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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 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 a I 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.
Summary
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.
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