A 24-year-old woman reports straining at stool, passage of small amounts of blood and mucus, and tenesmus. Rigid sigmoidoscopy shows a shallow ulcer on the anterior rectal wall 7 cm from the anal verge. Biopsy shows fibromuscular obliteration of the lamina propria with misplaced colonic epithelium trapped within the muscularis. What is the most appropriate initial treatment?
- A High fibre diet, stool softeners and biofeedback therapy ✓
- B Local surgical excision of the ulcer
- C Long course chemoradiotherapy
- D Transanal endoscopic microsurgical full thickness resection
Correct answer: A. High fibre diet, stool softeners and biofeedback therapy
Explanation
Solitary rectal ulcer syndrome is a benign disorder of disordered defecation, usually in young patients with chronic straining and paradoxical puborectalis contraction. Histology is characteristic: fibromuscular replacement of the lamina propria and crypt displacement mimicking invasive carcinoma, which tempts clinicians to overtreat. Treatment is non-surgical first: fibre, laxatives, pelvic floor retraining with biofeedback, and topical agents. Local excision or TEM resection is reserved for refractory cases, and radiotherapy has no role whatsoever.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.