RECTAL BLEEDING - CAUSES, SYMPTOMS AND MANAGEMENT

Causes for Rectal Bleeding

• Common causes for rectal bleeding
• Hemorrhoids:Hemorrhoids are swollen rectal veins in the anal and rectal area. They can cause burning, painful and bleeding.
• Anal fissure:This is a tear in the lining of the rectum caused by the passage of hard stools and bleeding per rectum.
• Diverticulosis:Diverticula are out-pouching that project from the bowel wall. It is caused by decreased fiber in the diet. When the diverticula becomes inflamed and infected it is called diverticulitis, which may cause rectal bleeding sometimes.
• Infection:Bacterial dysentery is commonly the source of infectious, bloody diarrhea.
• Inflammation:Inflammatory bowel disease (IBD) is a common cause of rectal bleeding in adults, typically younger than 50 years of age.
• Angiodysplasia:This is a vascular problem that involves enlarged veins and capillaries in the wall of the right colon. These areas become fragile and can cause bleed.

Major cause for rectal bleeding

• Polyps:Lumps of tissue or polyps bulge out from the lining of the colon. Bleeding occurs in case of large polyps, which can be hereditary. Usually harmless, some types can be precancerous.
• Tumours:Both benign and malignant forms are frequently found in the colon and rectum. People older than 50 years of age are most affected. However, tumours can be found in younger people.
• Trauma:Rectal bleeding from a traumatic cause is always a critical concern.
• Upper gastrointestinal source
• A common source of rectal bleeding is bleeding from the upper gut, usually the stomach or duodenum. The bleeding stomach ulcers or Mallory-Weiss tears (the tear or cuts or ruptures of vessels in the lining of the esophagus or stomach, esophageal varies.
• Alcohol consumption can also cause ulcers and gastritis.
• Meckel diverticulum: A rare condition, where gastric lining is found in an inappropriate location of the gastrointestinal tract. As a result, the gastric acid secreted from this lining erodes tissue and ultimately causing hemorrhage, which is more common in children's.

Rectal Bleeding Symptoms

• Bright red blood present in the stool
• Change in stool colour to black, red, or maroon
• Stool test positive for occult blood loss (blood may present, but you cannot see it)
• Rectal pain ±
• Confusion
• Dizziness, lightheadedness
• Fainting, palpitations or rapid heartbeat

When to Seek Medical Care for Rectal Bleeding

• All the rectal bleeding need to be investigated and should consultant physician
• 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 Black or maroon stools
• Dizziness, weakness, or fainting spells
• Rapid or irregular heartbeat
• Difficulty breathing

Diagnostic tests

• Depending on the type and severity of bleeding
• Digital rectal examination:Initially examination for all rectal bleeding
• Blood tests:Complete blood counts and coagulation profile blood samples are taken to assess the extent of blood loss, the clotting ability of blood, and the possibility of infection.
• Flexible sigmoidoscopy:A flexible tube inserted into the rectum is used to evaluate the rectum and lower end of the colon.
• Colonoscopy:To study the entire large colon. It is used to locate areas of bleeding, masses, or irregularities.
• CT scan:May be used to diagnose diverticulitis or tumours in the bowel.
• Angiography:A contrast dye study is used to evaluate active areas of brisk bleeding.

Management

• The treatment for rectal bleeding depends on the cause and source of the bleeding.
• Initially, oxygen will be provided to the patient and the vitals will be monitored. An IV will be started to administer fluids and for a possible blood transfusion.
• Further treatment options will depend on the suspected source of bleeding. It is likely a specialist such as gastroenterologist or surgeon will become involved in the treatment plan.
• Admission to the hospital is required when a marked amount of blood loss has occurred, if bleeding has not stopped, or if your vital signs have not become normal.

Remedies and Precaution to avoid Rectal Bleeding

• Decrease straining with bowel movements.
• Increase fibre in the diet and adequate water
• Take a sitz bath. This is a warm water bath with water just deep enough to cover the hips and buttocks, and can help relieve some symptoms of itching, pain and discomfort of hemorrhoids.
• Avoid drinking alcohol.
• If the person's symptoms do not improve within one week of treatment, or he or she is older than 40 years of age, a doctor should be seen for further evaluation.
• The majority of people with significant rectal bleeding are elderly. Members of this population commonly have many other medical problems. All other causes of rectal bleeding should be evaluated and treated by a physician promptly.

Article by Dr. Kannan. D, M.S, M.CH(GASTRO), FRCS(GLASG)
Consultant Surgical Gastroenterology
a Kauvery Hospital