Age Distribution in Solitary Rectal Ulcer Syndrome
Solitary rectal ulcer syndrome (SRUS) predominantly affects young adults, with the typical age of presentation ranging from the late teens through the fourth decade of life.
Primary Age Demographics
- The mean age at presentation is approximately 29-32 years, based on clinical case series 1, 2
- Young adults represent the core demographic, with SRUS being distinctly uncommon in both pediatric and elderly populations 3, 4
- The age range at diagnosis spans broadly from 10 to 81 years, though cases outside the 20-40 year range are exceptional 1
Age-Specific Clinical Patterns
Young Adult Predominance
- The condition typically manifests in patients during their third and fourth decades, aligning with the peak period for functional defecation disorders 5, 2
- In one comprehensive series, the median age was 32 years among 33 patients, with a notable female predominance (24 women vs 9 men) 2
Pediatric Presentation
- SRUS is rare in children and often misdiagnosed when it does occur in this age group 4
- Pediatric cases require high clinical suspicion as rectal bleeding may be incorrectly attributed to more common conditions like anal fissures or juvenile polyps 4
- The youngest documented case in reviewed series was 10 years old, representing the extreme lower end of the age spectrum 1
Clinical Implications by Age
Why Young Adults Are Affected
The predilection for young adults relates to the underlying pathophysiology:
- Straining during defecation and pelvic floor dysfunction are the primary contributing factors, behaviors more common in younger patients with functional disorders 4, 2
- 85% of patients report chronic straining, a behavioral pattern that develops in early adulthood 2
- Digital manual evacuation was reported in 11% of cases, indicating severe functional defecation disorders typical of younger patients 1
Disease Burden in Young Patients
- Despite being benign, SRUS causes significant morbidity in young adults: 68% were anemic at presentation and 57% required blood transfusion 1
- 64% of patients had multiple hospital admissions (mean 3.1 admissions, range 1-12), primarily for transfusion support 1
- Mean follow-up of 43.5 months showed persistent bleeding in 39% of patients, indicating chronic disease burden during productive years of life 1
Diagnostic Considerations
A high index of suspicion is essential when evaluating rectal bleeding in young adults, particularly those with:
- History of chronic straining at defecation 2
- Constipation with paradoxical pelvic floor contraction 4
- Anterior or anterolateral rectal wall lesions on endoscopy 5
Rectal biopsy remains the gold standard for diagnosis, showing characteristic fibromuscular obliteration of the lamina propria 4