What is the treatment of solitary rectal ulcer syndrome?
The answer of this question is not very easy. Because there are not many controlled clinical trials, there are no definitive treatment recommendations for patients with solitary rectal ulcer syndrome. The treatment of Solitary Rectal Ulcer Syndrome is a challenging issue in today's medical society. Current opinion leaders in this field view the treatment of SRUS as a problematic case. We all know that it is a frustrating case for many physicians in this field. Available treatment alternatives are usually inadequate. There are not many forthcoming, prospective, well-designed clinical studies evaluating the efficacy of treatment for Solitary rectal ulcer syndrome. There is a major difficulty to provide concrete treatment recommendations. Thus current treatment reality is mostly experiential. This means more a stepwise and individualized approach has to be employed.
Treatment of solitary rectal ulcer syndrome generally depends on the severity of symptoms and whether there is an underlying rectal prolapse. It can be concluded that the treatment of SRUS has a direct correlation with the patient's signs and symptoms. Plus having a rectal prolapse (a disease condition in which the rectum turns itself inside out) is also an important factor for the treatment of solitary rectal ulcer syndrome. Disease awareness play an important role for treating SRUS.
The cornerstone of treating solitary rectal ulcer syndrome is patient education and behavior modification. As soon as the patient is diagnosed with SRUS, they should be instructed on a highfiber diet and the consumption of bulk laxatives, and also stay away from straining and anal digitation. Time consumed on the commode should be minimized and defecation education underlined. These behavioral and dietary adjustments are especially efficacious in patients with mild to moderate symptoms and in the lack of important mucosal prolapse. Do not forget that if the patient does not show any symptoms or he/she is having mild symptoms, patient may prevent cramps and spasms by augmenting fluid and fiber intake. This may cure ulcer and improve the symptoms. Do not forget that this is true only for asymptomatic patients or patients who have mild symptoms. If the patients have severe symptoms or rectal prolapse a variety of methods are being employed to treat solitary rectal ulcer syndrome. Please find below the available treatment options:
Topical therapies.
Various topical medications have been employed with variable clinical success rates, but none has been tested inprospective controlled trials. Topical medications, like sulfasalazine enemas and glucocorticoids are not effective, However 5-aminosalicylate enemas have been anecdotally reported to be of some use. This group consists of 5-aminosalicylate enemas. Topical medications may aid to diminish inflammation and assist to manage ulcer.
Enemas.
Sucralfate enemas includes an aluminum salt and operate by coating the ulcer and building a barrier against irritants, permittin the ulcer to cure. Today we know that corticosteroid enemas may also assist to lower inflammation and support ulcer cure.
Biofeedback.
Patients with SRUS who do not have symptoms may may not need any treatment other than behavioral modifications. In various clinical trials, biofeedback showed a crucial improvement in rectal mucosal blood flow in patients who felt subjectively better after biofeedback. Biofeedback is a behavioral therapy for treating solitary rectal ulcer syndrome. In this therapy biofeedback specialist uses a feedback from various equipment and monitoring procedures. He/she will try to teach patients to manage certain involuntary body responses such as straining during defecation. Biofeedback may be beneficial if the patients have a nonrelaxed puborectalis muscle. Biofeedback is an effective behavioural treatment for the majority of patients with solitary rectal ulcer syndrome. It is a beneficial treatment for patient with SRUS. However there is a strong need of long term clinical trials to assess the benefits of this treatment.
Surgery.
Treating solitary rectal ulcer syndrome with surgery is beneficial when the disease is recurrent and associated by rectal prolapse. Surgery may capture removal of the lesions. It may also involve fecal diversion (creation of an ileostomy or colostomy), which is employing of an ostomy (An ileostomy is an opening between the surface of the skin and the small intestine, while a colostomy is an opening between the surface of the skin and the colon). —There, stool is removed into a pouch or bag that you empty.
According to the various clinical trials, rectopexy, aligns the rectum, avoids excessive mobilization and division of lateral ligaments thus preventing constipation and preserving potency. As an alternative surgery rectopexy corrects rectal prolapse by employing stitches to secure the rectum in its anatomically correct position.
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