Can you ignore rectal bleeding? Yes you can, but at a huge personal risk. Not
every case of rectal bleeding is from a pile (hemorrhoid) that will settle. (And
in fact, most do not.)
A very good friend of mine had a scare a few weeks back with
some rectal bleeding, but fortunately the cause was found with a colonoscopy,
the condition was amenable to surgery and he is now over it. But it could have
been the other way round. Never ignore rectal bleeding.
The rectum is the last portion of the large bowel that ends
just before the anus. Bleeding from this area can herald a sign of a mild or
life-threatening importance, which is why all episodes of rectal bleeding must
be investigated.
Depending upon how high up in the gastro-intestinal tract is
the cause of the bleeding, it may be seen as black, tarry stools, maroon stools;
bright red blood on or in the stool, blood on the toilet tissue, or blood
staining the water in the toilet bowl bright red. Treatment can range from
relief of symptoms and let Mother Nature do the rest, to antibiotics, blood
transfusion, or even surgery. It all depends on the cause.
There are many potential causes, including Hemorrhoids
(piles) which are swollen rectal veins in the anal and rectal area. They can
cause burning, painful discomfort, as well as bleeding. External hemorrhoids are
small swellings that are easy to see and quite painful; however, internal
hemorrhoids are usually painless. A feeling of incomplete emptying may be noted
with bowel movements. Treatment focuses on relieving these symptoms with the use
of stool bulking agents and softeners, and if necessary, removal of the bleeding
piles.
Rectal fissure is another. This is a tear in the lining of
the rectum caused by the passage of hard stools, which can lead to mild rectal
bleeding of bright red blood. Exposed nerves and vessels result in moderate to
severe pain.
Diverticulosis, those little pockets on the bowel wall, can
also bleed. The stools are dark red or maroon. Pain is usually absent but
surgery is required in up to 25 percent of these patients.
Bloody diarrhea is often seen in Bacterial dysentery, which
we have all had to a greater or lesser degree. Responsible organisms include
Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and Clostridium
difficile. A most unsavory bunch! The treatment depends upon the organism, but
generally intravenous fluid replacement and an anti-spasmodic and broad spectrum
antibiotic will bring this under control.
Another common cause of rectal bleeding is Inflammatory bowel
disease especially in young adults - typically those younger than 50 years of
age. Bleeding occurs in small to moderate amounts of bright red blood in the
rectum, usually mixed in with stool and mucus. Associated symptoms include fever
and abdominal cramps. This condition generally settles with steroids.
Of course, the one that everyone worries about is bowel
cancer. We lump these together under the general heading of Tumors and Polyps.
Polyps bulge out from the lining of the colon. Bleeding occurs when large polyps
develop. They can be hereditary, and are usually harmless, but some types can be
pre-cancerous.
Both benign and malignant tumors are frequently found in the
colon and rectum. Those people older than 50 years are most affected; however,
tumors can be found in younger people. It should also be noted that less than 20
percent of people with tumor or polyps will have rectal bleeding. However, when
bleeding does occur, it is usually slow, chronic, and minimal. Diagnosis
requires careful evaluation with colonoscopy.
Rectal bleeding from a traumatic cause is always a critical
concern. Rectal damage from a gunshot wound or foreign body insertion can result
in extensive infection or rapid and fatal blood loss.
And yes, there’s more! A common source of bleeding is
hemorrhage from the stomach or duodenum. This can occur after someone has
swallowed a foreign body that causes injury to the stomach lining or bleeding
stomach ulcers.
The list does go on, but these conditions are rare; however,
the message is that rectal bleeding must always be investigated. Never ignore
rectal bleeding!
