Rectal bleeding is a sign that something is wrong. It is usually
something minor that can be easily diagnosed, but not always.
It is, therefore, important that the specific cause of rectal
bleeding be identified so appropriate treatment can be started
and the problem corrected. Even though rectal bleeding may not
be serious, one must never assume this to be the case. Most
importantly, rectal bleeding may be a sign of rectal cancer.
The causes of Rectal Bleeding
Hemorrhoids- These are dilated blood vessels
or veins in the anal or rectal area. They can occur on the outside
where they are felt as small bumps when wiping. Or they may be
on the inside where they are usually painless. They develop
quite commonly with chronic constipation and especially with
pregnancy. Hemorrhoids are usually treated with stool bulking
agents that soften the stool and reduce straining.
Fistula- A fistula is an abnormal, burrowing channel that
usually runs from the rectum to the skin around the anus.
It often will drain a whitish discharge, but it can also bleed.
While it is usually just a local problem, a fistula can be
associated with chronic inflammation in other parts of the
intestinal tract. This disorder is called Crohn's disease.
Fistulas are treated with antibiotics and hot baths.
If they persist, surgery is usually required.
Fissure- The passage of a hard stool or severe diarrhea
may tear the lining tissue of the anus. This problem is similar to
having cracked lips in cold weather. Nerve endings and blood vessels
are exposed so that pain and bleeding occur with bowel movements.
Frequent warm baths and bulking agents, used to keep stools soft,
usually correct this problem. Sometimes surgery is needed.
Diverticulosis- Diverticulosis are pockets or sacs
that project from the bowel wall. They balloon out over the years
due to recurrent, high pressure spasm of the colon. Occasionally
they can bleed. They bleed a lot and the blood comes all at one
time. It does not bleed in small amounts with bowel movements
over days or weeks. Serious, persistent diverticular bleeding
usually requires hospitalization and, at times, surgery.
Proctitis and Colitis- Either the rectum, colon,
or both, can become inflamed and ulcerated. There are a number of
disorders which cause the inside surface of the bowel to become
ulcerated and bleed. There may be rectal urgency, cramps or
diarrhea associated with the bleeding. When the inflammation
is restricted to the rectum, the condition is called proctitis.
When the colon is involved, it is called colitis. It is
important to identify the specific cause of the inflammation
so that appropriate treatment can be started.
Polyps and Cancer- Of course, the greatest concern
about rectal bleeding is cancer. Polyps are benign growths in the colon.
When polyp are a larger size, they can bleed. And certain types of
polyps turn into cancer. Colon cancer is usually curable when
discovered early. It most often occurs in people over the age
of 50, but it is not unheard of in younger individuals, even
in their 30's or y ounger. Because colon cancer is such a
common cancer, it is always considered as a possible diagnosis.
Protrusion of the Rectum- Some older individuals
will have weakened rectal support tissues. Part of the rectum then
can project from the anus and bleed. This condition is called
rectal prolapsed. It can be felt as an abnormal bulging from
the rectum when wiping. Surgery is the only effective treatment.
Diagnosis
The Medical History
What is the patient's age?
Older people tend to have polyps and cancer more often.
Is there anal pain and a hard, large stool associated with bleeding?
A tear of the anus may be the answer.
Does blood drip into the toilet after a bowel movement?
Bleeding hemorrhoids may be the problem. The color and
frequency of the bleeding are additional considerations.
In most cases, the medical history provides clues,
but never the final answer.
The Visual and Digital Exam
The physician will inspect the anal area looking for tears and
hemorrhoids. A finger exam can provide information when there
is tenderness or a tumor inside. In men, the prostate is also examined.
Endoscopy
There are several types of endoscopes used to view the colon.
In the office, the physician may use a rigid or, more commonly,
a flexible viewing sigmoidoscope. This exam is called flexible
sigmoidoscopy and is performed in 5 to 10 minutes. A more
thorough exam is accomplished with a colonoscope, allowing
the physician to view the entire 5 to 6 foot long colon.
Sedation is usually given for this exam. Frequently a bleeding
lesion will be present beyond the reach of the sigmoidoscope.
So colonscopy may be the best initial exam. Both exams are
usually done on an outpatient basis.
Barium Enema X-ray
This is a complementary exam that uses liquid barium inserted
by enema into the rectum. X rays highlight abnormal shadows,
such as tumors, diverticuli and colitis. By itself, however,
it does not identify an actual bleeding point.