Rectal bleeding

Rectal bleeding, or bleeding from the lower gastrointestinal tract, can range from mild to severe and can be a symptom of various conditions. Here’s an overview:

Causes

  • Hemorrhoids: Swollen blood vessels in the rectal area, often due to straining during bowel movements.
  • Anal Fissures: Small tears in the lining of the anus.
  • Diverticulosis: Small pouches in the colon wall that can bleed.
  • Gastrointestinal Infections: Causing inflammation and bleeding.
  • Inflammatory Bowel Disease (IBD): Including Crohn’s disease and ulcerative colitis.
  • Colorectal Polyps or Cancer: Abnormal growths in the colon or rectum.
  • Angiodysplasia: Abnormal blood vessels in the gastrointestinal tract.
  • Proctitis: Inflammation of the rectum lining.

Diagnosis

  • History:
    • Nature of bleeding (color, amount, duration).
    • Associated symptoms (abdominal pain, weight loss, changes in bowel habits).
    • Medical and family history (IBD, colorectal cancer).
    • Medication history (NSAIDs, anticoagulants).
  • Examination:
    • Abdominal examination for tenderness or masses.
    • Digital rectal examination to detect hemorrhoids, fissures.
    • Anoscopy or proctoscopy for local rectal pathology.
  • Investigations:
    • Colonoscopy: To visualize the entire colon.
    • Flexible Sigmoidoscopy: If colonoscopy not feasible.
    • Stool tests: For occult blood, infections.
    • Blood tests: CBC for anemia, inflammatory markers.
    • Imaging: CT or MRI for further assessment of the GI tract.

Differential Diagnosis

  • Anal Fissure: Especially with painful defecation.
  • Hemorrhoids: Especially with a history of constipation or straining.
  • Diverticular Disease: Typically in older patients.
  • Colorectal Cancer: Particularly in older patients or those with a family history.
  • Inflammatory Bowel Disease: Especially if there’s chronic diarrhea.
  • Upper Gastrointestinal Bleeding: Dark, tarry stools, history of peptic ulcer disease.

Management

  • Conservative Treatment:
    • Diet: High-fiber diet, adequate hydration.
    • Over-the-counter topical treatments for hemorrhoids.
    • Warm baths for anal fissures.
  • Medication:
    • Stool softeners for constipation.
    • Topical anesthetics for fissures.
    • Anti-inflammatory medications for IBD.
  • Surgical Intervention:
    • For severe hemorrhoids, fissures not responding to conservative treatment.
    • For removal of polyps detected during colonoscopy.
    • For cancer treatment based on staging.
  • Follow-Up and Monitoring:
    • Regular monitoring for patients with IBD, polyps.
    • Post-surgical follow-up as needed.
  • Referral:
    • Gastroenterologist for endoscopic evaluation.
    • Colorectal surgeon for surgical assessment.
  • Patient Education:
    • Importance of follow-up, especially if polyps were removed.
    • Dietary advice and lifestyle modifications.

Conclusion

Rectal bleeding should always be evaluated to determine the underlying cause. The approach to diagnosis and management should be tailored to the individual’s age, medical history, and severity of symptoms. Early intervention can prevent complications and improve outcomes, particularly in cases like colorectal cancer where early detection is crucial.