible sources of injury include constipation or impacted stool, straining, rectal prolapse, pelvic floor muscle tightening that slows blood flow, attempts to manually remove impacted stool, and intussusception [1].

Who is most likely to get a rectal ulcer?

Anyone can, but adults between the ages of 30 and 40 are most affected [1]. The condition can happen in people with long-lasting constipation [1].

Is a rectal ulcer serious?

A rectal ulcer is a rare and poorly understood condition. Many cases improve with simple lifestyle strategies such as diet changes and more fluids, but in severe cases surgery may be needed [1]. Because other conditions can cause similar symptoms, any worrying symptom should be checked by a healthcare professional.

How is a rectal ulcer diagnosed?

With one or more of these tests: sigmoidoscopy (a camera examines the rectum and part of the colon, with a biopsy if a lesion is found), anorectal manometry (measures the response of the anal and rectal muscles and nerves), defecography (barium paste passed in stool shows up on X-rays), and ultrasound (sound waves help tell the syndrome apart from other conditions [2]).

How is a rectal ulcer treated?

Treatment depends on severity. Mild cases respond to dietary changes, fiber, fluids, bulk laxatives, stool softeners, and behavior therapy with biofeedback to reduce straining. Medicines such as topical steroids, sulfasalazine enemas, onabotulinumtoxinA (Botox), or argon plasma coagulation may help but do not work for everyone, and some are still experimental [2]. Severe cases may need rectopexy surgery or, rarely, removal of the rectum with a colostomy [2].

What can I do at home to help a rectal ulcer?

Increase fiber (22 to 34 grams a day, from fruits, vegetables, and whole grains), try bulk laxatives or stool softeners (take bulk laxatives with water), and drink about 64 ounces (2 liters) of fluid a day unless you have restrictions [2]. Prune juice can also help because it has a natural laxative effect [2].

References

1. Mayo Clinic Staff. Solitary rectal ulcer syndrome - Symptoms & causes. Mayo Clinic. Published September 20, 2025. https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/symptoms-causes/syc-20377749

2. Mayo Clinic Staff. Solitary rectal ulcer syndrome - Diagnosis & treatment. Mayo Clinic. Published September 20, 2025. https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

3. Qari Y, et al. A systematic review and meta-analysis of the efficacy of medical treatments for the management of solitary rectal ulcer syndrome. Saudi J Gastroenterol. 2020;26(1):4-12. PMID 31898642. https://doi.org/10.4103/sjg.SJG_213_19

4. Gaj F, et al. Efficacy of surgical treatments for the management of solitary rectal ulcer syndrome: a network meta-analysis. Colorectal Dis. 2024;26(8):1515-1534. PMID 38957108. https://doi.org/10.1111/codi.17080

Medical disclaimer

This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions. Rectal bleeding and changes in how your bowel movements feel deserve attention, because several other conditions can cause similar symptoms.