The use of anorectal manometry and dynamic proctography in patients for diagnosis of solitary rectal ulcer syndrome

BACKGROUND: Solitary rectal ulcer syndrome is caused by rectal prolapse and/or anismus. The diagnosis by physical examination, or using endoscopy or radiology alone is difficult. AIM: To evaluate the diagnostic utility of videoproctography and anorectal manometry in solitary rectal ulcer syndrome. PATIENTS AND METHODS: We studied six patients (5 women/1 man; 21-66 years) with rectal lesions suggestive of solitary rectal ulcer. By videoproctography, we measured the changes in the anorectal angle and the shape of the rectal wall during voiding. By manometry, we measured the resting pressure of the anal canal, and the pressure during maximal voluntary contraction and during straining. RESULTS: Proctography showed a rectal prolapse in 5 patients (non-exteriorized in 4). Both manometry and proctography demonstrated the normal relaxation of puborectalis and external sphincter during straining in 4 patients, manometry found sphincteric weakness in two of these patients. Both manometry and proctography evidenced anismus in a patient with rectal prolapse. CONCLUSION: The high prevalence of rectal prolapse in our patients allows us to recommend proctography in patients with morphological lesions suggestive of solitary rectal ulcer. The manometric examination identifies patients at risk of developing incontinence. Both techniques contribute to ascertain the presence of anismus and are indispensable in the selection of the adequate treatment for patients with solitary rectal ulcer.