Rectal Bleeding (Blood in Stool): Causes, When to Worry & Treatment

What Is Rectal Bleeding?

Rectal bleeding means that blood comes out from your rectum or anus and is seen in your stool (poop). Rectal bleeding can be a result of hemorrhoids, fissures, or other GI causes. Almost 13 to 20% adutls have complications related to rectal bleeding.

It may be just a few drops of blood, or sometimes it may appear as if your stool is streaked with blood. The color of the blood can tell a lot about where it comes from.

What Are the Causes of Rectal Bleeding?

There are numerous reasons for rectal bleeding, and they can be anything from harmless to life-threatening. Some of the most frequent are:

• Hemorrhoids (Piles): They are inflamed veins in or near the anus and rectum. Hemorrhoids are frequently caused by constipation, straining, long sitting on the toilet, or pregnancy. They can lead to:
  • Bright red blood while or after having a bowel movement.
  • Itching, tenderness, or swelling in or around the anus.
  • Blood on the toilet tissue or oozing into the toilet.
• Anal Fissure: It is a small tear or crack in the anal skin. Anal fissures are usual for individuals who have hard stools or constipation. It typically results in:
  • Sharp pain on having a stool.
  • A few drops of bright red blood.
• Colon Polyps: These are small growths within the colon (large intestine).
  • Most polyps are benign initially.
  • But some have the potential to become cancerous if left undiagnosed early.
  • Polyps can bleed slowly, and so blood may not be present unless detected through a test.
• Diverticulosis: These are small pouches or bulges that occur in the colon wall..
• Inflammatory Bowel Disease (IBD): Ulcerative colitis (inflammation and ulcers in the inner lining of the colon and rectum) and Crohn's disease are conditions that cause inflammation and sores within the intestines. Symptoms include:
  • Bloody stool.
  • Stomach pain and cramps.
  • Weight loss and tiredness.
• Colorectal Cancer: Though it could be frightening, we need to know about this possibility. Colorectal cancer is one of the most dangerous causes and often presents as painless bleeding in the rectum.
• Infections: Some bacteria, viruses, or parasites can inflame the intestines, causing:
  • Diarrhea containing blood.
  • Fever.
  • Stomach cramps.
• Peptic Ulcers or Gastritis: These are stomach or upper intestinal ulcers.
  • They produce black or dark stool (so-called tarry stool).
  • Often it results from infection or chronic use of pain medications.
• Anal Injury: Small anus injuries, due to scratching, wiping too hard, or inserting objects, may lead to minor bleeding.
• Angiodysplasia (Vascular Ectasia): It is a cause of rectal bleeding in older individuals. Dilated and fragile blood vessels often cause this kind of bleeding.
• Meckel's Diverticulum: In children and newborns, this often causes rectal bleeding. It is seen in 2% population. The presence of a pouch in the small intestine, this causes bleeding.
• Sexually Transmitted Diseases: Viral and bacterial infections like HPV infection, gonorrhea, and chlamydia are often related to rectal diseases.
• Medicines: Some medications, such as Aspirin, Ibuprofen, or blood thinners, can contribute to bleeding hazards.

In children and infants, the most common causes of rectal bleeding are Meckel's diverticulum, juvenile polyps, and anal fissure. In young adults, hemorrhoids, anal fissures, IBD, infectious colitis, and STIs can cause rectal bleeding.

What Are the Symptoms Associated With Rectal Bleeding?

In mid-aged adults, issues like hemorrhoids, polyps, and diverticulosis can lead to rectal cancer. In elderly persons, diverticulosis, angiodysplasia, colorectal cancer, and ischemic colitis lead to rectal bleeding.

The assessment of the type of blood coming from the rectum is essential. Based on that, your bleeding can be the following types;

• Bright red blood (Hematochezia) or red blood streaks in the stool usually indicate the bleeding is from the lower portion of the intestine, such as the rectum or anus.

• Dark red (Melena) or black stool can indicate the bleeding is from the upper GI (gastrointestinal tract), such as the small intestine or stomach.

• Sometimes blood is only detectable under a microscope. It is called occult blood.

Rectal bleeding can occur alone or with other symptoms of rectal bleeding, depending on the reason. You may experience:

• Painful bowel movements..

• Mucus or pus is present in the stool.

• Abdominal pain or cramps.

• Weakness or dizziness if you lose blood.

• Tiredness and pale skin (from anemia).

• Alterations in bowel habits, such as constipation or diarrhea.

Even if you do not have pain with your rectal bleeding, you should get checked because dangerous causes such as colon polyps or cancer do not always hurt.

How Is Rectal Bleeding Diagnosed?

Your doctor will begin by questioning you and performing a few tests to determine the reason for blood in your stool.

Medical History and Physical Examination:

• The physician asks about your symptoms, your diet, family history, nature of bleeding, timing of bleeding, and your bowel movements.

• They can do a digital rectal exam by inserting a gloved finger gently to check for swelling or lumps.

Blood Tests:

• A complete blood count (CBC) tests for anemia (low red blood cells).

Stool tests: FIT (Fecal Immunochemical Test) and FOBT (guaiac-based fecal occult blood test) is done test for hidden (occult) blood, infection, or parasites. Also, stool calprotectin and stool lactoferrin can be used to detect gut inflammation.

Colonoscopy: It helps in detecting polyps, inflammation, or cancer.

Sigmoidoscopy: Less invasive than a colonoscopy, but it examines only the lower colon.

CT (computed tomography) scan or MRI (magnetic resonance imaging): These imaging tests help in the detection of tumors, bleeding, or inflammation in the abdomen.

Endoscopy: If bleeding originates from the stomach or upper intestines, the physician examines the digestive tract (upper part) by using an endoscope or through capsule endoscopy.

How Is Rectal Bleeding Treated?

Treatment for rectal bleeding depends on what is causing it. The aim is to stop bleeding, reduce symptoms, and prevent its relapse. Some of the treatments include:

• In case of hemorrhoids, consume a balanced meal. Eat high-fiber foods like fruits, vegetables, and whole grains, and drink a lot of water. Do not strain. Avoid sitting on the toilet for a long time. Use creams or suppositories as directed by the physician. In severe cases, treatment by a laser or surgery may be necessary.

• Warm baths (sitz baths) and stool softeners are very effective. Also, you have to drink enough water to prevent constipation.

• Colon polyps are typically removed through colonoscopy to prevent bleeding and reduce the risk of colon cancer.

• In diverticulosis, mild cases are managed with rest and dietary modifications. If infection or severe bleeding occurs, hospital care and antibiotics may be necessary.

• Inflammatory bowel disease (IBD) is treated using anti-inflammatory drugs, steroids, or immunomodulating medications. Physicians may also recommend a specific diet to help manage symptoms.

• Ulcers or gastritis are managed with medications that decrease stomach acid and protect the stomach lining.

• Infections are treated with antibiotics or antiparasitic medications once the cause has been identified.

• If medications are causing bleeding, your physician may adjust the dosage. It is better to switch to an alternative drug.

How Can I Prevent Rectal Bleeding?

Here are some easy and healthy tips to avoid rectal bleeding:

• Have a high-fiber diet. Fruits, vegetables, oats, and whole grains soften stools and help avoid constipation.

• Drink enough glasses of water every day.

• Exercise exercise prevent constipation and promot digetion.

• Do not strain while passing stools.

• Drink minimal caffeine and alcohol, as they can cause drying up stool.

• Don’t suppress your bowel movment; doing so will lead to constipation.

• Undergo routine check-ups by a doctor, particularly if you have a history of colon cancer or polyps in your family.

• If you are over 45 and have rectal bleeding, please consult a doctor for rectal cancer screening.

When to Consult a Doctor?

If you have the following symptoms, you must consult a doctor.

1. Presence of bleeding in stool for more than 2 weeks.

2. A change in the bowel habit for more than 6 weeks.

3. Redish or black terry stool.

4. Continuous pain in the abdomen.

5. Sudden weight loss.

Conclusion

If there is blood in your stool, it may be due to rectal bleeding. Rectal bleeding can be caused by several factors. Based on your symptoms, the nature of bleeding, and age, doctors try to evaluate the cause of your rectal bleeding. Modern diagnostic tests are useful to determine the exact cause of bleeding. If you have any queries regarding rectal bleeding, you can consult a medical gastroenterologist for evaluation.

Key Takeaways

• Blood coming out from the anus or rectum is known as rectal bleeding, and it is seen in almost among 20% adult population.

• The usual suspects are hemorrhoids, anal fissures, colon polyps, infection, or colon cancer.

• Blood color (bright red or black) is an indicator of the origin.

• Symptoms of rectal bleeding may be bloody stool, abdominal discomfort, and fatigue.

• Eat food with enogh fiber, and drink enough water for prevention.