Background: The presence of rectal ulcers may be caused by several factors such as solitary rectal ulcer,inflammatory bowel disease, and infections. But it is not always possible to clarify the
underlying etiological factor.Case Report: Eighteen years old female with rectal bleeding was admitted to the hospital. Colonoscopy showed 2 cm long and 1 cm wide elliptic rectal ulcer with exudation located on the anterior wall at 6 cm from the anal verge. Around the ulcer a few small polypoid structures due to fibrosis were seen. Histological examination of biopsy samples taken around the ulcer was consistent with the diagnosis of solitary rectal ulcer. Malignancy, infection, infestation, collagen tissue disease, and inflammatory bowel disease were ruled out by appropriatetechniques. After having some private interviews with the patient, it was learned that the patient was performing rectal digitation for last 2 years. She did not experience constipation and this behavior was not stool evacuation. Psychiatric consultation revealed that she was in an obsessive traumatic autoerotic behavior by anal digitations. Topical steroids were given andthe patient was convinced to stop this behavior by repetitive psychiatric consulting. There was endoscopic healing with symptomatic improvement during her hospital stay. But at the 3 month follow-up control, the ulcer was present at the same location. She accepted that she continued this behavior and could not stop. She had to spend 2-3 hours in the bathroom by being busy with this obsessive and compulsive sexual behavior.Conclusions: In the differential diagnosis of rectal ulcers, traumatic rectal digitations must be kept in mind. Traumatic rectal ulcers are distinct entities from solitary rectal ulcers and absolute avoidance from rectal digitation is necessary to have a complete healing.

Keywords: rectal ulcer, rectal bleeding, autoerotic digitations, sexual, compulsive