SRUS (Solitary Rectal Ulcer Syndrome): Causes and Non-Surgical Fixes

Solitary Rectal Ulcer Syndrome (SRUS) is a benign (non-cancerous) disorder tied to the physical mechanics of defecation. Symptoms include bleeding, pain, straining, or tenesmus. The cause is mechanical: repeated straining causes the upper rectum to fold down into the lower part (internal telescoping), leading to friction and ulcers or irritated tissue. A definitive diagnosis requires an endoscopy and a biopsy, which identifies specific microscopic scar tissue in the rectal wall. For the vast majority of patients, the treatment is non-surgical. The goal is to fix the mechanical root cause by reducing straining through diet changes, bowel retraining, and pelvic floor physical therapy. Surgery is rarely the primary solution, reserved only for severe structural issues like a deep internal prolapse that cannot be fixed otherwise.