Fifty-one cases of solitary rectal ulcer syndrome diagnosed over the past 10 years have been studied. The syndrome, of which solitary ulceration was a feature in only 35 per cent of cases, included patients with multiple 'solitary' ulcers (22 per cent), broad-based polypoid lesions (25 per cent) and patchy granular hyperaemic rectal mucosa (18 per cent). The syndrome was found to be strongly associated with abnormal rectal descent. Full-thickness prolapse to or beyond the anal verge was present in 59 per cent of patients while a further 32 per cent had lesser degrees of rectal descent. In only 9 per cent was no such abnormality demonstrated. Treatment with high roughage diet supplemented with bulking agents benefited two-thirds of 27 patients so treated. Ivalon sponge rectopexy has been performed in 6 patients with associated complete rectal prolapse, and in the first 3 of these (followed for a sufficient period) the results have been satisfactory.