SRUS is a rare condition in children, which usually presents with a symptom complex of rectal
bleeding, passage of mucus and straining on defecation, tenesmus, perineal and
abdominal pain, sensation of incomplete defecation,
constipation and
rectal prolapse. The underlying etiology of SRUS is not fully understood but it is likely to be secondary to ischemic changes in the rectum associated with paradoxical contraction of pelvic floor and external anal sphincter muscles and
rectal prolapse. Conservative measures like high intake of fluids and fibers, laxatives,
biofeedback and behavior modification
therapy may be beneficial for treatment of
constipation. Excision of rectal
ulcer and surgery of overt
rectal prolapse, however, may be required in refractory cases not responding to
conservative treatments. A therapeutic role for
botulinum toxin injection into the external anal sphincter for treatment of SRUS associated with
constipation and paradoxical contraction of pelvic floor and external anal sphincter muscles in children, may exist.