Rectal Bleeding - Causes, Diagnosis, and Management

Introduction

Rectal bleeding is also called hematochezia. Bleeding from the rectum can be a symptom of many conditions, like hemorrhoids, anal fissures, inflammatory bowel diseases, and colorectal cancer. It can indicate a proximal lower gastrointestinal pathology or other diseases, specifically in the rectal area. Irrespective of the cause, the condition must be managed and treated appropriately to prevent further progression.

What Is Rectal Bleeding?

Rectal bleeding is when blood is seen in the rectal area or stool is passed. It can be alarming to the patient. It is usually presented as bright red blood exiting from the anus. The disorder can range in severity from minor to severe. Mild cases present as fresh red blood in stool, while severe cases present a large volume of brisk blood. It can be due to a local condition in the rectum or some lower gastrointestinal pathology.

What Are the Causes of Rectal Bleeding?

Rectal bleeding can occur due to many reasons. They can range from mild common conditions to severe conditions that might require medical attention. The common causes of rectal bleeding can include;

• Hemorrhoids: These are veins swollen in the anus or rectum. It is the most common cause of bleeding in the rectum. These swollen veins are present very close to the surface of the skin. Sometimes, a tear in the skin can cause a rupture of these blood vessels, causing rectal bleeding. Hemorrhoids are caused by strain on the area, like pregnancy, constipation, or heavy weight lifting.

• Anal Fissure: These are tears in the lining of the anal canal. It usually happens due to straining to pass a hard stool and is easily mistaken for hemorrhoids. Both hemorrhoids and anal fissures are related to constipation and cause anal pain and bleeding.

• Irritable Bowel Syndrome (IBS): Irritable bowel syndrome is a chronic illness that causes inflammation in the lining of the digestive tract. Crohn's disease affects the small intestine, while ulcerative colitis affects the large intestine. The common symptoms of IBS include vomiting and diarrhea. In severe cases, it can progress to bleeding.

• Diverticulitis: This condition is seen in the colon, which lies close to the rectum. When the pockets in the colon's inner lining get infected, it is called diverticulitis. This makes the blood vessels in the colon to be more fragile and tend to break easily. When they break, it can cause rectal bleeding.

• Infectious Colitis: Some bacterial infections like E.coli infections can cause bleeding from the colon. It is usually seen as bloody diarrhea.

• Sexually Transmitted Infections: Some sexually transmitted diseases, like gonorrhea, chlamydia, syphilis, etc., cause inflammation and bleeding in the anal or rectal lining. Getting it diagnosed and treated in the initial stages is essential to prevent complications.

• Peptic Ulcer Disease: Peptic ulcers usually occur in the various parts of the stomach or on top of the intestine. When the acids in the stomach cause eroding the stomach lining, it causes peptic ulcers. Bleeding in the upper gastrointestinal tract usually takes time to reach the stool. Hence it is seen as a dark, black, tarry stool.

• Colon Polyps and Colorectal Cancer: Larger polyps can bleed and become cancerous. Cancerous polyps may bleed more than normal.

• Angiodysplasia: Enlarged blood vessels that develop in the intestines are called angiodysplasia. They can become fragile and bleed easily.

• Bleeding Disorders: These conditions can cause bleeding by interfering with the coagulation procedure. Vitamin. K deficiency, hemophilia, and thrombocytopenia can be included in bleeding disorders.

What Are the Symptoms of Rectal Bleeding?

The main symptom of rectal bleeding is blood in the stool. However, the color of the blood and stool can indicate various conditions.

1. Bleeding in the lower gastrointestinal tract, like the colon or the rectum, can be seen as bright red blood in the stool.

2. Dark red or vine-red blood in the stool can indicate bleeding in the small intestine or the early portion of the colon.

3. A dark tarry stool can indicate bleeding in the upper gastrointestinal tract, like the stomach or upper part of the intestine. Other symptoms can include;

• Dizziness.

• Fainting.

• Pain in the rectal region.

• Abdominal pain.

However, medical assistance should be sought if the following symptoms are seen:

• Cold, clammy skin.'

• Confusion.

• Rectal bleeding that occurs continuously.

• Fainting and dizziness.

• Rapid breathing.

• Pain in the anal area.

• Severe nausea.

• Blood in vomit.

How Is Rectal Bleeding Diagnosed?

A detailed case history will be taken, evaluating the symptoms noticed, bleeding, and color of blood. Other tests can include;

• Physical Examination: The affected area is checked or palpated. A lubricated, gloved finger is inserted into the anus to evaluate any abnormalities like hemorrhoids.

• Endoscopy: A flexible, thin tube with a light and a camera is inserted into the anus. Sigmoidoscopy and colonoscopy are such procedures.

• Blood Tests: Tests such as complete blood count (CBC) help to assess the severity of bleeding. It helps to check if the patient is frail.

• Stool Tests: These tests check for bleeding that may not be visible.

• Gastric Lavage: If the cause of bleeding is found in the stomach, the doctors may clean the stomach to find the exact location of the bleeding.

• Imaging Tests: Imaging studies like X-rays, usually with a contrast agent, will be done to find the cause.

How Is Rectal Bleeding Managed?

Rectal bleeding can be managed based on its severity and cause. Taking lukewarm baths at home can ease the pain and discomfort of hemorrhoids. Over-the-counter creams can also help to reduce irritation. If anal fissures cause bleeding due to constipation, treating constipation will gradually solve the rectal bleeding. Consuming a diet rich in fiber, regular exercise, staying hydrated, and keeping the area clean can help to prevent the condition.

Hemorrhoids might require more invasive management. Rubber band ligation, laser treatments, and surgical removal of hemorrhoids might be required. Anal fissures would resolve once the underlying condition is treated. Colon cancer might require long-term treatments like surgery, radiation therapy, and chemotherapy. Polys should be managed if they are large or become cancerous.

Conclusion

Rectal bleeding can be commonly prevalent and caused by a simple reason like hemorrhoids or a more severe reason like colon cancer. Seeking medical assistance early can help prevent further complications. Answering their questions honestly and helping them assess the condition will help diagnose it quickly and treat them appropriately.