Medically termed as hematochezia, rectal bleeding refers to the discharge of bright red blood from the anus, often combined with stools and/or blood clots. It usually develops quickly, and is commonly related to abdominal disorders. Although the blood discharge is usually from the rectum, in some cases, it can occur from other parts of the gastrointestinal tract. The bleeding is commonly observed in the form of black and tarry stools, maroon stools, bright red blood on or in the stool, blood on the toilet tissue, or pink staining of the toilet water. Mild or severe rectal bleeding in men can rapidly deplete a patient’s body of blood, hence resulting in symptoms like weakness, dizziness, nausea, fainting, low blood pressure, or orthostatic hypotension (a drop in blood pressure when going from the sitting or lying position to the standing position). It can be a mild or life-threatening matter, hence, needs immediate care and medical attention for proper diagnosis and treatment.
Anal Fissure: In this condition, the lining of the anal canal gets torn due to constipation or forceful bowel movements, which not only cause blood discharge but also severe pain while passing the stools.
Angiodysplasia: It is a vascular malformation in the gut, that causes gastrointestinal (GI) bleeding due to increased dilation of the blood vessels. It may cause anemia, if the bleeding is substantial. It occurs due to aging and degeneration of blood vessels.
Gastroenteritis: Also known as infectious diarrhea, it involves the infection of the GI tract by viruses like rotavirus, bacteria like Escherichia coli and Campylobacter , or other parasitic and non-parasitic microbial organisms. It causes diarrhea, vomiting, and stomach cramps. In case of sever infection, it also causes internal bleeding, which results in bloody stools.
Hemorrhoids (Piles): They are basically masses or clumps of tissues that enlarge due to chronic constipation or straining of the anus while passing hard or dry stools. This causes bleeding or anal discomfort. However, bleeding from hemorrhoids is usually moderate, and does not lead to anemia or low blood pressure.
Fistula: It is an unusual, burrowing channel that extends from the rectum to the skin around the anus. It usually drains a whitish discharge, but sometimes can also bleed. Fistula is normally related with the chronic inflammation of the intestinal tract, causing pain and bleeding while passing feces.
Diverticulosis: It is a condition in which the pockets or sacs called diverticula present in the colon project out. This projection of these sacs is mainly due to recurrent, high pressure spasms of the colon or weakness in the colon wall, which results in mild rectal bleeding.
Proctitis and Colitis The condition may occur due to inflammation or ulceration of the rectum, colon, or both. When the inflammation is restricted to the rectum, the condition is called proctitis, and if it spreads to the colon, it is known as colitis. Cramps, diarrhea, and rectal urgency are some other symptoms that accompany bleeding.
Polyps and Cancer: Polyps are the benign tumors of the large intestine, which when reach a large size, can start bleeding. Certain types of polyps develop into malignant tumors, and lead to colon or rectal cancer, that cause bright red bleeding, maroon colored stools, and sometime melena.
Rectal Prolapse: This condition usually occurs due to weakened rectal support tissues, and so is commonly seen in older people. The person can feel an abnormal bulging from the rectum while wiping, which may eventually cause rectal bleeding. It involves the projection of the rectum through the anus (rectum come out of the anus).
Anticoagulant Drugs: Drugs such as warfarin and aspirin, that are routinely recommended for managing several cardiovascular conditions, promote anti-coagulation. Prolonged usage of these drugs in a high dose, may incur chances of developing internal injuries, that lead to internal bleeding.
Sexually Transmitted Infections: Any sexual acts performed, that involve the anal area, carry a very high risk of infection. The insertion of any foreign object into the anal region not only causes physical injury to the tissue, but also provides a way for external pathogens to gain an entry into the body, which may later cause infections. These effects eventually lead to internal bleeding of the rectal tissues.
The type or severity of the bleeding can be determined by performing diagnostic tests, as given below:
Anoscopy: In this test, a plastic or metal scope is inserted into the anus which enables a quick examination of the rectal vault.
Flexible Sigmoidoscopy: The test is performed by inserting a flexible tube in to the rectum to examine the rectum and lower end of the colon.
Colonoscopy: A soft tube having a light and camera is inserted into the rectum and slowly forced into the colon. It provides an entire visualization of the colon, and helps to locate areas of bleeding, masses, or irregularities.
Barium Enema X-ray: This study uses liquid barium, which is inserted into the rectum, to highlight the infected area like tumors or diverticula.
Blood Tests: Blood samples are used to evaluate the degree of blood loss, the clotting ability of blood, and the possibility of infection.
Depending upon the source of bleeding, treatment varies from simple self care at home, antibiotics, blood transfusion or even a surgery. Correcting the low blood volume and anemia, diagnosing the cause and site of the bleeding, and ending active bleeding and preventing re-bleeding are the three main parameters that are taken into consideration while treating rectal bleeding. Normally mild bleeding can be cured without any need of hospitalization, by using over the counter rectal ointments and suppositories. For severe bleeding, the patient may need immediate hospitalization to stabilize the condition.
Exerting minimal strain on bowel movements, drinking 8 – 10 glasses of water daily, following a healthy diet containing lots of fiber-rich foods like whole grains, fresh fruits, and vegetables, and regular exercising will help the intestines work better and avoid internal bleeding.