Suggested approach for management of solitary rectal ulcer syndrome in adults

SRUS: solitary rectal ulcer syndrome.
* In patients with incomplete resolution of symptoms, it is important to consider alternative diagnoses and consider the severity of symptoms before proceeding with additional interventions. Surgery is reserved for patients with severe symptoms that are unresponsive to initial management including biofeedback.
¶ A full-thickness (complete) rectal prolapse is the protrusion of all layers of the rectum through the anus, manifesting as concentric rings of rectal mucosa. A mucosal (partial) rectal prolapse is protrusion of only the rectal mucosa through the anus. If a prolapse cannot be reproduced on physical examination, we perform an additional evaluation to diagnose a rectal intussusception (eg, defecography). A rectal intussusception, also termed occult or internal rectal prolapse, is a "telescoping" of the bowel on itself internally, without protruding through the anal verge. Refer to UpToDate content on solitary rectal ulcer syndrome.