Gender-based variations in clinical course, Endoscopic and histological findings of solitary rectal ulcer syndrome - Multicenter study from Pakistan

Abstract

Background and Objective: Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon, chronic disorder of the pelvic floor associated with defecatory dysfunction. This prospective observational study aimed to assess the comprehensive manifestations of SRUS with a focus on sex differences in risk factors, clinical presentation, and endoscopic and histopathological findings.

Methodology: The study included 132 patients (81 females, 51 males) diagnosed with SRUS at a Jinnah Postgraduate Medical Centre and National Medical Centre in Pakistan between 2017 and 2024.

Results: The most commonly affected age group was 21-30 years. Clinically, rectal bleeding was the predominant symptom in both genders (74.5% males, 71.6% females; p=0.715), followed by rectal pain (41.2% males, 48.1% females; p=0.433) and altered bowel habits (15.7% males, 16.0% females; p=0.956). Self-digitation was reported by 86.2% of males and 88.8% of females (p=0.654). Endoscopically, solitary rectal ulcer was observed in 60.7% of males and 60.4% of females (p=0.973), while proctitis was present in 58.8% of males and 59.2% of females (p=0.960). Histologically, crypt distortion was noted in 43.1% of males and 29.6% of females (p=0.113), fibromuscular obliteration in 56.8% of males and 45.6% of females (p=0.211), and surface ulceration in 47.0% of males and 45.6% of females (p=0.877). Although no statistically significant gender differences were identified, the study highlights the need for larger-scale investigations to explore these patterns further.

Conclusion: This study shows SRUS is more common in females 81 (61%) and commonly affects those aged 21 to 30 years, 46 (34.8%) and bleeding per rectum was the most frequent presenting symptom 96 (72.7%).