What is Rectal Bleeding?
Rectal bleeding is the passage of fresh blood or mixed blood with stools or clots from the anus. It is also known as hematochezia.
The rectum is the terminal part of the digestive system; it lies just before the anus; that is why bleeding from anus is thought to originate from the rectum, this is a misnomer as bleeding from the anus can originate from anywhere in the digestive system, for example, from the colon.
Rectal bleeding severity depends mainly on the quantity and duration of bleeding. Severe cases required urgent management and hospitalization as the patient may be given the blood transfusion to maintain the blood volume while mild cases can be managed in the office of the doctor without hospitalization.
Most of the patients have mild rectal bleeding with small amount; usually found on the toilet papers. The initial purpose in managing rectal bleeding is to support the patient circulation then to diagnose and manage the underlying cause.
At What Age and Who Gets Rectal Bleeding?
Rectal bleeding can occur in any age group even in small children with chronic constipation, however rectal bleeding in old age is more serious than adulthood. Old aged patients with rectal bleeding are more prone to have hypotension, confusion, and loss of consciousness. Add to that, they are at higher risk of having a malignant cause of rectal bleeding than young patients.
What Causes Rectal Bleeding?
Many diseases can cause rectal bleeding; ranging from simple to more malignant causes. Following are the most important:
- Fissures or tears in the anus mainly due to chronic constipation and straining
- Hemorrhoids which are swollen veins in the anus or rectum which are painful
- Diverticulosis which is the presence of multiple pouches in the colonic lining; this condition is very common in old aged
- Colon cancer; this diagnosis should be kept in mind when managing old aged patients with rectal bleeding
- Colon polyps which are outgrowth from the colonic lining
- After any surgery in the colon
- Malformation of the arteries and veins in the colon leading to frequent painless bleeding
- Inflammation of the colon
- Inflammation of the rectum
- Severe bleeding from the stomach or small intestine
What Are The Signs and Symptoms of Rectal Bleeding?
Rectal bleeding can be present in different forms:
- Passing fresh blood only
- Fresh blood on the surface of stools
- Fresh blood on the toilet paper
- Pink coloration of the toilet paper
- Fresh blood mixed with stool
- Dark colored stools; tarry stools or maroon stools
- Blood on the underwear
Sometimes small amount of rectal bleeding can be detected accidentally during investigation of unexplained anemia in old aged patients. Many other symptoms may be associated with rectal bleeding; following are some of them:
- Pain when passing blood; this is very significant as most local causes of rectal bleeding are painful, such as anal tears
- Sensation of tearing before passing stools
- Sensation of bulge from the anus
- Pain in the abdomen
- Long straining
- Unintentional loss of weight
- Loss of appetite
- Unexplained fatigue
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What is the Diagnosis of Rectal Bleeding?
The diagnosis of rectal bleeding cause depends on the following guidelines:
- Taking full medical history regarding the current compliant and its details; such as the onset, the duration, any associated symptoms, the estimated amount, previous history, and family history.
- Full physical examination; especially for the signs of severe anemia, signs in the abdomen, and rectal exam.
- Visualization of the anus and rectum; this can be done using anoscopy which is an endoscopy for the anus only, or sigmoidoscopy, or colonoscopy especially if we suspect colonic abnormalities.
- Some nuclear studies can help to determine the location of the site of bleeding; this is known as radionuclide scans.
- Tests for the blood especially complete blood count to determine the severity of anemia caused by the rectal bleeding.
What Mayo Clinic is Saying about Rectal Bleeding?
Depending on the recent recommendations of the Mayo Clinic, the patient should seek urgent medical help if he had rectal bleeding with one of the following symptoms and signs:
- Rapid breathing
- Difficulty breathing
- Blackout after standing
- Changes in the vision
- Pale cold skin
- Decreased urine output
- Heavy rectal bleeding
- Continuous rectal bleeding
- Severe pain in the abdomen
- Severe cramping
- Severe pain in the anus
Rectal Bleeding Follow-up
After stabilizing the patient condition, the doctor will do further workup to diagnose the underlying etiology of rectal bleeding. Once the cause of rectal bleeding is diagnosed, the doctor will discuss with you the options of management. You have to stick to your doctor recommendations and follow up your condition thus preventing rebleeding.
What are the Prognosis and Preventions?
Following are some tips to prevent rectal bleeding:
- Applying creams containing cortisone, vitamin A, or vitamin D
- Adopting high fiber diet
- Getting oral iron supplementations which prevent further anemia
- Applying cold objects; such as ice, to the anus
- Avoid long sitting
- Drink good amount of water daily