Pelvic Floor Dysfunction and Manometric Features in Pediatric Solitary Rectal Ulcer Syndrome

Background/Objectives: Solitary rectal ulcer syndrome (SRUS) is a rare benign disorder presenting with rectal bleeding, straining, and mucosal discharge. Its pathogenesis likely involves pelvic floor dysfunction, particularly dyssynergic defecation. Although studied in adults, pediatric data-specifically anorectal manometry (ARM) findings-remain limited. We aimed to evaluate dyssynergic defecation in pediatric SRUS using ARM and analyze associated clinical, endoscopic, histopathological, and treatment data. Methods: A retrospective study of 24 children with biopsy-proven SRUS diagnosed between 2016 and 2024 was conducted. Clinical symptoms, colonoscopic, histopathological, treatment, and outcome data were reviewed. ARM was performed in 20 patients unresponsive to conservative treatment to assess anal pressures, rectal sensation, rectoanal inhibitory reflex, and balloon expulsion. Results: The median age was 13 years, with male predominance. Rectal bleeding was the most common symptom (95.8%). Colonoscopy revealed predominantly solitary ulcerative lesions 5-10 cm from the anal verge. Dyssynergic defecation was detected in 60% of patients, and only 25% could expel the balloon. Resting anal pressures were lower than reference values. Treatments included diet, laxatives, and topical agents, with partial or complete clinical response in approximately 60% of patients after 12 months. Conclusions: Pediatric SRUS is strongly associated with dyssynergic defecation. More pediatric-specific manometric studies are needed to optimize diagnosis and guide targeted therapies.