Bleeding Rectum? No it’s not Piles necessarily!

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Bleeding per rectum means bleeding in any segment of the gastrointestinal tract(GI) from ESOPHAGUS to RECTUM.

The color of the blood can indicate where the bleeding is coming from:

  • Bright red blood usually indicates bleeding low in the colon or rectum (lower GI)
  • Dark red or maroon blood usually indicates bleeding higher in the colon or the small bowel (upper GI)
  • Melena usually means bleeding in the stomach, such as bleeding from ulcers

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Not all rectal bleeding is visible to the eye. In some cases, rectal bleeding can only be seen by looking at a stool sample through a microscope. There is also a test, called a Hemoccult® test that s done in the lab.

What other than Hemorrhoids or Piles could cause Rectal Bleeding?

 

Bleeding Rectum 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

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
  • Diarrhea
  • Diverticulosis (a bulging pouch that forms on the wall of the intestine)
  • 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 (ulcer of the rectum)
  • Ulcerative colitis (a type of inflammatory bowel disease)

What can be the Frequency and Duration of bleeding in various cases?

Bleeding per rectum is persistent or intermittent in polyps. Acute bleeding may be due to diverticular disease, angiodysplasia, jejunoileal diverticula, Meckel’s diverticulum, neoplasms/lymphomas, enteritis/Crohn’s disease, Peptic ulcer, gastritis/duodenitis, and esophageal varices. Angiodysplasia, small bowel tumors, small bowel ulcers and erosions, Crohn’s disease, small bowel diverticulosis, and radiation enteritis are causes for chronic intermittent bleeding.

What could be the Nature of Pain?

Painless bleeding may be due to hemorrhoids, colorectal carcinoma, polyps, diverticular disease, and Bleeding will be painful in anal fissure which is a severe sharp pain occurring with straining on defecation and resolves within an hour after defecation. Strangulated hemorrhoids are usually associated with pain.

Rectal Bleeding in Children

Rectal bleeding in small children should be taken 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:

1. intermittent abdominal pains,
2  vomiting, and
3. 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.

3Rectal 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.

When to Seek Medical Care for Rectal Bleeding?

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

  • Fever
  • Stomach pain or swelling
  • Nausea or vomiting
  • Bleeding 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, a visit to the hospital’s emergency department is warranted:

  • Black or maroon stools
  • Large volume blood loss
  • Rectal pain or trauma
  • Dizziness, weakness, or fainting spells
  • Rapid or irregular heartbeat
  • Difficulty breathing

How Is Rectal Bleeding Diagnosed?

A physical examination will be performed by the physician. 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:
1. Vital signs: Low blood pressure and elevated heart rate will indicate a significant loss of blood. An elevated temperature will suggest infection.
2. Abdominal 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.
3. Anal and digital rectal examination: The anus will be inspected for possible external sources of bleeding such as trauma, foreign body, or hemorrhoids. A finger examination is performed to assess tenderness, the character of stool, and the presence of masses.

Diagnostic tests: Depending on the type and severity of bleeding, special tests may be performed to aid in diagnosis.

  • Blood tests: Blood samples are taken to assess the extent of blood loss, the clotting ability of blood, and the possibility of infection.
  • Nasogastric tube: A flexible tube is passed 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 placed into the anus allows for quick examination of the rectal vault.
  • Flexible sigmoidoscopy: A flexible tube inserted into the rectum is used to evaluate the rectum and lower end of the colon.
  • Colonoscopy: A soft tube equipped with a light and camera is inserted into the rectum and pushed into the colon. The entire large colon is visualized. It is used to locate areas of bleeding, masses, or irregularities.
  • Barium enema X-ray: This study uses liquid barium inserted into the rectum. An X-ray is taken to highlight problem areas such as tumors or diverticula. However, sites of active bleeding cannot be distinguished.
  • Nuclear medicine studies: A tagged red blood cell scan may be used to pinpoint areas of slow bleeding.
  • CT scan: May be used to diagnosing diverticulitis or tumors in the bowel.
  • Angiography: A contrast dye study is used to evaluate active areas of brisk bleeding.
  • Radionuclide scans: There are two types of radionuclide scans that are used for determining the site of gastrointestinal bleeding; a Meckel’s scan, and a tagged red blood cell (RBC) scan.

5How is rectal bleeding treated?

The treatment of rectal bleeding depends on the cause of the bleeding. Bleeding due to diverticular disease, colitis or angiodysplasia may resolve spontaneously without intervention. However, recurrent bleeding may require endoscopic therapy, and severe massive life-threatening bleeding may sometimes even require surgery.

Hemorrhoids are generally treated with a combination of lifestyle and dietary advice, medications and/ or rubber band ligation of the hemorrhoids. This is done in the outpatient clinic. Surgery may be performed if the bleeding is recalcitrant in spite of medical therapy.

Bleeding as a result of colorectal cancer should be managed with surgery for the primary tumor

Medicine: Given to decrease pain.
Vasoconstrictors: This medicine decreases the size of blood vessels and helps stop the bleeding.
Iron supplement: Iron helps the body make more red blood cells.
Steroids: This medicine decreases inflammation in the rectum. It may be applied as a cream, ointment, or lotion.
IV:To compensate dehydration. Extra liquids recommended.
Blood transfusion: Blood is tested for diseases, such as hepatitis and HIV, to be sure it is safe.
Surgery: Surgery to remove hemorrhoids, tumors, or polyps.

What Is the Prognosis for Rectal Bleeding?

The majority of people with significant rectal bleeding are elderly. Members of this population commonly have many other medical problems. As a result, they tend to suffer increased rates of illness and death.

In recent years, death from rectal bleeding has significantly decreased. This reduction is due to more efficient emergency departments, recent advances in procedures, and evolving surgical management.

The majority of complications from rectal bleeding occur when large amounts of blood have been lost.

The areas causing acute rectal bleeding may rebleed. This underscores the need for making a definitive diagnosis and in discovering the source of the bleeding so that the corrective actions may be made.

Rectal bleeding with symptoms of weakness, dizziness, or fainting is associated with at least 1 liter (2 pints) of blood loss is a medical emergency. Seek medical care immediately. Sudden loss of 2 liters (4.2 pints) or more of blood can be dangerous, if not fatal.


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