Background and Objectives: The etiology, pathophysiology, nomenclature and clinical manifes-tation of solitary rectal ulcer syndrome (SRUS) is poorly understood. Aim: To examine the pathology of mucosal changes and clinical features of this syndrome. Materials and Methods: The mucosal biopsies of 19 patients with clinical evidence of solitary rectal ulcer as been reviewed in accordance with their clinical complaints and endoscopic findings within three years. Results: SRUS has been seen in both sexes (11 male and 8 female) at the age ranging from 12 to 72 years (mean 29 years). The main clinical complaints were rectal bleeding, mucorrhea and perianal pain. The major rectoscopic findings were ulceration, erythema of mucosal surface, congestion and polypoid pattern. The significant pathologic features were mucosal architectural distortion, very superficial and irregular mucosal ulceration, fibrosis of lamina propria and thickening of the muscularis mucosa with splaying of its fibers and extension of muscularis fibers between the mucosal crypts. Conclusion: Although SRUS is rare but it can be confused clinically with other similar diseases such as inflammatory bowel disease,cloagenic carcinoma and other malignancies. It must be looked in differential diagnoses of pelvic disorders since it is well recognized on rectoscopic and morphologic basis.