Causes of Rectal Bleeding

Rectal bleeding (bleeding from the anus) is a common occurrence among gastrointestinal system bleedings. It is often identified by the presence of blood in the stool, and the underlying cause may vary. Below are the most common causes of rectal bleeding:

1.    Hemorrhoids
o    Caused by the dilation of veins in the anal region.
o    Bleeding is usually bright red and painless.

2.    Anal Fissures
o    Tears in the anal region caused by the passage of hard stool.
o    Bleeding is bright red and often accompanied by pain during defecation.

3.    Colorectal Polyps
o    Benign growths in the large intestine.
o    Bleeding often appears smeared on the stool and is frequently unnoticed.

4.    Colorectal Cancer
o    Results from the malignant transformation of polyps over time.
o    Bleeding may be mixed with stool or occult (hidden).

5.    Diverticular Disease
o    Small pouches (diverticula) in the intestine become inflamed or bleed.
o    It may cause sudden and painless heavy bleeding.

6.    Infectious Colitis and Inflammatory Bowel Diseases (IBD)
o    Conditions like Crohn’s disease and ulcerative colitis can lead to bleeding.
o    Blood is often mixed with mucus and stool.

7.    Angiodysplasia
o    Bleeding occurs due to abnormal blood vessel formations in the intestinal wall.
o    More common in elderly individuals.

8.    Trauma and Foreign Bodies
o    Injuries or foreign objects in the anal region may result in bleeding.

9.    Ischemic Colitis
o    Caused by reduced blood flow to the intestinal tissue.
o    Bleeding is often seen in elderly patients.

10.    Post-Hemorrhoid Surgery
•    Bleeding may occur during the healing phase in patients who have undergone hemorrhoidectomy.

Approach to a Patient with Rectal Bleeding

When rectal bleeding is detected, taking a thorough history and performing a physical examination are critical to diagnosing and planning treatment. The following steps should be followed:

1.    Taking the Patient’s History
o    Ask about the duration, amount, and characteristics of the bleeding.
o    Assess for additional symptoms such as pain, changes in stool color, weight loss, or fever.
o    Inquire about previous bowel diseases, family history, and medication use.

2.    Physical Examination
o    Inspect the anal region for hemorrhoids, fissures, or anal trauma.
o    Perform a digital rectal examination to feel for abnormal masses.

3.    Laboratory Tests
o    Perform a complete blood count to check for anemia, liver function tests, and a fecal occult blood test.
o    If infection is suspected, stool cultures may be recommended.

4.    Imaging and Endoscopic Tests
o    Colonoscopy is the gold standard for determining the cause of rectal bleeding.
o    In some cases, CT angiography or capsule endoscopy may be necessary.

5.    Evaluation of Emergency Situations
o    Rapid intervention is essential for severe, life-threatening bleeding.
o    Stabilize the patient’s hemodynamic status (blood pressure, pulse).

 

Importance of Colonoscopy

Colonoscopy is the most effective diagnostic tool for identifying the cause of rectal bleeding. Through this procedure, many conditions can be accurately diagnosed.

1.    Why is Colonoscopy Performed?
o    It is used to directly observe the source of bleeding and, if necessary, take a biopsy.
o    Effective in diagnosing polyps, cancer, or inflammatory bowel diseases.

2.    Preparation Before Colonoscopy
o    The patient’s bowel must be completely cleaned.
o    Follow the prescribed laxatives and dietary recommendations provided by the doctor.

3.    What to Expect During and After Colonoscopy
o    The procedure is usually performed under sedation and is painless.
o    The patient can typically be discharged a few hours after the procedure.
o    The cause of bleeding can be identified, and appropriate treatment initiated.

4.    Detection of Hidden Bleeding
o    Colonoscopy plays a vital role in identifying low-level, unseen bleeding

 

Treatment of Rectal Bleeding

The treatment of rectal bleeding begins with identifying the underlying cause. Once determined, the treatment plan is tailored to address the specific cause.
Prevention of Rectal Bleeding and Lifestyle Recommendations
1.    High-Fiber Diet: Consuming foods rich in fiber softens stools and prevents constipation.
2.    Adequate Hydration: Drinking plenty of water aids digestion and regulates bowel movements.
3.    Exercise: Regular physical activity supports intestinal health.
4.    Stress Management: Reducing stress is crucial, especially for preventing flare-ups of inflammatory bowel diseases.
5.    Regular Check-Ups: Periodic screenings are essential, particularly for individuals with a family history of bowel diseases.

 

Conclusion

Rectal bleeding encompasses a wide range of causes, from mild conditions to serious health issues. Therefore, seeking medical attention as soon as symptoms are noticed is critical. Modern diagnostic tools like colonoscopy play a crucial role in quickly identifying the cause and devising an effective treatment plan.
Remember, adopting a healthy lifestyle and undergoing regular health check-ups are the most effective ways to minimize the risk of rectal bleeding.