Rectal Bleeding

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Overview

Rectal bleeding, or hematochezia, is a frequently encountered problem in the outpatient setting. It can herald a pathology in the proximal lower gastrointestinal tract, but it can also be from diseases specific to the rectal region such as hemorrhoids, fissures, proctitis, and anorectal malignancy. Unfortunately, it has been reported that less than half the patients with rectal bleeding will ever seek medical help for their symptoms. 

Rectal bleeding presents as frank red blood exiting from the anus. The presentation may range from mild to severe, depending on the etiology of the bleeding. Mild cases may appear as red blood streaking the patient's stool or toilet paper after wiping, and severe cases may present as a large volume, brisk bleed. The following review will discuss rectal bleeding with more focus on hemorrhoids as it is the most common cause of rectal bleeding in the middle-aged and elderly populations.

Symptoms

Feeling rectal pain and/or pressure.

Seeing bright red blood in or on your stool, underwear, toilet paper or in the toilet bowl.

Having stool that's red, maroon or black in color.

Having stool that has a tar-like appearance.

Experiencing mental confusion.

Causes

Causes of rectal bleeding can range from mild to serious. Conditions associated with rectal bleeding include:

Anal fissures. Small tears in the lining of the anus can lead to bleeding and pain when passing stools. Tears can occur because of constipation or during childbirth.

Angiodysplasia. Enlarged blood vessels develop in the intestine. They can become fragile, break, and bleed.

Hemorrhoids. Also called piles, these are masses of tissue made up of blood vessels and muscle fibers. Internal hemorrhoids are inside the body. They don’t hurt but can cause bleeding. In some cases, they can pass through the anus.

Constipation. Hard stool and straining to relieve constipation can lead to anal fissures and hemorrhoids, both of which can result in bleeding.

Anal or colorectal polyps. Polyps are growths that can appear in many places throughout the body. If polyps develop in the intestine, they can bleed. Polyps aren’t cancerous, but some can become malignant in time.

Ulcers. An ulcer can form when an erosion worsens in the digestive track. Black, tarry stools may occur if an ulcer is bleeding higher in the gut, but an ulcer further down may produce bright red blood. However, this isn’t always the case, and your doctor will need to investigate.

Anal cancer or colon cancer. As tumors form, they need blood vessels to grow. The blood vessels in the colon are fragile and can tear, causing bleeding. Only 3.4 percentTrusted Source of cases of rectal bleeding are due to colon cancer.

Inflammatory bowel disease (IBD). This includes ulcerative colitis (UC) and Crohn’s disease. Bleeding may occur alongside rectal pain and diarrhea.

Diverticular disease. Diverticula are small pouches or bulges in the colon where, over time, blood vessels can erode, rupture, and bleed. When there are no symptoms, it’s called diverticulosis, but if inflammation occurs, this is diverticulitis. Together, they’re called diverticular disease.

Infections. Intestinal infection, or infections caused by bacteria, such as salmonella, can cause bleeding.

Bleeding conditions. Some conditions can contribute to bleeding because they affect the blood’s ability to coagulate. They include vitamin K deficiency, hemophilia, and a low platelet count, also called thrombocytopenia.

Damage to the upper gastrointestinal (GI) tract. Tears or other problems in the stomach or even the esophagus can cause bleeding from the rectum. Bleeding from the upper GI tract is more likely to appear as black, tarry stools.

Risk factors

A number of factors increase the risk of developing rectal bleeding. Not all people with risk factors will get rectal bleeding. Risk factors for rectal bleeding include:

Abdominal gas, which increases pressure on the rectum and may cause bleeding hemorrhoids

Alcoholism or heavy alcohol ingestion, which is associated with esophageal varices (swollen veins in the esophagus that have the potential to rupture)

Constipation, which may cause straining and dry hard stools, which can abrade the rectum

Family history of gastrointestinal diseases such as ulcerative colitis and Crohn’s disease, which is known to cause bleeding

Older age, which may result in weakened intestinal blood vessels

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Complications

You can help minimize your risk of serious complications of rectal bleeding by following the treatment plan that you and your health care professional design specifically for you. Complications of rectal bleeding include:


Anemia (low red blood cell count)

Need for blood transfusion

Spread of cancer

Spread of infection

Shock

Prevention

The best way to prevent rectal bleeding is to prevent its chief causes. To prevent hemorrhoids, it's important to keep your stools soft so they can pass easily. To do this, drink plenty of fluids and eat a diet high in fiber. Go to the bathroom as soon as you feel the urge and avoid straining when passing stools.