Rectal Bleeding: Symptoms, Causes, Treatment

What are the symptoms of rectal bleeding?

Rectal bleeding can manifest in various ways, depending on the underlying cause. Symptoms may include:

1. Visible Blood:

• Bright Red Blood: Blood that appears bright red on toilet paper, in the toilet bowl, or on the surface of the stool, indicating bleeding from the lower rectum or anus.
• Dark Red or Maroon Blood: Blood that appears darker, which can suggest bleeding from higher in the colon or rectum.

2. Blood in Stool:

• Red or Black Stools: Stools that are red or black and tarry can indicate bleeding from the upper gastrointestinal tract. Black stools are typically a sign of digested blood.

3. Blood on Toilet Paper:

• After Bowel Movements: Noticing blood on toilet paper after wiping can indicate minor bleeding, often from hemorrhoids or anal fissures.

4. Rectal Pain:

• Discomfort or Pain: Pain during or after bowel movements, which can be associated with hemorrhoids, anal fissures, or infections.

5. Itching or Irritation:

• Perianal Itching: Itching or irritation around the anus, which can accompany hemorrhoids or other conditions.

6. Abdominal Pain:

• Cramping or Discomfort: Abdominal pain or muscle cramps, which can be associated with conditions like diverticulitis or inflammatory bowel disease (Crohn’s disease or ulcerative colitis).

7. Changes in Bowel Habits:

• Diarrhea or Constipation: Changes in bowel habits, including diarrhea or constipation, which may accompany rectal bleeding depending on the underlying cause.

8. Other Systemic Symptoms:

• Weight Loss: Unexplained weight loss, which might occur in cases of chronic disease or cancer.
• Fatigue: Feeling unusually tired or weak, potentially related to chronic bleeding or anemia.

Rectal bleeding should always be evaluated by a healthcare professional, as it can be a symptom of various conditions, ranging from benign issues like hemorrhoids to more serious conditions like colorectal cancer. The evaluation typically includes a detailed medical history, physical examination, and possibly further diagnostic tests such as a colonoscopy.

What are the causes of rectal bleeding?

Rectal bleeding can have various causes, ranging from benign to serious. Some common and less common causes include:

1. Hemorrhoids:

• Internal Hemorrhoids: Swollen veins inside the rectum that can cause bright red bleeding during bowel movements.
• External Hemorrhoids: Swollen veins outside the anus that may cause pain, itching, and bleeding.

2. Anal Fissures:

• Tear in the Anus: Small tears in the lining of the anus can cause pain and bleeding, often associated with passing hard stools.

3. Anal Abscesses and Fistulas:

• Infection: Abscesses are painful collections of pus near the anus, which can lead to bleeding if they rupture. Fistulas are abnormal connections between the anus and surrounding tissues.

4. Diverticulosis and Diverticulitis:

• Diverticulosis: Small pouches (diverticula) in the colon wall that can bleed if they become inflamed or infected (diverticulitis).

5. Inflammatory Bowel Disease (IBD):

• Ulcerative Colitis: Chronic inflammation of the colon and rectum leading to ulcers and bleeding.
• Crohn’s Disease: Inflammation that can affect any part of the digestive tract, potentially causing bleeding.

6. Colorectal Polyps and Cancer:

• Polyps: Benign growths on the lining of the colon or rectum that can bleed and may progress to cancer if not removed.
• Colorectal Cancer: Malignant tumors in the colon or rectum can cause rectal bleeding, often with other symptoms such as weight loss or changes in bowel habits.

7. Gastrointestinal Bleeding:

• Upper GI Bleeding: Conditions like peptic ulcers or esophageal varices can cause bleeding that appears in the stool as black and tarry (melena).

8. Rectal Trauma or Injury:

• Physical Injury: Trauma or injury to the rectal area, including from childbirth or vigorous anal intercourse, can cause bleeding.

9. Rectal Prolapse:

• Prolapse: The rectum protruding from the anus, which can lead to bleeding and mucous discharge.

10. Infectious Diseases:

• Infections: Certain infections, such as sexually transmitted infections (STIs) or bacterial infections, can cause bleeding and discomfort.

11. Medication Side Effects:

• Anticoagulants: Medications that prevent blood clotting can increase the risk of bleeding, including rectal bleeding.

12. Other Conditions:

• Radiation Therapy: For cancers in the pelvic area, radiation therapy can cause rectal bleeding as a side effect.

Accurate diagnosis of the cause of rectal bleeding requires a thorough evaluation by a healthcare provider, which may include a physical examination, medical history, and diagnostic tests such as a colonoscopy or imaging studies.

What is the treatment for rectal bleeding?

The treatment for rectal bleeding depends on the underlying cause of the bleeding. Rectal bleeding can result from a variety of conditions, including hemorrhoids, anal fissures, diverticulosis, colorectal polyps, or more serious conditions like colorectal cancer. Here’s a general approach to treating rectal bleeding based on its potential causes:

1. Assessment and Diagnosis

Before treatment can be determined, a thorough evaluation is necessary:

• Medical History: Review of symptoms, medical history, and any recent changes in bowel habits.
• Physical Examination: Includes a digital rectal exam (DRE) to check for abnormalities.
• Diagnostic Tests: May include:
• Colonoscopy: To visualize the inside of the colon and rectum.
• Sigmoidoscopy: To examine the lower part of the colon and rectum.
• Endoscopy: To inspect the upper gastrointestinal tract.
• Imaging: CT scans or MRI if needed to evaluate other possible sources of bleeding.

2. Treatment Based on Cause

Hemorrhoids

• Over-the-Counter Remedies: Topical treatments, ointments, and suppositories to reduce inflammation and discomfort.
• Dietary Changes: Increasing fiber intake to ease bowel movements and prevent straining.
• Procedures:
• Rubber Band Ligation: To remove internal hemorrhoids.
• Sclerotherapy: Injection of a solution to shrink hemorrhoids.
• Hemorrhoidectomy: Surgical removal of hemorrhoids in severe cases.

Anal Fissures

• Topical Treatments: Medications like nitroglycerin ointment or calcium channel blockers to relax the sphincter muscle and promote healing.
• Dietary Changes: High-fiber diet and increased water intake to prevent constipation.
• Sitz Baths: Warm baths to soothe the area.
• Surgery: In persistent cases, lateral internal sphincterotomy may be performed.

Diverticulosis

• Dietary Modifications: High-fiber diet to prevent diverticular disease complications.
• Antibiotics: If diverticulitis (infection of diverticula) occurs.
• Surgery: In severe cases or complications, such as diverticular bleeding or perforation.

Colorectal Polyps

• Polypectomy: Removal of polyps during a colonoscopy to prevent progression to colorectal cancer.
• Regular Surveillance: Follow-up colonoscopies to monitor for new polyps.

Colorectal Cancer

• Surgery: To remove the tumor and surrounding tissue.
• Chemotherapy: To treat cancer that has spread beyond the colon or rectum.
• Radiation Therapy: Often used in conjunction with surgery or for specific types of colorectal cancer.
• Targeted Therapy and Immunotherapy: For advanced cases, based on specific genetic markers and cancer characteristics.

3. General Measures

• Hydration: Ensuring adequate fluid intake to maintain bowel health.
• Medications: Pain relief and management of underlying conditions as necessary.
• Follow-Up: Regular check-ups to monitor for recurrence or complications.

4. Lifestyle Modifications

• Healthy Diet: Emphasizing a diet high in fiber, fruits, and vegetables.
• Exercise: Regular physical activity to promote bowel health.

When to Seek Immediate Care

• Heavy Bleeding: If you experience significant or persistent bleeding.
• Severe Pain: Accompanied by rectal bleeding.
• Other Symptoms: Such as significant weight loss, changes in bowel habits, or symptoms of anemia.

It’s crucial to consult a healthcare provider for an accurate diagnosis and appropriate treatment plan. Early diagnosis and treatment are essential for managing rectal bleeding and addressing any underlying conditions effectively.