Rectal Bleeding

Have you ever had blood in your stool (poop)? In fact, many people have experienced seeing blood in stool. After going to the toilet, they found a small amount of bright red to black blood in the toilet bowl, toilet paper or stool. In addition to common hemorrhoids, blood in the stool may also be caused by indigestion, large intestine polyps, intestinal cancers and even rare anal cancer.

Therefore, if you have persistent stool bleeding, especially dark red blood stains on the stool, accompanied by symptoms such as fainting and abdominal cramps, you should seek medical assistance as soon as possible. 

Causes

Anal fissure

Small cracks in the lining of the anus, causing bloody stool and painful defecation

Hemorrhoid

Tissue lining the rectum composed of blood vessels and muscle fibres swells due to pressure and gravity

Angiodysplasia

Abnormal, tortuous, dilated small blood vessels developed in the intestine, causing them to become fragile, rupture, and bleed

Constipation

Hard stools, the excessive straining can lead to anal fissures and hemorrhoids

Internal hemorrhoids

Internal hemorrhoids do not hurt but can cause bleeding

Anal or colorectal polyps

Polyps are projecting growth of tissue into the bowel cavity that can cause bleeding 

Anal or colon cancer

The tumours are highly vascular and fragile and can often tear or break and cause bleeding

Ulcers

Black, tarry stools may occur from bleeding in the stomach (common with people regularly taking aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and mefenamic acid) and small bowel ulcers; bright red blood may be from large bowel ulcers

Inflammatory bowel disease (IBD)

Includes ulcerative colitis (UC) and Crohn's disease

Diverticular disease

Dierticula are small pouches or bumps in the wall of the colon where blood vessels can be corroded rupture and bleed over time

Infection

An intestinal infection or an infection caused by bacteria such as Salmonella, E. Coli or Shigella can cause bleeding

Common symptoms

• Dark red blood in stool
• The friction of feces causes the blood vessels near the anus to rupture, resulting in bright red blood in the stool
• Dark chestnut-colored stool
• Toilet water stained red
• Black, tarry stools
• Anal or rectal pain on defecation

• Severe abdominal or rectal pain
• Dizziness
• Fainting
• Low blood pressure
• Vomiting
• Rapid heartbeat

Checking for rectal bleeding?

Medical history and physical examination

Doctors will ask the patient about their symptoms, medical and family history, and any medications they are taking. They may also perform a physical check-up, like a digital rectal examination,  to look for signs of bleeding, such as blood in the stool or anal area.

Blood test

It can help identify specific conditions that may be causing rectal bleeding, such as anemia or inflammation in the body.

Colonoscopy

A colonoscopy is a procedure that involves inserting a long, flexible tube with a light and camera into the rectum and colon to examine the lining of the colon for abnormalities or signs of bleeding. A biopsy may also be taken during the procedure if necessary.

Anoscopy

It is a procedure that involves inserting a short, rigid tube with a camera into the anus to examine the anal canal for signs of bleeding or other abnormalities.

Imaging Tests

A computed tomography (CT scan) or magnetic resonance imaging (MRI) may be used to look for abnormalities in the rectum or colon that could be causing rectal bleeding.

Angiography

It is a procedure that uses contrast dye and X-rays to visualise blood vessels and identify a source of bleeding in the gastrointestinal tract.

Scintigraphy

An imaging technique using radioactive isotopes to localise the bleeding bowel segment, and to estimate the rate of blood loss.

Treatments

Hemorrhoids or Anal Fissure

• For small amounts of bleeding caused by internal hemorrhoids or anal fissures, conservative management consists of:  plenty of water, ice packs, and over-the-counter creams or suppositories to lessen the pain (from anal fissures), stimulate bowel movements or soften stools, while changes in diet (increase soluble fiber) and fluid intake improves the consistency of stool to make it easier to pass out. 

Polyps or Cancer

• For benign (non-cancerous) polyps endoscopic removal and regular monitoring is usually done; for cancerous growths, surgical intervention with possible adjuvant therapies (like chemotherapy, biological drugs and radiation) is the standard treatment. 

Prevention

• Drink plenty of water and eat a fiber-rich diet to prevent hemorrhoids
• Intake of sufficient oils in daily diet
• Develop a regular bowel habit
• Avoiding excessive straining during bowel movements
• Do not use harsh or scented toilet paper
• High-risk groups with family or personal history of colorectal tumours should do regular medical checkups

It's important for patients to be aware of their family and personal history and discuss any concerns or questions they have with their doctor and follow their recommendations for diagnosis and treatment. 

Reference

1. Bleeding from the bottom (rectal bleeding) - NHS. (n.d.). 16 July, 2023, Retrieved from https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

2. How to stop rectal bleeding: Causes, treatment, symptoms & remedies. (n.d.). 16 July, 2023, Retrieved from https://www.emedicinehealth.com/rectal_bleeding/article_em.htm

3. Cleveland Clinic. Rectal Bleeding. 16 July, 2023, Retrieved from https://my.clevelandclinic.org/health/symptoms/14612-rectal-bleeding 

4.Mayo Clinic. Rectal bleeding. 21 July, 2023, Retrieved from https://www.mayoclinic.org/symptoms/rectal-bleeding/basics/causes/sym-20050740 

5. Health Direct. Rectal bleeding. 21 July, 2023, Retrieved from https://www.healthdirect.gov.au/rectal-bleeding 

6. NIH, National Library of Medicine. Rectal bleeding. 31 July 2023. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK563143/#:~:text=Rectal%20bleeding%2C%20or%20hematochezia%2C%20is,%2C%20proctitis%2C%20and%20anorectal%20malignancy