Rectal bleeding

Rectal bleeding

What is Rectal Bleeding (Hematochezia)?

Rectal bleeding (also called hematochezia, meaning bright red blood in the stool) is a symptom of a problem in the digestive tract. Rectal bleeding can refer to any blood that passes from your anus, although rectal bleeding is usually assumed to refer to bleeding from your lower colon or rectum. Your rectum makes up the lower portion of your large intestine.

Rectal bleeding may show up as blood in your stool, on the toilet paper or in the toilet bowl. Blood that results from rectal bleeding is usually bright red in color, but occasionally can be dark maroon.

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Causes

Rectal bleeding may occur for many reasons.

Common causes of rectal bleeding include:

. Anal fissure (a small tear in the lining of the anal canal)

. Constipation

. Hard stools

. Hemorrhoids (swollen and inflamed veins in your anus or rectum)

Less common causes of rectal bleeding include:

. Anal cancer

. Angiodysplasia (abnormalities in the blood vessels near the intestines)

. Colon cancer

. Colon polyps

. Crohn's disease (a type of inflammatory bowel disease)

. Diarrhea

. Diverticulosis (a bulging pouch that forms on the wall of the intestine)

. Inflammatory bowel disease (IBD)

. Ischemic colitis (colon inflammation caused by reduced blood flow)

. Proctitis (inflammation of the lining of the rectum)

. Pseudomembranous colitis (colon inflammation caused by an infection)

. Radiation therapy

. Rectal cancer

. Solitary rectal ulcer syndrome (a sore on the wall of the rectum)

. Ulcerative colitis

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What are the Signs and Symptoms of Rectal Bleeding?

. Rectal pain

. Bright red blood present in or on the stool

. Pain in the stomach, lower abdomen, rectum, or back

. Change in stool color to black, red, or maroon

. Stool test positive for occult blood loss (blood may present, but you cannot see it)

. Confusion

. Dizziness, lightheadedness

. Fainting, palpitations or rapid heartbeat

How is rectal bleeding diagnosed?    

A physician will perform a physical examination. If necessary, diagnostic tests may be ordered.

Physical exam: The focus is on finding the source and extent of bleeding. Priority is to identify significant low blood volume and begin appropriate treatment. This is the most life-threatening situation. The physician will focus on three aspects:

. Vital signs: Low blood pressure and elevated heart rate will indicate significant loss of blood. An elevated temperature will suggest infection.

. examination: The physician will search for abdominal distension, discomfort, or tenderness that may suggest a possible bleeding ulcer. A mass the doctor can feel is cause for concern about cancer.

. Anal and digital rectal examination: A medical professional will inspect the anus for possible external sources of bleeding such as trauma, foreign body, or hemorrhoids. A finger examination can assess tenderness, character of stool, and the presence of masses.

Diagnostic tests: Depending on the type and severity of bleeding, health care providers may perform special tests to aid in diagnosis.

. Blood tests: Health care professionals will take blood samples to assess the extent of blood loss, the clotting ability of blood, and the possibility of infection.

. Nasogastric tube: A medical professional may need to pass a flexible tube through the nose into the stomach to check for the presence of active bleeding. This may be uncomfortable, but can be a vital diagnostic test.

Scope examinations:

. Anoscopy: A plastic or metal scope (anoscope) placed into the anus allows for quick examination of the rectum.

. Flexible sigmoidoscopy: A flexible tube inserted into the rectum evaluates the rectum and lower end of the colon.

. Colonoscopy: A physician inserts a soft tube equipped with a light and camera into the rectum and pushes it into the colon. The medical professional can visualize the entire large colon. A colonoscopy can locate areas of bleeding, masses, or irregularities, and can be used to screen for colon cancer.

. Barium enema X-ray: This study uses liquid barium inserted into the rectum. An X-ray can highlight problem areas such as tumors or diverticula. However, it cannot distinguish sites of active bleeding.

. Nuclear medicine studies: A tagged red blood cell scan can pinpoint areas of slow bleeding.

. CT scan: This scan can help diagnose diverticulitis or tumors in the bowel.

. Angiography: A contrast dye study evaluates active areas of brisk bleeding.  

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Treatment

What is the Medical Treatment for Rectal Bleeding?

The treatment for rectal bleeding depends on the cause and source of the bleeding.

. Regardless of the source of bleeding, treatment of significant blood loss will begin by stabilizing the patient's condition.

. Initially, medical professionals will provide oxygen to the patient and monitor the heart. An IV will be started to administer fluids and for a possible blood transfusion.

. Further treatment options will depend on the suspected source of bleeding. A general surgeon, gastroenterologist, or ulcerative colitis specialist will likely become involved in the treatment plan.

. Admission to the hospital is required when a marked amount of blood loss has occurred, if bleeding has not stopped, or if vital signs have not become normal.

Home Remedies for Rectal Bleeding

If minimal rectal bleeding, such as blood-streaked toilet tissue, is the source of the problem, it may be due to hemorrhoids or a rectal fissure. Home therapy can be attempted. A physician should promptly evaluate and treat all other causes of rectal bleeding.

Self-care of rectal bleeding may include various rectal ointments and suppositories. People can buy these over-the-counter items without a prescription. If the person's symptoms do not improve within one week of treatment, or he or she is older than 40 years of age, a doctor should be seen for further evaluation.

Simple home care of rectal bleeding includes the following:

. Drink eight to 10 glasses of water per day.

. Bathe or shower daily to cleanse the skin around the anus.

. Decrease straining with bowel movements.

. Increase fiber in the diet with supplements such as Metamucil, Benefiber, or foods such as prunes.

. Avoid sitting on the toilet too long.

. Apply ice packs to the affected area to decrease pain.

. Take a sitz bath. This is a warm water bath with water just deep enough to cover the hips and buttocks, and can help relieve some symptoms of itching, pain and discomfort of hemorrhoids.

. Avoid drinking alcohol, as that contributes to dehydration, which is one cause of constipation.

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When to Seek Medical Care for Rectal Bleeding

When rectal bleeding is present with one or more of the following symptoms, call a doctor:

. Stomach pain or swelling

. Nausea or vomiting

. Continues or worsens

. Recent weight loss

. Altered bowel habits

. Severe or prolonged diarrhea

. Pencil-sized stools, involuntary seepage of stools, or inability to have a bowel movement

If any of these signs and symptoms are present, one should visit the hospital's emergency department:

. Black or maroon stools

. Large volume blood loss

. Rectal pain or trauma

. Vomiting blood or other areas of the body bleeding or bruising

. Fever

. If the patient is on blood thinners

. Dizziness, weakness, passing out, or fainting spells

. Rapid or irregular heartbeat

. Difficulty breathing

Rectal Bleeding in Children

Take rectal bleeding in small children seriously. Some children may require admission to the hospital and evaluation by a surgeon.

Intussusception: This condition occurs when the bowel folds in upon itself. It is the most common cause of intestinal obstruction and rectal bleeding in children up to 36 months. A majority of cases occur within the first year of life.

The three cardinal symptoms are:

. Intermittent abdominal pains,

. Vomiting, and

. Rectal bleeding that looks like currant jelly.

However, these are not always present. Admission to the hospital is warranted because observation, further imaging tests, and surgery may be required.

Rectal Bleeding During Pregnancy

Hemorrhoids in the second and third trimesters of pregnancy are common. The cause is generally an increased pressure on the blood vessels in the pelvic area. Constipation and straining during bowel movements can also put pressure on the blood vessels. Straining during delivery can also exacerbate hemorrhoids.

If rectal bleeding occurs during pregnancy, even if a woman suspects the cause to be hemorrhoids, consult a physician.