What are the main causes of diverticular bleeding. How is diverticular bleeding diagnosed. What are the most effective treatment options for diverticular bleeding. Can diverticular bleeding be prevented through lifestyle changes.

Understanding Diverticular Bleeding: An Overview

Diverticular bleeding occurs when pouches (diverticula) that have developed in the wall of the large intestine (colon) bleed. This condition is associated with diverticulosis, which is characterized by the presence of these pouches. Diverticular bleeding typically results in a substantial amount of blood appearing in the stool, often requiring immediate medical attention.

The Underlying Causes of Diverticular Bleeding

The exact cause of diverticular bleeding is not fully understood, but several factors contribute to its development:

• High pressure inside the colon pushing against weak spots in the colon wall
• Low-fiber diet leading to increased pressure and prolonged stool transit time
• Weakening of blood vessels passing through the muscle layer of the bowel wall
• Rupture of blood vessels supplying the diverticula

Are certain individuals more prone to developing diverticular bleeding? While anyone with diverticulosis can experience bleeding, some factors may increase the risk:

• Advanced age
• Regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Chronic constipation
• Obesity
• Sedentary lifestyle

Recognizing the Symptoms of Diverticular Bleeding

The primary symptom of diverticular bleeding is sudden, severe bleeding from the rectum. This bleeding is often characterized by:

• Dark red or bright red blood in the stool
• Passage of blood clots
• Absence of abdominal pain in most cases

How quickly does diverticular bleeding typically occur? In most instances, the onset is rapid and can be quite alarming for the individual experiencing it. The amount of blood loss can vary, but it’s often significant enough to warrant immediate medical attention.

Diagnostic Approaches for Diverticular Bleeding

Diagnosing diverticular bleeding involves ruling out other potential causes of rectal bleeding. The diagnostic process typically includes:

1. Medical history and physical examination
2. Blood tests to assess hemoglobin levels and coagulation factors
3. Imaging studies such as angiography or computed tomography (CT) scans
4. Colonoscopy to directly visualize the colon and identify the source of bleeding
5. Technetium-labeled red blood cell bleeding scan to locate persistent bleeding sources

Why is colonoscopy considered one of the most useful tests for diagnosing diverticular bleeding? Colonoscopy allows for direct visualization of the entire colon, enabling physicians to identify the specific location of bleeding diverticula and potentially treat them during the same procedure.

Treatment Options for Diverticular Bleeding

The treatment of diverticular bleeding depends on the severity of the condition and may include:

• Observation and monitoring for cases of self-limiting bleeding
• Intravenous fluid administration to maintain hydration
• Blood transfusions to replace lost blood and stabilize hemodynamics
• Endoscopic interventions to stop active bleeding
• Angiographic embolization for persistent bleeding
• Surgical resection of the affected colon segment in severe or recurrent cases

What factors determine the choice of treatment for diverticular bleeding? The decision depends on the rate and volume of bleeding, the patient’s overall health status, and the effectiveness of conservative measures. In many cases, bleeding stops spontaneously, but more aggressive interventions may be necessary for persistent or life-threatening hemorrhage.

Preventing Diverticular Bleeding: Lifestyle Modifications

While preventing the formation of diverticula entirely may not be possible, certain lifestyle changes can potentially reduce the risk of diverticular bleeding:

• Adopting a high-fiber diet rich in fruits, vegetables, and whole grains
• Ensuring adequate fluid intake to promote healthy bowel function
• Engaging in regular physical exercise to support overall digestive health
• Maintaining a healthy body weight
• Limiting the use of aspirin and NSAIDs, especially in individuals with known diverticulosis

How effective are these preventive measures in reducing the incidence of diverticular bleeding? While these lifestyle modifications may help in preventing the formation of new diverticula and promoting overall colon health, their direct impact on preventing bleeding in existing diverticulosis is less clear. However, they are generally recommended as part of a comprehensive approach to digestive health.

Long-term Management and Follow-up Care

After an episode of diverticular bleeding, ongoing management and follow-up care are essential. This may involve:

1. Regular colonoscopies to monitor for recurrence or new diverticula formation
2. Dietary counseling to optimize fiber intake and overall nutrition
3. Medication adjustments, particularly regarding the use of blood thinners or NSAIDs
4. Monitoring for signs of anemia or other complications related to blood loss
5. Education on recognizing early symptoms of recurrent bleeding

What is the typical follow-up schedule for patients who have experienced diverticular bleeding? The frequency of follow-up visits and colonoscopies can vary based on individual risk factors and the severity of the initial bleeding episode. Generally, a colonoscopy is recommended within 6-12 months after the acute bleeding event, with subsequent screenings determined by the findings and the patient’s overall health status.

Emerging Research and Future Directions in Diverticular Disease Management

Ongoing research in the field of diverticular disease is exploring new avenues for prevention, diagnosis, and treatment of diverticular bleeding. Some areas of focus include:

• Genetic factors contributing to diverticulosis and bleeding risk
• Novel endoscopic techniques for more precise localization and treatment of bleeding diverticula
• The role of the gut microbiome in diverticular disease progression
• Potential pharmacological interventions to reduce diverticular formation or bleeding risk
• Advanced imaging modalities for non-invasive detection of diverticular complications

How might these research directions impact the future management of diverticular bleeding? As our understanding of the underlying mechanisms of diverticular disease improves, we may see more targeted preventive strategies, refined diagnostic tools, and personalized treatment approaches tailored to individual patient profiles and risk factors.

The Impact of Diverticular Bleeding on Quality of Life

Experiencing an episode of diverticular bleeding can have significant psychological and social impacts on patients. Some common concerns include:

• Anxiety about recurrence of bleeding
• Dietary restrictions and lifestyle changes
• Fear of engaging in certain activities or travel
• Impact on work and social relationships
• Long-term health implications and potential complications

How can healthcare providers address the psychosocial aspects of diverticular bleeding? A comprehensive care approach should include patient education, psychological support, and strategies for coping with the uncertainty associated with the condition. Support groups and patient resources can also play a valuable role in helping individuals manage the emotional and practical challenges of living with diverticular disease.

The Role of Minimally Invasive Techniques in Managing Diverticular Bleeding

Advancements in medical technology have led to the development of minimally invasive techniques for managing diverticular bleeding. These approaches offer several advantages:

• Reduced recovery time compared to traditional open surgery
• Lower risk of post-operative complications
• Shorter hospital stays
• Improved cosmetic outcomes
• Potential for same-day diagnosis and treatment

What are some examples of minimally invasive techniques used in diverticular bleeding management? Endoscopic clipping, band ligation, and thermal coagulation are among the techniques that can be employed during colonoscopy to stop active bleeding. For cases requiring surgical intervention, laparoscopic approaches have become increasingly common, offering the benefits of minimally invasive surgery while effectively addressing the underlying cause of bleeding.

Nutritional Considerations in Diverticular Disease

Proper nutrition plays a crucial role in managing diverticular disease and potentially reducing the risk of complications such as bleeding. Key dietary considerations include:

1. Gradually increasing fiber intake to promote regular bowel movements
2. Staying well-hydrated to support optimal digestive function
3. Incorporating probiotics to maintain a healthy gut microbiome
4. Avoiding excessive consumption of red meat, which has been associated with increased diverticulitis risk
5. Limiting alcohol intake, as it may exacerbate digestive issues

How should patients approach dietary changes after experiencing diverticular bleeding? It’s essential to work closely with a healthcare provider or registered dietitian to develop a personalized nutrition plan. Gradual changes are often recommended to allow the digestive system to adapt and to identify any specific food sensitivities that may contribute to symptoms or complications.

The Importance of Patient Education in Diverticular Bleeding Management

Effective patient education is crucial for managing diverticular bleeding and preventing future episodes. Key areas of focus include:

• Understanding the signs and symptoms of diverticular bleeding
• Recognizing when to seek immediate medical attention
• Implementing and maintaining dietary and lifestyle modifications
• Proper medication management, including awareness of potential interactions
• Adherence to follow-up care and screening recommendations

What strategies can healthcare providers use to enhance patient education in diverticular disease management? Multi-modal approaches, including written materials, video resources, and interactive counseling sessions, can help reinforce key information. Additionally, involving family members or caregivers in the education process can provide valuable support and improve overall adherence to management plans.

Diverticular Bleeding | Cigna

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Diverticular Bleeding

1. Diverticula

Condition Basics

What is diverticular bleeding?

Diverticular bleeding occurs when pouches (diverticula) that have developed in the wall of the large intestine (colon) bleed. If you have these pouches, you have a condition called diverticulosis. Diverticular bleeding causes a large amount of blood to appear in your stool.

What causes it?

The reason pouches (diverticula) form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall.

Normally, a diet with enough fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure.

Pouches may form when the high pressure pushes against weak spots in the colon. Weak spots are where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall.

Bleeding occurs when the blood vessel going to the pouch breaks open.

What are the symptoms?

Diverticular bleeding usually causes sudden, severe bleeding from the rectum. The blood may be dark red or bright red clots. In most cases there is no abdominal (belly) pain.

How is it diagnosed?

Diverticular bleeding is diagnosed by ruling out other causes of the bleeding. Your doctor will do a medical history and physical exam, along with some tests. Imaging tests such as angiography (also known as arteriography) may be done to find the location of persistent bleeding. Colonoscopy—the inspection of the entire large intestine (colon) using a long, flexible, lighted viewing scope (colonoscope)—is thought to be one of the most useful tests for finding the source of bleeding in the lower intestines.

Your doctor might do a test called a technetium-labeled red blood cell bleeding scan to look for the source of bleeding. In this test, some blood is taken from you, and a small amount of radioactive material called technetium is added to the blood. The blood containing the technetium is then injected back into your bloodstream and traced to the source of bleeding.

How is diverticular bleeding treated?

Bleeding from diverticula often will stop on its own. If it doesn’t, treatment may be needed to stop it and to replace lost blood, and you may need to be hospitalized. Treatment may include intravenous fluids, blood transfusions, injection of medicines, and in some cases surgery to remove the diseased part of the colon.

How can you prevent it?

Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent the formation of diverticula. But if you already have diverticulosis, diet may not help prevent bleeding.

You may have a higher risk of diverticular bleeding if you take aspirin regularly (more than 4 days a week).^{footnote 1}

References

References

Citations

1. Strate LL, et al. (2011). Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology, 140(5): 1427–1433.

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Diverticular Bleeding: Symptoms, Diagnosis, and Treatment

Diverticulitis can cause rectal bleeding. In fact, diverticular bleeding is the most frequent cause of lower gastrointestinal bleeding.

Diverticulitis is a condition where small sacs that have bulged in your intestine (diverticula) become inflamed.

People who have diverticulitis often have no symptoms, but sometimes complications are possible. One common complication is rectal bleeding. The bleeding can range from mild to severe.

Let’s take a look at what diverticular bleeding looks like, how long it typically lasts, how it’s treated, and what the outlook is for people who experience it.

Diverticulitis is more likely to affect people as they get older. About half of all people over the age of 60 have it. While most people with diverticulitis don’t have symptoms, others experience symptoms such as:

• bloating
• stomach cramps
• one-sided abdominal pain
• bleeding

Diverticular bleeding leads to almost 200,000 hospital admissions in the United States per year and is the most frequent cause of lower gastrointestinal bleeding. Fewer than 5% of people with diverticulosis will experience diverticular bleeding.

When diverticular sacs bleed, the bleeding can range from mild to severe. Some people notice a little fresh blood mixed in with their stool when they use the toilet. But other people might notice large blood clots that get passed during particularly challenging diverticulitis episodes.

The majority of diverticular bleeding cases are mild and resolve on their own without treatment. However, about 10% to 20% of people will experience diverticular hemorrhaging, where large amounts of blood are lost.

Diverticular hemorrhaging may become serious, resulting in severe symptoms such as blood loss and dehydration. In very rare cases, fatalities can result.

Anytime you are experiencing rectal bleeding — whether you’ve been diagnosed with diverticulitis or not — you should see a healthcare professional promptly.

In order to diagnose diverticular bleeding, your healthcare professional will take your medical history and do a physical exam to try to identify the source of your bleeding. You may be asked questions about what your bleeding has been like, how long it’s gone on, and whether any pain is involved. You may also be asked questions about changes in bowel movements and how your overall health has been.

Your physician will likely:

• take your vital signs and blood pressure
• listen to your heart
• palpate your abdomen
• perform a rectal exam
• order lab tests that might include blood work to measure complete blood count, liver function, and kidney function
• perform or order imaging tests that may include CAT scan or barium X-rays
• perform or order an endoscopy, such as a colonoscopy or sigmoidoscopy

If you’re hospitalized for rectal bleeding, you are likely to have a diagnostic colonoscopy, especially if you haven’t had a good quality colonoscopy recently.

Some people are more likely to experience diverticular bleeding than others, including:

• elderly people
• people with vascular diseases
• people with diabetes
• people who use nonsteroidal anti-inflammatory drugs (NSAIDs) frequently
• people who use calcium channel blockers, anticoagulants, or antithrombotics

The vast majority of people, up to 80%, will experience a spontaneous resolution of their bleeding. Some people will experience rebleeding at some point in the future. Between 22% and 38% of people will have episodes of rebleeding. Individuals 80 years old or older are more likely to experience rebleeding.

If bleeding can’t be managed at home or is severe, you might need hospital care, which could involve IV fluids or blood transfusions. Sometimes minimally invasive techniques such as angiography will be used. At other times, surgery will be necessary.

For most people with severe rectal bleeding, it can be resolved with these interventions. Deaths are rare but possible.

If you have rectal bleeding, it’s vital that you get a formal diagnosis to rule out any other potential causes. Besides diverticulitis, other causes of lower gastrointestinal bleeding can include:

• hemorrhoids
• post-polypectomy bleeding
• angiodysplasia
• inflammatory bowel disease (IBD)
• colitis
• proctitis
• colon cancer

What is the main cause of diverticulitis?

Most physicians believe that the main cause of diverticulitis is eating a low fiber diet, which can cause constipation. Pressure from stool that doesn’t pass, as well as straining during bowel movements, can trigger the condition.

What color is the blood from diverticular bleeding?

In most cases, blood from diverticular bleeding is red or maroon. Dark clots are possible, and the blood may be mixed with stool.

What kind of doctor should I see for diverticular bleeding?

You can visit your primary care doctor if you have rectal bleeding, but it’s likely that they will refer you to a specialist. In most cases, you will be referred to a gastroenterologist, a physician who specializes in gastrointestinal conditions.

Experiencing rectal bleeding can be distressing. If you have diverticulitis, you might wonder whether the bleeding you’re experiencing is from that. If you’ve never been diagnosed with diverticulitis, you might also be wondering whether that’s the cause of your bleeding.

Either way, anytime you are experiencing new rectal bleeding, it’s important to visit your doctor so that the cause can be correctly identified and you can receive the treatment you need.

Symptom: blood in stool | Articles by doctors of the EMC clinic about diseases, diagnosis and treatment

Surgical Clinic

Moscow, st. Shchepkina, 35

Moscow, Orlovsky pereulok, 7

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December 25, 2015

Ekaterina Borodina

Coloproctologist

Blood in the stool is a common symptom. The quantity and quality of blood can be different, which, in turn, indicates different diseases.

Blood marks on toilet paper after defecation . This may indicate the presence of small defects in the perianal skin associated with inflammation of the skin in this area (perianal dermatitis). The causes of this disease can be: a violation of the intestinal flora, a violation of the flora of the vagina or a local (perianal) infection that “came” from the outside (public baths, saunas, swimming pools, etc. ) a study in the form of a smear or sowing from the skin in the anus (funnel).

1. The most common cause of bleeding from the anal canal is hemorrhoids. With this disease, blood discharge most often occurs at the end of a bowel movement, and in a “neglected case” it can be outside of it (during urination, coughing, sneezing, active movements during the day). The amount of blood can be different – blots on toilet paper, “drops” on underwear, sometimes blood discharge can even be a “stream”. The blood is most often bright, scarlet in color, without clots and not mixed with feces (on them or even without them). There is a whole range of reasons for the development of bleeding hemorrhoids and many factors that cause an exacerbation of this disease. Most often, the cause is prolonged, chronic constipation, prolonged sitting on the toilet, heavy physical exertion (including sports), pregnancy, etc. An unhealthy diet (abuse of spicy, spices, alcohol), frequent visits to saunas or baths, frequent flights, etc. The diagnosis is most often made at the initial appointment after a detailed history (complaints of the patient and the history of the development of his disease) and examination. It is worth noting that in the diagnosis of this disease, not only a digital examination is often used, but also an examination with an anoscope (rectal mirror) or sigmoidoscopy (the study is carried out by a proctologist, but if this study is necessary, a little preparation is needed and the doctor will warn about the time of the study in another day).
2. In 50-70% of cases, bleeding can occur when anal fissures appear (both with the appearance of acute mucosal defects and with exacerbation of chronic ones). The intensity of blood discharge during anal fissures also varies: from blood blots on toilet paper to drops in the toilet bowl. With this disease, the blood will also be a bright scarlet color, without clots and not mixed with feces, it may look like a strip on feces.
3. Blood discharge also accompanies such diseases as ulcerative colitis and other colitis, radiation and other proctitis, Crohn’s disease, diverticula, endometriosis, prolapse, rectal intussusception, etc.
4. The most terrible disease in which blood appears in the feces is oncological lesions of the large intestine (including cancer of the anal canal and rectal cancer). Blood discharge can begin in small portions and resemble blood discharge during hemorrhoids, this is very dangerous, because. oncoprocess can develop almost asymptomatically in the initial stages and manifest itself only by the release of blood. In this case, the blood can be both scarlet and dark, with clots and mucus.

If you notice the appearance of blood after or during a bowel movement, you should consult a proctologist. EMC provides a full range of diagnostic, conservative and surgical care for coloproctological diseases of any severity.

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Surgical Clinic

Moscow, st. Shchepkina, 35

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Where does blood come from in the stool and what to do with it

Likbez

Health

September 10, 2022

Most likely, you won’t have to run to the doctor on the same day. But the bleeding cannot be ignored either.

How to tell if there is blood in the stool

Blood in the stool is also known as rectal bleeding. Various signs can speak about it:

• blood on toilet paper;
• bloody streaks or inclusions in feces;
• toilet water dyed pink or red after a bowel movement;
• dark red, black, tarry stool.

The blood will not necessarily look the same (although it often does). In order to digest food, that is, to turn it from something large and complex in structure into small molecules, there are different chemicals throughout the gastrointestinal tract. The farther the bleeding is from the anus, the more of these substances will react with the blood, so you can see:

• bright red blood if the rectum or lower colon is damaged;
• dark red or maroon blood if the overlying sections are thick or thin;
• dark and tarry stools, or melena if there is blood in the stomach. This black color is obtained by the interaction of hemoglobin with acidic gastric juice.

It happens that there is so little blood that it cannot be detected by eye. It is possible only with the help of a fecal occult blood test.

What symptoms require an ambulance

Some rectal bleeding can lead to shock: the blood volume in the vessels drops, it is no longer enough for all organs, the body’s response begins, which in the end can cost a person life. Therefore, call an ambulance if there is blood in the stool, and also:

• pressure has dropped sharply;
• heart beats very fast;
• unable to urinate;
• consciousness is disturbed.

Why there can be blood or something similar in the stool

Sometimes diseases are to blame, and sometimes it is not blood at all.

Use of certain foods or drugs

Sometimes, after examination, it turns out that the color of the feces has changed not from blood, but from foods eaten the day before, such as beets, berries, dark leafy vegetables such as black basil, licorice and others. Also blood-like are red food colorings and drugs that turn black stools, such as:

• iron preparations;
• bismuth compounds for treating ulcers;
• activated carbon and others.

Hemorrhoids

With hemorrhoids, the veins in the lower part of the rectum dilate, as with varicose veins. Because of this, they become more sensitive and easily damaged if you push or use paper. Therefore, they often bleed. There is usually no pain, but the person notices blood on the paper or in the toilet.

Anal fissure

An anal fissure is a tear in the mucous membrane of the wall of the anus. In addition to bleeding, there is usually burning pain during or after a bowel movement.

Inflammatory bowel disease

These include Crohn’s disease and ulcerative colitis. Due to chronic inflammation, erosions and ulcers appear on the intestinal wall, which can bleed.

Peptic ulcer

At the bottom of a gastric or duodenal ulcer there can be quite large vessels, which, when ruptured, open heavy bleeding. The very surface of the ulcers is also easily damaged and can bleed during an exacerbation of the disease.

Diverticula

Diverticula that look like sacs can form in weakened and thinned areas of the intestinal wall. If such a bag is damaged, it will begin to bleed. And if it becomes inflamed, then diverticulitis will develop – an acute inflammation resembling appendicitis.

Intestinal polyps

Polyps are benign tumors in the intestine. If they are damaged, they cause bleeding. They can be of different sizes, but large ones often turn into cancer, so they require more attention and control.

Cancer of the colon or rectum

Sometimes people ignore bleeding for years, thinking it’s hemorrhoids. But it turns out to be colorectal cancer – a malignant tumor in the intestines. The later it is detected, the more difficult it is to treat, so if you have any signs of bleeding, you should consult a doctor. And for some people, it is desirable to do screening tests, for example, for occult blood. This applies to those who:

• are over 40-50 years old;
• suffering from inflammatory bowel disease such as Crohn’s disease or ulcerative colitis;
• has relatives with colon polyps or cancer or has experienced these conditions in the past;
• suffers from familial intestinal polyposis;
• smokes;
• is overweight;
• leads a sedentary lifestyle;
• consumes alcohol, low fiber and high fat.

What to do if there seems to be blood in the stool

Most people with rectal bleeding do not have colon cancer or other serious conditions. But in any case, this is an abnormal situation, and it requires examination.

First you need to see a therapist. He will examine and decide who to go to next – to the surgeon, if it’s a fissure or hemorrhoids, or to a gastroenterologist, if there are suspicions of inflammatory diseases or an ulcer. To make a diagnosis, you may need:

• rectal digital examination of the anus and rectum;
• colonoscopy or sigmoidoscopy, that is, examination of the entire large intestine or part of it;
• gastroscopy – examination of the esophagus, stomach and duodenum;
• fecal occult blood test.