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, an individual should 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 common problems are actually widened blood vessels or veins. 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 quite commonly develop with chronic constipation and especially with pregnancy. Hemorrhoids are usually treated with stool bulking agents to soften the feces 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 swelling in other parts of the intestinal tract. This inflammatory 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 to keep stools soft usually correct this problem. Sometimes surgery is needed.
Diverticulosis - Diverticula 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 usually produce a lot of blood, and it comes all at one time. It does not persist 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 swollen and ulcerated. There are a number of disorders which cause the inside surface of the bowel to become ulcerated and bleed painlessly. There may be rectal urgency, cramps or diarrhea associated with the bleeding. When the swelling is restricted to the rectum, the condition is called proctitis. When the colon above it 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 polyps reach a large 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. 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 caused by frequent straining to have a bowel movement and/or diarrhea. Part of the rectum then can project from the anus and bleed. This condition is called a rectal prolapse. It can be felt as an abnormal bulging from the rectum when wiping. Surgery is the only effective treatment.
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.
The Scopes - There are several types of viewing scopes. 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. Not infrequently a bleeding lesion will be present beyond the reach of the sigmoidoscope. So frequently colonoscopy is the best initial exam. Both are usually done on an outpatient basis and require intravenous sedation.
Barium Enema X-ray - This is a complementary exam that uses liquid barium inserted by enema through the rectum. X-rays highlight abnormal shadows, such as tumors, diverticuli and colitis. By itself, however, it does not identify an actual bleeding point.
Rectal bleeding always means that there is a problem. It is usually not a serious problem, but it should always be assumed to be serious until proven otherwise. Fortunately, the diagnosis is easy to make and effective treatment is almost always available.