Solitary Rectal Ulcer Syndrome in Pakistan: A Prospective Study Highlighting Gender and Age Patterns

Abstract

Background: Solitary Rectal Ulcer Syndrome (SRUS) is a rare, chronic disorder of the pelvic floor associated with defecatory dysfunction.

Objective: This prospective observational study aimed to evaluate the clinical, endoscopic, and histopathological features of SRUS, with an emphasis on sex-specific differences in presentation and risk factors.

Methodology: One hundred and thirty-eight (138): 85 female and 53 male patients diagnosed with SRUS were recruited from the department of Gastroenterology at Thumbay University Hospital, Ajman, UAE, between 2019 and 2024. They included patients with rectal bleeding, pain, bowel-habit changes, or self-digitation. Clinical assessment, endoscopy and histopathology of the rectal biopsies were conducted. The SPSS version 26 was used in the analysis of data, and the gender-based comparison was assessed with the help of chi-square tests.

Results: The majority of patients were aged 21–30 years (36.2%). Rectal bleeding was the most frequent symptom (74.1% females, 77.4% males), followed by rectal pain (51.8% females, 44.3% males) and altered bowel habits (17.6% females, 17.0% males). Self-digitation was reported in 92.0% of females and 89.6% of males. Endoscopy revealed solitary ulcers in 64.7% of females and 63.2% of males, while proctitis was present in 61.2% and 62.3%, respectively. Histopathology showed crypt distortion (32.9% females, 46.2% males), fibromuscular obliteration (48.2% females, 60.4% males), and surface ulceration (48.2% females, 50.9% males). No statistically significant differences were observed between sexes.

Conclusion: SRUS predominantly affects young adults, with a slight female preponderance. Rectal bleeding is the most common symptom, and histopathological changes, including fibromuscular obliteration and crypt distortion, are frequent. Recognition of clinical and tissue-level features is essential for accurate diagnosis and management.