Solitary Rectal Ulcer Syndrome: A Biopsychosocial Assessment

Abstract

Background: Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the gastrointestinal tract and its etiology is not well understood. There is no specific treatment for this syndrome and patients with SRUS may, for years, experience many complications. The aim of the present research was the biopsychosocial study of patients with SRUS.Methods: The study participants consisted of 16 patients with SRUS (7 men and 9 women). Their medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Moreover, psychiatric and personality disorders [based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision (DSM IV-TR)], psychosocial stressors, early life traumas, and coping mechanisms were assessed through structured interviews.Results: At presentation, mean age of the patients was 39 years (16 to 70). Common symptoms reported included rectal bleeding (93.8%), rectal self-digitations (81.2%), passage of mucous (75%), anal pain (75%), and straining (75%). Endoscopically, solitary and multiple lesions were present in 9 (60%) and 4 (26.7%) patients, respectively, and 87% of lesions were ulcerative and 13.3% polypoidal. The most common histological findings were superficial ulceration (92.85%) and intercryptic fibromuscular obliteration (87.71%). Common psychosocial findings included anxiety disorders (50%), depression (37.5%), obsessive-compulsive personality disorder (OCPD) or traits (62.5%), interpersonal problems (43.75%), marital conflicts (43.75%), occupational stress (37.5%), early life traumas, physical abuse (31.25%), sexual abuse (31.25%), dysfunctional coping mechanisms, emotional inhibition (50%), and non-assertiveness (37.5%).Conclusion: Given the evidence in this study, we cannot ignore the psychosocial problems of patients with SRUS and biopsychosocial assessment of SRUS is more appropriate than biomedical evaluation alone.