What are the common causes of rectal bleeding. How can you identify the symptoms of rectal bleeding. What are the most effective treatment options for rectal bleeding. When should you seek medical attention for rectal bleeding. How can you prevent rectal bleeding from occurring.

Understanding Rectal Bleeding: An Overview

Rectal bleeding, also known as hematochezia, is a condition that can range from mild to potentially life-threatening. It occurs when blood is passed through the rectum, often appearing in the stool or on toilet paper after wiping. While the rectum is located between the last portion of the bowel and the anus, rectal bleeding can originate from various parts of the gastrointestinal tract, not just the rectum itself.

The severity of rectal bleeding can vary significantly, and it’s crucial to understand the underlying causes and associated symptoms to determine when medical attention is necessary. In some cases, rectal bleeding may be a sign of a more serious condition that requires immediate medical intervention.

Common Causes of Rectal Bleeding

Rectal bleeding can be attributed to various factors, ranging from minor issues to more severe conditions. Some of the most common causes include:

• Hemorrhoids
• Anal fissures
• Diverticulosis
• Inflammatory bowel disease (IBD)
• Colorectal polyps or tumors
• Infections
• Ischemic colitis

Hemorrhoids: A Leading Cause of Rectal Bleeding

Hemorrhoids are swollen blood vessels in the rectum or anus and are one of the most common causes of rectal bleeding. They can be internal or external, with external hemorrhoids often causing anal itching. While usually painless, inflamed or swollen hemorrhoids can lead to discomfort and bleeding, especially during bowel movements.

How do hemorrhoids develop? They often result from straining during bowel movements or prolonged sitting on the toilet. Pregnancy and obesity can also increase the risk of developing hemorrhoids.

Anal Fissures: Another Common Culprit

Anal fissures are small tears in the lining of the anus, typically caused by passing hard stools or excessive straining during bowel movements. These tears can lead to bright red blood in the stool or on toilet paper. While anal fissures can be painful, they are generally not considered a serious medical condition.

Recognizing the Symptoms of Rectal Bleeding

Identifying the symptoms of rectal bleeding is crucial for timely diagnosis and treatment. The most obvious signs include:

• Bright red blood on toilet paper after wiping
• Blood in the toilet bowl
• Maroon-colored stools
• Visible blood mixed with stool

In addition to these primary symptoms, rectal bleeding may be accompanied by other concerning signs, such as:

• Abdominal cramping
• Rectal pain
• Dizziness or fainting
• Vomiting
• Rapid heartbeat
• Low blood pressure
• Confusion

Is rectal bleeding always visible to the naked eye? Not necessarily. In some cases, blood in the stool may not be apparent and can only be detected through medical tests. This is why regular check-ups and screenings are important, especially for individuals at higher risk of gastrointestinal issues.

When to Seek Medical Attention for Rectal Bleeding

While not all instances of rectal bleeding require immediate medical attention, certain situations warrant prompt evaluation by a healthcare professional. You should seek medical care if you experience:

• Large amounts of blood in your stool
• Rectal bleeding accompanied by severe abdominal pain
• Rectal bleeding along with dizziness, fainting, or rapid heartbeat
• Persistent bleeding that doesn’t improve with home remedies
• Black, tarry stools (which may indicate bleeding higher up in the digestive tract)

How quickly should you see a doctor for rectal bleeding? If you’re experiencing any of the above symptoms or have concerns about your rectal bleeding, it’s best to consult with a healthcare provider as soon as possible. They can perform the necessary examinations and tests to determine the underlying cause and appropriate treatment.

Diagnostic Procedures for Rectal Bleeding

To identify the cause of rectal bleeding, healthcare providers may employ various diagnostic procedures. These may include:

• Physical examination and medical history review
• Digital rectal examination
• Anoscopy
• Colonoscopy
• Sigmoidoscopy
• Stool tests
• Imaging studies (such as CT scans or MRI)

The specific tests recommended will depend on the individual’s symptoms, age, and risk factors. For instance, a colonoscopy is often recommended for individuals over 50 or those with a family history of colorectal cancer, even in the absence of symptoms.

The Importance of Colonoscopy in Diagnosing Rectal Bleeding

Colonoscopy is a crucial diagnostic tool for evaluating rectal bleeding, particularly in detecting colorectal polyps or tumors. During this procedure, a flexible tube with a camera is inserted into the rectum and colon, allowing the doctor to visualize the entire large intestine.

How effective is colonoscopy in diagnosing the cause of rectal bleeding? Colonoscopy is highly effective, with the ability to detect even small abnormalities in the colon and rectum. It also allows for the removal of polyps and the collection of tissue samples for biopsy if necessary.

Treatment Options for Rectal Bleeding

The treatment for rectal bleeding depends on its underlying cause. Some common treatment approaches include:

• Dietary changes and increased fiber intake
• Over-the-counter medications (e.g., stool softeners, hemorrhoid creams)
• Prescription medications (for conditions like inflammatory bowel disease)
• Minimally invasive procedures (e.g., rubber band ligation for hemorrhoids)
• Surgery (for more severe cases or certain conditions)

Managing Hemorrhoids and Anal Fissures

For hemorrhoids and anal fissures, conservative treatments are often effective. These may include:

• Warm sitz baths
• Topical creams or ointments
• Increased fiber intake and adequate hydration
• Avoiding straining during bowel movements

In more severe cases of hemorrhoids, procedures such as rubber band ligation or surgical removal may be necessary. For persistent anal fissures, topical medications or, in rare cases, surgical intervention may be recommended.

Treating Inflammatory Bowel Disease

For rectal bleeding caused by inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, treatment typically involves a combination of medications to reduce inflammation and manage symptoms. These may include:

• Anti-inflammatory drugs
• Immunosuppressants
• Biologic therapies

In some cases, dietary modifications and stress management techniques may also be recommended as part of the treatment plan.

Preventing Rectal Bleeding: Lifestyle Changes and Precautions

While not all cases of rectal bleeding can be prevented, certain lifestyle changes and precautions can help reduce the risk:

• Maintain a high-fiber diet
• Stay well-hydrated
• Exercise regularly
• Avoid straining during bowel movements
• Practice good anal hygiene
• Limit time spent sitting on the toilet
• Manage underlying conditions (e.g., chronic constipation)

How effective are these preventive measures? While they can significantly reduce the risk of certain causes of rectal bleeding, such as hemorrhoids and anal fissures, they may not prevent all instances of rectal bleeding, especially those related to more serious underlying conditions.

The Role of Diet in Preventing Rectal Bleeding

A diet rich in fiber is particularly important in preventing rectal bleeding associated with constipation and straining. High-fiber foods include:

• Whole grains
• Fruits and vegetables
• Legumes
• Nuts and seeds

Gradually increasing fiber intake and ensuring adequate water consumption can help maintain regular bowel movements and reduce the risk of hemorrhoids and anal fissures.

Long-term Outlook and Complications of Rectal Bleeding

The long-term outlook for individuals with rectal bleeding largely depends on the underlying cause. In many cases, especially those related to hemorrhoids or anal fissures, the prognosis is generally good with appropriate treatment and lifestyle modifications.

However, rectal bleeding can sometimes be a sign of more serious conditions, such as colorectal cancer. Early detection and treatment of these conditions are crucial for improving outcomes.

Potential Complications of Untreated Rectal Bleeding

If left untreated, rectal bleeding can lead to various complications, including:

• Anemia due to chronic blood loss
• Progression of underlying conditions
• Increased risk of infection
• Delayed diagnosis of serious conditions

How can you prevent these complications? Regular check-ups, prompt attention to symptoms, and adherence to recommended treatment plans are essential in preventing complications associated with rectal bleeding.

Special Considerations: Rectal Bleeding in Children and Pregnant Women

Rectal bleeding can occur in specific populations, such as children and pregnant women, with unique considerations for each group.

Rectal Bleeding in Children

In children, rectal bleeding may be caused by:

• Anal fissures
• Juvenile polyps
• Intussusception (a serious condition where part of the intestine slides into an adjacent part)
• Infections

Parents should be vigilant and seek medical attention if their child experiences rectal bleeding, especially if it’s accompanied by abdominal pain, fever, or changes in bowel habits.

Rectal Bleeding During Pregnancy

Pregnant women may experience rectal bleeding, often due to:

• Hemorrhoids (common in the second and third trimesters)
• Anal fissures
• Constipation

While these causes are often benign, pregnant women should always consult their healthcare provider about any instances of rectal bleeding to rule out more serious conditions.

How can pregnant women manage rectal bleeding safely? Treatment options for pregnant women may be limited due to potential risks to the fetus. Safe management strategies often include dietary modifications, topical treatments, and careful use of certain over-the-counter medications as advised by a healthcare provider.

Rectal Bleeding Treatment, Causes, Symptoms & Remedies

There can be many causes of blood in the stool or rectal bleeding, some of which are more serious than others. In fact, the seriousness of rectal bleeding ranges all the way from mild to life-threatening, so it’s ideal to be aware of certain comorbid conditions or other problems that may precipitate a visit to your doctor or the emergency room. Read on to learn more about rectal bleeding and it causes, when you should be concerned, and diagnostics and treatment for this issue. 

What Is Rectal Bleeding (Hematochezia)?

The rectum is the very bottom of the large bowel and is located between this last portion of the bowel and the anus. This area is easily irritated by problems such as hemorrhoids and anal fissures; however, more serious complications of rectal bleeding can indicate that there is something wrong in another portion of the gastrointestinal tract. Rectal bleeding often occurs concurrently with blood in the stool, and blood in the stool may be a sure sign that there is rectal bleeding present. These are slightly different conditions but are very closely related. Many cases of rectal bleeding do not come directly from the rectum and can be actually located in the colon or anus. Rectal bleeding is often associated with diarrhea, as strong, uncontrollable diarrhea can lead to rectal and anal irritation and cause blood in the stool and rectal bleeding. 

What Are the Signs and Symptoms of Rectal Bleeding?

There are many signs and symptoms of rectal bleeding and blood in the stool. The first is seeing maroon-colored stools or blood left on toilet tissue paper after wiping. These can be concerning signs to see, but may not always be indicative that something is seriously wrong. You may also see bright red blood within the stool, or blood in the toilet bowl after using the bathroom. These are sure signs that there is rectal bleeding or blood in the stool, but there are other symptoms to watch out for that may point to a problem further up the digestive tract. You may see bloody stools comorbid with abdominal cramping, rectal pain, dizziness or fainting, vomiting, rapid heartbeat, low blood pressure, and confusion. If you experience rectal bleeding alongside any of these other symptoms, it’s imperative to see your physician as soon as possible. 

Children may experience blood in the stool and these types of symptoms if they are suffering from intussusception, which is a folding of the bowel. Pregnant women may also have rectal bleeding problems due to hemorrhoids, which are very common in the second and third trimesters. 

Causes of Blood in the Stool

There are many different causes for blood in the stool. Hemorrhoids and anal fissures are very common culprits. Other causes may include diverticulosis, infection, inflammation (such as inflammatory bowel disease or irritable bowel disease, Crohn’s disease, and colitis. Other gastrointestinal disturbances that can cause rectal bleeding include stomach ulcers, Meckel’s diverticulum, and ischemic colitis. Still, yet other serious causes may include colon polyps, tumors, or trauma to the area. 

Hemorrhoids are one of the primary culprits of blood in the stool or rectal bleeding, along with other anorectal disorders. There are two types of hemorrhoids: internal and external. External ones are easy to see with the naked eye and are often accompanied by anal itching. Internal hemorrhoids are on the inside of the anus and are not visible. Both types, without irritation, are quite painless. However, with the hemorrhoid is inflamed or swollen, it can cause pain and discomfort, as well as bleeding. Very often, this swelling is brought on by hard bowel movements or strenuous pushing during bowel movements. These are known as thrombosed hemorrhoids. A good rule of thumb is to take stool softeners often to prevent this from happening. If hemorrhoids become too thrombosed, a clot will form, which will be painful (and will cause more bleeding). At this juncture, minor surgery will be required for removal.  

Anal fissures are also created by the passage of hard stools or from too much pushing. These are conditions that are tears in the lining of the rectum. Anal fissures can cause bright, red blood from broken blood vessels, which can be disconcerting; but while anal fissures can be painful, from a medical standpoint they are not exceedingly serious. The best way to keep anal fissures at bay is to take warm baths, add fiber to the diet, and take daily stool softeners. 

Diverticulosis is another common cause of rectal bleeding. A diet that is too low in fiber can cause the diverticula to jut out from the bowel wall. When the diverticula are irritated or inflamed, it causes a condition known as diverticulitis. This condition usually occurs in people aged 40 and over and presents with dark, tarry stools or dark maroon stools. This condition is usually not painful; however, if patients experience pain or high fever with diverticulitis, they should seek help immediately. 

Infection and inflammation are also common causes of rectal bleeding. Infections from Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and Clostridium difficile are common culprits, as well as inflammation from gastrointestinal disorders, which can include inflammatory bowel disease (IBD), which is a collective term for both Crohn’s disease and ulcerative colitis (UC). These conditions can also independently cause blood in the stool or rectal bleeding. 

When to Seek Medical Care for Rectal Bleeding

Generally speaking, any type of rectal bleeding should be evaluated by a healthcare provider or medical professional. If you have blood in the stool or rectal bleeding, this is a marker that something is indeed wrong; it is the severity of the problem that needs to be diagnosed. Rectal bleeding may be caused by something as benign as hemorrhoids or as serious as late-stage colon cancer. If you have rectal bleeding accompanied by any of the symptoms mentioned several paragraphs above, you may want to seek help immediately. Irregular heartbeat, loss of blood, confusion, dizziness, or fainting along with rectal bleeding should prompt you to dial 9-1-1 or visit your closest walk-in urgent care.

Blood in Stool Diagnosis

To diagnose the cause of blood in the stool, your doctor will give you a thorough workup and physical exam, checking your abdomen and vital signs closely. An examination of the rectum and anus is also warranted to deem if the cause might be anal fissures or hemorrhoids. If your doctor suspects something more severe, you may have blood tests or a nasogastric tube, which is a quick procedure to check for blood in the digestive tract. 

Further diagnostics may be ordered to rule out certain conditions, such as colonoscopy, sigmoidoscopy, or anoscopy. Your physician may want you to have a barium enema X-ray or a CT scan. 

Blood in Stool Treatments

Treatment for blood in the stool or rectal bleeding depends heavily on the diagnosis. If you are suffering from anal fissures or hemorrhoids, the most common treatment is stool softeners and dietary changes. More serious problems require more aggressive treatment. Severe rectal bleeding may require a blood transfusion or IV fluids if there has been a great blood loss. Generally, however, rectal bleeding is most pronounced as small flecks in bowel movements and will not require hospital admission. To treat rectal bleeding, doctors must treat the underlying cause. IBD or IBS may require some medication and lifestyle changes, while E. coli infection may require aggressive treatment. Your doctor will best advise you on the course of action to treat the underlying cause of your bleeding.

If you need more information about blood in the stool or rectal bleeding or wish to be evaluated by a physician, contact Gastroenterology Consultants of Savannah, P.C. today. We have one South Carolina location and five Georgia locations for your convenience.

Rectal Bleeding (Blood in Stool) | What to do | Causes and Treatment

What is rectal bleeding?

The term rectal bleeding is used by doctors to mean any blood that is passed out of your bottom when you go to the toilet to pass stools (faeces). However, not all bleeding that is passed out actually comes from the back passage (rectum). The blood can come from anywhere in the gut. The more correct term is gastrointestinal tract bleeding, often abbreviated to GI bleeding. There are many causes of rectal bleeding (GI bleeding) which are discussed later.

What is the gut?

The gut (gastrointestinal tract) starts at the mouth and ends at the anus. When we eat or drink, the food and liquid travel down the gullet (oesophagus) into the stomach. The stomach starts to break up the food and then passes it into the small intestine.

The small intestine (sometimes called the small bowel) is several metres long and is where food is digested and absorbed. Undigested food, water and waste products are then passed into the large intestine (sometimes called the large bowel). The main part of the large intestine is called the colon, which is about 150 cm long. This is split into four sections: the ascending (on the right side of your tummy), transverse (across the top of your tummy), descending (on the left side of your tummy) and sigmoid colon (in your pelvis). Some water and salts are absorbed into the body from the colon. The colon leads into the back passage (rectum) which is about 15 cm long. The rectum stores stools (faeces) before they are passed out from the anus.

Types of rectal bleeding/GI tract bleeding

When you have GI bleeding, the things that a doctor needs to assess include the following:

How bad (severe) the bleeding is

Bleeding can range from a mild trickle to a massive life-threatening severe bleed (haemorrhage). In most cases the bleed is mild and intermittent. In this situation, any tests that need to be done can be done as an outpatient. There is no immediate risk to life with mild, intermittent GI bleeding. However, always report to a doctor if you have a large amount of bleeding, as a lot of blood loss needs urgent treatment.

Sometimes bleeding from a condition in the gut (GI tract) is so mild (like a slight trickle) that you do not notice any actual bleeding and it is not enough to change the colour of your stools (faeces). However, a test of your faeces can detect even small amounts of blood. This test may be done in various situations (described later).

Where the bleeding is coming from

Bleeding can come from anywhere in the GI tract. As a general rule:

• Bleeding from the anus or low down in the back passage (rectum) – the blood tends to be bright red and fresh. It may not be mixed in with faeces but instead you may notice blood after passing faeces, or streaks of blood covering faeces. For example, bleeding from an anal tear (fissure) or from haemorrhoids (described later).
• Bleeding from the colon – often the blood is mixed up with faeces. The blood may be a darker red. For example, bleeding from colitis, diverticular disease, or from a bowel tumour. However, sometimes, if the bleeding is brisk then you may still get bright red blood not mixed up too much with faeces. For example, if you have a sudden large bleed from a diverticulum (described later).
• Bleeding from the stomach or small intestine – the blood has far to travel along the gut before it is passed out. During the time it takes to do this the blood changes and becomes dark and mixed with faeces. This can make your faeces turn a black and tarry or plum colour – this is called melaena. For example, this may occur due to a bleeding stomach ulcer or a duodenal ulcer. Note: if you have melaena it is a medical emergency, as it usually indicates a lot of bleeding that is coming from the stomach or duodenum. You should tell a doctor immediately if you suspect that you have melaena.

The cause of the bleeding

A doctor may ask various questions to get an idea as to the main possible causes of the bleeding. So, for example, you may be asked about possible symptoms. You may be asked about:

• Whether you have any pain.
• If you have any pain, where it is and what type of pain it is.
• Any itching around your bottom.
• Any change in your bowels, such as diarrhoea or constipation.
• Any weight loss.
• Whether you have been feeling unusually tired.
• Any history in your family of bowel disease.
• Any medications you take, as some can increase the risk of GI bleeding.

The doctor is then likely to examine you. This may include examining your back passage (anus and rectum) by inserting a gloved finger into your anus. Sometimes they may use an instrument called a proctoscope to look a little way inside your back passage. Sometimes, a diagnosis can be made after this. For example, of an anal fissure or pile (haemorrhoid). However, further tests are commonly needed to clarify the cause. This is because the examining finger or the proctoscope can only go a short way up your GI tract. If no cause is found, the bleeding may be coming from higher up.

What are the causes of rectal bleeding/GI tract bleeding?

There are many possible causes. Below is a brief overview of the more common causes:

Piles

Piles (haemorrhoids) are swellings that can occur in the anus and lower back passage (lower rectum). There is a network of small blood vessels (veins) within the inside lining of the anus and lower rectum. These veins sometimes become wider and filled with more blood than usual. These swollen (engorged) veins and the overlying tissue may then form into one or more small swellings called haemorrhoids. Haemorrhoids are very common and many people develop one or more haemorrhoids at some stage. Small haemorrhoids are usually painless. The most common symptom is bleeding after going to the toilet. Larger haemorrhoids may cause a mucous discharge, some pain, irritation and itch. See the separate leaflet called Piles (Haemorrhoids) for details.

Anal fissure

An anal fissure is a small tear of the skin of the anus. Although the tear of an anal fissure is usually small (usually less than a centimetre), it can be very painful because the anus is very sensitive. Often an anal fissure will bleed a little. You may notice blood after you pass stools (faeces). The blood is usually bright red and stains the toilet tissue but soon stops. See the separate leaflet called Anal Fissure for details.

Diverticula

A diverticulum is a small pouch in the wall of the gut (intestines). Diverticula is the word used for more than one diverticulum. They can develop on any part of the gut but usually occur in the colon. Several diverticula may develop over time. A diverticulum may occasionally bleed and you may pass some blood via your anus. The bleeding is usually abrupt and painless. The bleeding is due to a burst blood vessel that can happen in the wall of a diverticulum and so the amount of blood loss can be heavy. Diverticula can cause other symptoms such as tummy pains and changes in your normal bowel habit. See the separate leaflet called Diverticula (Diverticulosis, Diverticular Disease, Diverticulitis) for details.

Crohn’s disease

Crohn’s disease is a condition which causes the gut to become inflamed. The disease flares up from time to time. Symptoms vary, depending on the part of the gut affected and how bad the condition is. Common symptoms include bloody diarrhoea, tummy (abdominal) pain and feeling unwell. See the separate leaflet called Crohn’s Disease for details.

Ulcerative colitis and other forms of colitis

Ulcerative colitis (UC) is a disease where inflammation develops in the colon and rectum. A common symptom when the disease flares up is diarrhoea mixed with blood. The blood comes from ulcers that develop on the lining of the inflamed gut. There are other rare causes of inflammation of the colon (colitis) or inflammation of the rectum (proctitis) that can cause rectal bleeding. See the separate leaflet called Ulcerative Colitis for details.

Polyps

A bowel polyp is a small growth that sometimes forms on the inside lining of the colon or rectum. Most develop in older people. Polyps are non-cancerous (benign) and usually cause no problems. However, sometimes a polyp bleeds and sometimes a polyp can turn cancerous. See the separate leaflet called Bowel Polyps (Colonic Polyps) for details.

Cancer

Cancer of the colon and rectum are common cancers in older people. They sometimes affect younger people. Rectal bleeding is one symptom that may occur. Bleeding is often not visible (occult – see later) and other symptoms are often present before visible bleeding occurs. For example, weight loss, tiredness due to blood loss (anaemia), diarrhoea or constipation. Cancers of other parts of the gut higher up from the colon sometimes cause rectal bleeding but these are uncommon. See the separate leaflet called Colon, Rectal and Bowel Cancer (Colorectal Cancer) for details.

Angiodysplasia

Angiodysplasia is a condition where you develop a number of enlarged blood vessels within the inner lining of the colon. Angiodysplasia most commonly develops in the ascending (right) colon, but they can develop anywhere in the colon. The cause is unknown but they occur most commonly in older people. Bleeding from an angiodysplasia is painless. The blood seen can range from bright red brisk bleeding, to dark blood mixed with faeces, to black- or plum-coloured faeces (melaena). An angiodysplasia may also cause non-visible (occult) blood loss (see below).

Abnormalities of the gut

In young children various abnormalities of the gut or the gut wall may cause rectal bleeding. Examples include:

• Volvulus – a twisting of the gut.
• Intussusception – one part of the gut is sucked into another, creating a blockage.
• Meckel’s diverticulum – an extra bulge or pouch in the small intestine, present from birth (congenital).
• Hirschsprung’s disease – a condition where a part of the lower bowel does not function as it should. The muscles of the bowel wall are unable to squeeze along the faeces as they should do.
• Abnormal blood vessel development.

See the separate leaflet called Rectal Bleeding in Children for more information.

Stomach and duodenal ulcers

An ulcer in the stomach or duodenum may bleed. This can cause melaena, where your faeces turn black- or plum-coloured as described earlier.

There are separate leaflets on both of these conditions, called Stomach Ulcer (Gastric Ulcer) and Duodenal Ulcer.

Some gut infections

These may cause bloody diarrhoea due to inflammation of the gut, caused by some infections.

See the separate leaflet called Gastroenteritis for more information.

There are various other rarer causes.

What should I do if I have rectal bleeding?

See a doctor. If the bleeding is heavy, or if you have black- or plum-coloured stools (faeces) – called melaena (described above), see a doctor immediately or call an ambulance. If you feel dizzy, collapse or feel generally unwell then consider calling an ambulance, as this might indicate a heavy bleed. However, often the bleeding is mild. In this situation, make an appointment with your doctor soon. Some people assume that their rectal bleeding is due to piles (haemorrhoids) and do not get it checked out. Haemorrhoids are perhaps the most common cause of rectal bleeding. However, you should not assume the bleeding is coming from a haemorrhoid unless you have been properly assessed by a doctor.

What tests might be advised?

It depends on the possible causes of the bleeding. This will be determined by a doctor talking to you (your history) and examining you. You will often have a blood test (for anaemia) and usually one of the following tests is suggested:

• Sigmoidoscopy.
• Colonoscopy.
• A virtual colonoscopy (CT colonography).

What is a colonoscopy?

A colonoscopy is a test where a doctor or nurse looks into your colon using a colonoscope. A colonoscope has fibre-optic channels that light up the inside of the colon. It is also possible to take a small sample (biopsy) using a colonoscope and sometimes to treat the cause of the rectal bleeding. See the separate leaflet called Colonoscopy for details.

What is a sigmoidoscopy?

A sigmoidoscopy is a test that allows a doctor or nurse to look inside the rectum and sigmoid colon. The sigmoid colon is the final portion of the bowel that is joined to the rectum. A sigmoidoscope is similar to a colonoscope but much shorter. A sigmoidoscopy is easier to do than a colonoscopy. See the separate leaflet called Sigmoidoscopy for details.

What is a virtual colonoscopy?

A virtual colonoscopy (also called CT colonography) is a newer test. It uses a CT scanner to produce detailed pictures of the inside of the colon. It is usually used for people who are more frail and cannot tolerate a colonoscopy. However it is not available in all areas. Also it is not possible to have a sample (biopsy) taken during a virtual colonoscopy. See the separate leaflet called CT Colonography for details.

What is a faecal occult blood test?

The faecal occult blood (FOB) test detects small amounts of blood in your stools (faeces) which you would not normally see or be aware of.

When and why is the FOB test done?

As discussed, there are several disorders which may cause bleeding into the gut. These may cause rectal bleeding which you can see. However, some of these disorders in some people may only bleed with a trickle of blood. If you only have a small amount of blood in your faeces then the faeces look normal. However, the FOB test will detect the blood. So, the test may be done if you have other symptoms that may suggest a gut problem. For example, persistent tummy (abdominal) pain, weight loss, anaemia, etc. It may also be done to screen for bowel cancer before any symptoms develop (see below).

Note: the FOB test can only say that you are bleeding from somewhere in the gut. It cannot tell from which part. If the test is positive then further tests will usually be arranged to find the source of the bleeding. For example, colonoscopy.

How is the FOB test done?

A small sample of faeces is smeared on to a piece of card. You obtain a sample by using a small scraper to scrape some faeces off toilet tissue which you have just used after going to the toilet. The sample is tested by adding a chemical to the sample on the card. If there is a change in colour after adding the chemical, it indicates that some blood is present.

Usually two or three FOB tests are done on two or three separate samples of faeces, obtained on different days. This is because a bleeding disorder of the gut may only bleed now and then. So, not every sample may contain blood. A series of two or three samples done on several days may be more accurate in detecting a bleeding gut disorder.

See the separate leaflet called Faecal Occult Blood Test for more details.

Screening for bowel cancer

Screening means looking for early signs of a particular disease in otherwise healthy people who do not have any symptoms and when treatment is likely to be curative. Bowel cancer (colorectal cancer) screening aims to detect colorectal cancer at an early stage when there is a good chance that treatment will cure the cancer.

In the UK there is a screening programme for certain age groups. This involves testing three samples of your faeces for blood. The age group is slightly different in different parts of the UK. If you are in the relevant age groups, you will automatically be sent an invitation and then your FOB screening kit, so you can do the test at home. After your first screening test, you will then be sent another invitation and screening kit every two years until you reach the maximum age. You can then request further kits if you would like to continue to be included in the screening programme.

See the separate leaflet called Bowel Cancer Screening for more details.

What is the treatment for rectal bleeding?

The treatment depends on the cause. See individual leaflets on the various diseases that can cause rectal bleeding.

Rectal Bleeding – Symptoms, Causes, Treatments

Rectal bleeding indicates the passage of blood from the anus. The bleeding may arise from any part of the gastrointestinal tract, including the rectum. Therefore, rectal bleeding can be caused by any number of gastrointestinal difficulties. 

Typically, bleeding from the upper gastrointestinal tract manifests as black or tarry stool known as melena. The black color develops because of chemical changes that occur as the blood passes through the digestive tract. Certain over-the-counter medications such as iron supplements and heartburn remedies containing bismuth can also turn the stool black. The passage of bright red blood from the anus is known as hematochezia and usually results from bleeding from sources that are closer to the anus and rectum

Common causes of rectal bleeding are hemorrhoids, anal fissures, and diverticulosis. The severity of rectal bleeding varies among individuals depending on the cause. Most often, people experience rectal bleeding that is mild, is caused by minor problems such as hemorrhoids, and resolves on its own. People who have severe bleeding may see a large amount of blood after a single bowel movement, which, if it continues, can result in significant blood loss. Symptoms of blood loss include lightheadedness, dizziness, fainting, and difficulty breathing.

While rectal bleeding can be minor, it can also result from severe conditions that are characterized by prolonged bleeding. In these cases, serious complications such as shock can develop. Rectal bleeding can also occur from cancers in the digestive tract.

Left untreated, severe rectal bleeding can result in a life-threatening loss of blood. Seek immediate medical care (call 911) for serious symptoms, such as pale skin or pallor and difficulty breathing, severe abdominal pain, vomiting blood or black material, or change in level of consciousness.

11 causes of rectal bleeding

Rectal bleeding usually refers to bleeding from the anus, rectum, or colon, all of which are the final portions of the digestive tract.

In most cases, bright red blood indicates bleeding in the lower colon or rectum, while darker red blood is a sign of bleeding in the small bowel or upper colon.

Very dark or black-red blood is often associated with bleeding in the stomach or other organs in the digestive system.

In this article, we examine 11 causes of rectal bleeding, along with other symptoms that each one can prompt. We also look at when rectal bleeding should be referred to a doctor.

A wide range of health conditions and factors can cause or add to rectal bleeding.

Some of the most common causes include:

1. Hemorrhoids

Hemorrhoids are inflamed anal blood vessels, and they are extremely common. They can develop on the outside or inside of the anus, appearing as small bumps that occasionally bleed during bowel movements or when wiping.

Hemorrhoids, which are also referred to as piles, can impact anyone of any age but are associated with a few risk factors, including:

• pregnancy
• chronic constipation and straining
• chronic diarrhea
• straining during bowel movements or sitting on the toilet for too long
• obesity
• low fiber or unbalanced diet
• aging

Hemorrhoids usually respond well to over-the-counter creams and suppositories that contain hydrocortisone. Taking warm baths frequently, eating a high-fiber diet, and using stool softeners can also help reduce the discomfort of hemorrhoids.

If initial treatments fail, a doctor may perform minor surgery to remove the hemorrhoids.

2. Fistulas

A fistula occurs when an abnormal opening or pocket develops between two neighboring organs. Fistulas that appear between the anus and rectum, or anus and skin, can cause a discharge of white fluid and blood.

Fistulas are sometimes treated with antibiotics, but they may require surgery if they progress.

3. Fissures

Fissures occur when tissues lining the anus, colon, or rectum are torn, resulting in pain and rectal bleeding.

Warm baths, a high-fiber diet, and stool softeners can all help reduce symptoms of fissures. In severe cases, fissures may require prescription creams or surgery.

4. Diverticulitis

Diverticulosis is when small pockets called diverticula develop on the walls of the colon around a weakness in the organ’s muscular layers.

These pockets or diverticula are extremely common. Sometimes diverticula can start bleeding, but this bleeding usually stops on its own.

Usually, these pockets do not cause symptoms or require treatment unless they become infected, which is when a condition called diverticulitis occurs.

Infected and inflamed diverticula are often painful and can cause rectal bleeding, usually a moderate rush of blood that flows for a few seconds.

Diverticulitis is treated with antibiotics and, if severe, surgery.

5. Proctitis or colitis

Proctitis occurs when the tissues that make up the rectum become inflamed, often resulting in pain and bleeding.

Colitis occurs when the tissues lining the colon become inflamed. A type of colitis called ulcerative colitis can also cause ulcers, or open, progressive sores, that are prone to bleeding.

Treatments for proctitis and colitis vary, depending on the causes and range from antibiotics to surgery.

Common causes of proctitis and colitis include:

• infection
• some conditions that cause digestive problems, such as irritable bowel syndrome (IBS) and Crohn’s disease
• some medications, such as blood thinners
• radiation or chemotherapy
• anal intercourse
• reduced blood flow to the colon or rectum
• a blockage in the colon or rectum

6.

Gastroenteritis

Bacterial infections can cause inflammation of the colon and stomach, causing diarrhea that may contain mucus and spots of blood. Viral gastroenteritis does not typically cause bloody diarrhea.

Treatment for gastroenteritis usually involves fluids, rest, and antibiotics or antivirals, depending on the cause.

7. Sexually transmitted infections (STIs)

Unprotected sexual intercourse that involves the anal area can spread a wide range of viral and bacterial diseases. These can cause inflammation of the anus and rectum. Inflammation, if it occurs, increases the likelihood of bleeding.

Treatment for STIs usually involves either an antibiotic, antiviral, or antifungal medication, depending if the cause is bacterial, viral, or fungal.

8. Prolapse

Weakened rectal tissues can allow a portion of the rectum to push forward or bulge outside of the anus, usually resulting in pain and, almost always, bleeding.

Prolapse is more common in older adults than in younger people. Some people with this condition may require surgery to correct it.

9. Polyps

Polyps are noncancerous, abnormal growths. When polyps grow on the lining of the rectum or colon they can cause irritation, inflammation, and minor bleeding.

In many cases, a doctor will remove polyps so they can be tested for signs of cancer and to avoid the risk of them becoming cancerous.

10. Colon or rectal cancer

Cancer that impacts the colon or rectum can cause irritation, inflammation, and bleeding. As many as 48 percent of people with colorectal cancer have experienced rectal bleeding.

Colon cancer is a very common form of cancer and tends to progress slowly, so it is often treatable if caught early.

Rectal cancer, while far rarer than colon cancer, is also usually curable if detected and treated in time.

Some cases of colon and rectal cancer develop from initially benign polyps. All cases of gastrointestinal cancer require treatment, which usually involves a combination of chemotherapy, radiation therapy, and surgery.

11. Internal bleeding

Major injury to any of the gastrointestinal organs can result in internal bleeding that passes through the rectum. Severe gastrointestinal disease can also lead to internal bleeding.

Internal bleeding almost always requires hospitalization and surgery.

A few occasional drops or streaks of blood in the toilet, when wiping, or in the stool, is usually not a worry.

Some people may avoid talking with their doctor about rectal bleeding out of embarrassment and anxiety, even in moderate or severe cases. While rare, heavy or chronic rectal bleeding can cause serious blood loss or be a sign of an underlying condition that requires treatment.

People should see a doctor about rectal bleeding that is chronic or noticeable, abnormal growths around the anus. It is also a good idea to talk with a doctor about rectal bleeding that does not respond to home remedies.

People should seek emergency medical attention for rectal bleeding or stool that is very dark, especially if they are also vomiting or coughing up blood. It is also vital to seek immediate help for bleeding that lasts for more than a few minutes or is accompanied by other symptoms, such as severe pain, fever, or weakness.

Read the article in Spanish here.

Rectal Problems | HealthLink BC

Do you have a rectal problem?

This includes symptoms like rectal pain, itching, or bleeding. It could also include a change in your stool other than diarrhea or constipation.

How old are you?

Less than 12 years

Less than 12 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

The medical assessment of symptoms is based on the body parts you have.

• If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Do you have moderate or severe belly pain?

This is not the cramping type of pain you have with diarrhea.

Have you had:

At least 1 stool that is mostly black or bloody?

At least 1 stool mostly black or bloody

At least 1 stool that is partly black or bloody?

At least 1 stool partly black or bloody

Streaks of blood in your stool?

Streaks of blood in stool

Are you bleeding from your rectum?

How much blood has there been?

More than 30 mL (2 tablespoons)

More than 30 mL (2 tablespoons)

More than a few streaks but no more than 30 mL (2 tablespoons)

More than a few streaks but no more than 30 mL (2 tablespoons)

Streaks of blood on the toilet paper

Streaks of blood on the toilet paper

Has there been a recent injury to the rectum or vagina?

Physical or sexual abuse and other injuries to these areas can cause problems like rectal pain and bleeding, urination problems, constipation, and vaginal bleeding.

Yes

Recent injury to rectum or vagina

No

Recent injury to rectum or vagina

Do you think the rectal problem may be causing a fever?

Infections and other rectal problems can sometimes cause pain and a fever.

Do you have pain in the rectal area?

How long have you had the pain?

Less than 1 day (24 hours)

Rectal pain for less than 1 day

One day to 1 week

Rectal pain for 1 day to 1 week

More than 1 week

Rectal pain for more than 1 week

Is there any swelling, a lump, a sore, or a new growth in the rectal area?

Yes

Swelling, lump, or sore in rectal area

No

Swelling, lump, or sore in rectal area

Has it been there for longer than 1 week?

Yes

Swelling, lump, or sore in rectal area for more than 1 week

No

Swelling, lump, or sore in rectal area for more than 1 week

Is there an object in the rectum?

Have you had any stool leaking from your rectum for more than 2 days?

Yes

Leakage of stool for more than 2 days

No

Leakage of stool for more than 2 days

Have you tried any home treatment for the itching for more than 1 week?

Yes

Tried home treatment for more than 1 week for rectal itching

No

Tried home treatment for more than 1 week for rectal itching

Have you had other signs of illness, such as weight loss, fatigue, or a rash, for more than 1 week?

Yes

Other signs of illness present for more than 1 week

No

Other signs of illness present for more than 1 week

Have your symptoms lasted longer than 2 weeks?

Yes

Symptoms for more than 2 weeks

No

Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines and natural health products can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.

A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.

Certain medicines and foods can affect the colour of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food colouring can turn the stool black.

If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Rectal itching is most often caused by dry or irritated skin in the rectal area. It can also be a sign of pinworms, especially in children.

Itching may be more serious if it occurs with a rash or if it does not improve with home treatment.

Home treatment for rectal itching includes things like:

• Keeping the area clean and dry.
• Washing the area with water several times a day and after bowel movements.
• Sitting in a few inches of warm water in a bathtub.
• Wearing loose-fitting cotton underwear.
• Using a non-prescription hydrocortisone cream on the area.

Pain in adults and older children

• Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
• Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
• Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

• Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
• Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
• Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Feeling very dizzy or light-headed, like you may pass out.
• Feeling very weak or having trouble standing.
• Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Being very sleepy or hard to wake up.
• Not responding when being touched or talked to.
• Breathing much faster than usual.
• Acting confused. The child may not know where he or she is.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

• Make an appointment to see your doctor in the next 1 to 2 weeks.
• If appropriate, try home treatment while you are waiting for the appointment.
• If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Abdominal Pain, Age 11 and Younger

Abdominal Pain, Age 12 and Older

What Is Rectal Bleeding: Causes

There are a lot of colors, usually shades of brown, we are accustomed to seeing when we are done going to the restroom. But what happens if you get up from the toilet and see bright red streaks of blood on the toilet paper, in your feces, or in the water in the toilet bowl? Should this be a cause for alarm? What might be wrong with you?

Since your gastrointestinal system is (normally) a one-way street, anything that goes wrong from your esophagus on down will eventually show up in your poop. This means the causes, seriousness, and treatment of rectal bleeding are numerous. 

What Does Rectal Bleeding Mean?

Unlike some other medical issues with confusing names, rectal bleeding is what it sounds like: blood issuing from your rectum. It is possible the source of the bleeding is at the anus itself in the form of hemorrhoids, or it could be coming from higher up in your digestive tract. In fact, prolonged, constant vomiting can even cause blood to show up on toilet paper or in your stool. 

Minor rectal bleeding can be nothing more than irritation of the area around the anus, or it could be evidence of life-threatening illnesses like cancer. A little blood on your toilet paper that goes away soon is probably nothing to worry about. On the other hand, if your bleeding continues, worsens, or is accompanied by other symptoms like abdominal pain, fainting, nausea, or other symptoms, you should seek medical treatment immediately. 

What Causes Rectal Bleeding?

Many things can cause rectal bleeding. Anal fissures, or small tears in the lining of the anus from passing hard stool, are a common cause, as are hemorrhoids. Hemorrhoids are caused by swollen, irritated, or ruptured veins in the end of your rectum or around your anus. These weakened blood vessels are one example of a cause of rectal bleeding that is not dangerous, though people who suffer from the irritation and pain of hemorrhoids will definitely tell you hemorrhoids are no laughing matter.

There are other common causes of gastrointestinal bleeding that come from weakened blood vessels further upstream in your intestines. Angiodysplasia is a condition where the blood vessels in the lining of the colon become fragile over time. This condition is more common with the elderly, and typically appears slowly.

Further up the digestive tract, issues with your esophagus, stomach, and small intestine can all possibly contribute to rectal bleeding. These sources of blood may not be as obvious to spot, as the blood has time to mix with your stool before it reaches the anus. In these cases, it is sometimes likely you will see maroon or black tarry stool rather than bright red blood. This kind of bleeding can come from damage to the esophagus or the lining of the stomach.  

Diverticulitis is another digestive disease that is relatively common, especially in older Americans. Diverticula are pouches in the side of the intestine that form in places where the wall of the intestine has become weakened. These pouches often form in people who eat a low fiber diet. Food can become trapped in these pouches, leading to inflammation, infection, and sometimes bleeding. 

Colon polyps are another source of blood that ends up in your stool. Unlike diverticula that create pockets in the intestinal wall, polyps are bulges of tissue that protrude into the intestinal tract. Bleeding can occur as these polyps form, but these lumps are typically not dangerous or harmful. Some colon polyps can be a cause of concern, though, as certain types of these growths can be precancerous. 

Another cause of rectal bleeding is a set of digestive diseases such as Crohn’s disease. This condition, which is believed to be an autoimmune disease, is one of the major conditions lumped in under the term Inflammatory Bowel Disease (IBD). For people with Crohn’s disease, inflammation, and irritation in the wall of the intestine causes a range of unpleasant or dangerous symptoms. Diarrhea, fatigue, and weight loss are all possible, as your intestines are unable to absorb nutrition properly when they are inflammed. This condition can lead to blood seeping into the intestine from irritated tissue, thus leading to blood in the stool. 

Blood in your stool could be caused by something relatively harmless, but at the serious end of the spectrum lies the specter of cancer. There are a few different types of cancer that could result in blood in your stool. Colon cancer and anal cancer are two of the most well known, though they are not the only varieties. Both of these forms of cancer can be deadly, especially when they are not caught until cancer has progressed to an advanced stage.  

When Should I Seek Medical Help? 

The decision on when to seek medical advice for rectal bleeding will depend on how severe your bleeding is, and whether you are experiencing other symptoms. As mentioned above, if you don’t have any other symptoms, a little blood showing on your toilet paper for just a few bowel movements may indicate nothing more than hemorrhoids or small anal fissures. These conditions can heal on their own, or be treated with conservative home remedies and over-the-counter treatments aimed at reducing the severity of symptoms.  

Long-lasting bleeding is a cause for concern. The volume of blood in your stool is also an indicator of how severe problems may be. If you suddenly see a large amount of blood in the toilet, or if the amount of blood you have seen increases rapidly, seek medical treatment as soon as possible. 

The real concern with rectal bleeding comes when your bleeding occurs alongside other concerning symptoms. If you are having any of the following in conjunction with blood appearing in your stool, seek medical treatment immediately:

• Severe fatigue
• Nausea
• Unexplained weight loss
• Abdominal pain
• Swelling in the abdomen
• Low blood pressure
• Confusion
• Rapid heart rate
• Dizziness
• Vomiting
• A distinct change in bowel habit

Blood loss, especially from internal bleeding, can be a danger in its own right, especially for the elderly. It can also be a sign of other issues such as intestinal trauma. If something has caused a hole to develop in your intestines, you are at high risk for fast moving and potentially deadly infection and must seek medical treatment immediately. 

How is Rectal Bleeding Diagnosed?

The presence of blood in your stool is not hard to identify. Sorting out just where it is coming from inside you can be more difficult. There are a number of diagnostic options your doctor will have if the bleeding is coming from the area immediately around the anus. If your bleeding is originating further inside your digestive tract, though, your doctor will need to find a way to take a look inside. 

There are several procedures for looking inside your gastrointestinal tract, and not surprisingly many of them are variations on the same theme. Upper endoscopy, sigmoidoscopy, and colonoscopy are all terms for different types of a procedure where a small tube is inserted into either the mouth (in the case of an upper endoscopy) or the anus. This flexible tube has a tiny camera and light at the end to allow your doctor to see what is going on inside your GI tract. In some cases, tissue samples can also be retrieved for further analysis. This is commonly done if cancer is suspected and tissue samples are needed for biopsy. 

The images and tissue samples gathered during a colonoscopy or sigmoidoscopy are typically what your doctor will use in diagnosing the cause and severity of your rectal bleeding. Other diagnostic procedures can sometimes be needed, including blood tests and fecal sample tests. 

How is Rectal Bleeding Treated?

As you can imagine, the treatments for rectal bleeding can vary widely depending on the cause. For hemorrhoids, over-the-counter creams or a sitz bath may provide relief to the irritated tissue and allow the bleeding to heal. For people who have Crohn’s disease, changes in diet and lifestyle may be necessary. For ulcerative colitis patients, drug therapy can sometimes help, although surgical intervention may be necessary. When colorectal cancer or anal cancer is found, more aggressive treatment is required to eliminate the cancerous tissue and prevent the spread of the disease.  

Talk to Your Doctor About Rectal Bleeding

Given the wide variety of causes of rectal bleeding, and the potentially serious diseases like cancer that can cause it, talking to your doctor is essential if your bleeding extends beyond a few days, or is accompanied by other concerning symptoms. Some causes of blood in the stool are not life-threatening, and can be solved by conservative treatment, but if you are experiencing unexplained weight loss, severe abdominal pain, vomiting, or fainting spells, you should seek medical treatment immediately. 

Talking to your doctor sooner rather than later, especially if you are older or have had a history of problems in your digestive tract, could save your life. If you have been experiencing blood in your stool and you are concerned something serious could be wrong, make an appointment at Cary Gastroenterology Associates today.  

Rectal Bleeding

Overview

Rectal bleeding should be viewed as a symptom and not a disorder itself. Most rectal bleeding is associated with a condition that can be treated. Although the cause of the bleeding may not be serious, it is important to determine its source. Rectal bleeding can come in different forms such as tarry stool and bright red or maroon in color. Some rectal bleeding can be serious, so it is important to see your doctor.

Hemorrhoids

Probably the most common cause of rectal bleeding is hemorrhoids, also known as piles. Hemorrhoids are enlarged blood vessels in the anal canal that rupture and produce bright red blood. These swollen veins can be located inside the anal canal (internal hemorrhoids) or on the outside (external hemorrhoids). While external hemorrhoids can cause pain, throbbing or burning, internal hemorrhoids are usually painless. Besides rectal bleeding, other common symptoms of hemorrhoids are pain, itching, lumps around the anus, painful bowel movement and leakage of feces.

Mild cases of hemorrhoids can be treated at home with over-the-counter medication. Topical gels, creams, cold compresses, sitz baths, oral pain relievers, and keeping the area clean and dry are all recommended methods to reduce the symptoms of hemorrhoids. Wearing cotton clothing and avoiding constricting garments also can help bring relief.

For chronic hemorrhoids, removal by banding, injections or infrared coagulation may be the best options for relief. You can also opt to have your hemorrhoids removed surgically.

Anal Fissures

If you have a hard bowel movement, the stool can create small tears in the lining of the anus. This can be very painful and produce blood. An anal fissure is a tear in the lining of the anal canal. Other causes of anal fissures include constipation, diarrhea or childbirth. Besides rectal bleeding, common symptoms of anal fissures are itching in the anal area or a stinging/burning sensation during bowel movements.

There are two types of anal fissures: acute and chronic. Acute anal fissures usually clear up on their own after a few days or weeks, but deep anal fissures can remain problematic. An anal fissure that has not healed after 8 to 12 weeks is considered chronic. Occasionally, surgery is required to correct chronic fissures.

Colon Conditions

Sometimes, the colon will develop a small growth called a polyp. Most polyps are harmless, but some can develop into cancer. Polyps usually are not accompanied by symptoms, but rectal bleeding may occur. Along with rectal bleeding, common symptoms of colon cancer are

• Change in bowel habits
• Unexplained weight loss
• Unexplained anemia
• Abdominal pain
• Vomiting

The earliest sign of colon cancer may be bleeding, which may be intermittent. Screening for colon polyps and cancer is recommended in people over age 50 (earlier in those with risk factors such as a family history of colon cancer or polyps). Although there are several methods of colon screening, colonoscopy is the gold standard because it can both diagnose and prevent/treat colon cancer. Doctors can both discover and remove polyps during the procedure. Early detection and removal helps prevent colon polyps from developing into cancer.

Infection

Intestinal infection can result in inflammation, which can produce bloody diarrhea. There are many different viruses and bacteria that can cause intestinal infection. Contaminated food and poor hygiene are the most common ways that intestinal infection occurs. Other symptoms of intestinal infection, besides rectal bleeding, are loss of appetite, nausea, abdominal pain, cramping, diarrhea, headaches and skin rashes.

The most important reason to get treatment for an intestinal infection is to prevent dehydration. If you have experienced symptoms for more than three days, you should call your doctor. Prescribed medication may be necessary.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) causes chronic inflammation of the digestive tract. In people with IBD, the immune system attacks the lining of the intestines. This causes cramping, loose stool, bloody stool and fever. These disorders often are also accompanied by abdominal pain, weight loss and fatigue. No one knows the source of IBD and there is no cure. The most common types of IBD are Crohn’s disease and ulcerative colitis.

Crohn’s disease causes inflammation anywhere along the lining of the digestive tract, and it can also involve other parts of the body besides the digestive tract. Besides rectal bleeding, common symptoms of Crohn’s disease are abdominal pain, chronic diarrhea, weight loss and poor absorption of nutrients.

Ulcerative colitis causes inflammation and sores in the lining of the colon and rectum. Bloody diarrhea is a common symptom of ulcerative colitis.

IBD can range from uncomfortable to life-threatening. Doctors diagnose IBD with a colonoscopy, blood tests and specialized X-rays including a CT scan. There are medications that help control the symptoms, and these include steroids and medicines that suppress the immune response. When medications do not help, surgery may be necessary to remove the diseased parts of the digestive tract. Being under the care of a doctor is essential so the symptoms can be monitored and managed.

If you are experiencing rectal bleeding, do not attempt to diagnose yourself. Rectal bleeding can indicate a more serious condition that needs to be checked out immediately. Make an appointment with your doctor and bring a detailed list of symptoms with you, along with questions.

90,000 Anal bleeding: what to do with it?

No one is immune from the discovery of red traces of blood on toilet paper, in feces or on the surface of feces. The statistics of proctology specialists indicate hemorrhoidal disease as the leading cause of such symptoms. Anal bleeding can be drip, jet and even splatter. The latter is typical for diseases in serious stages. However, hemorrhoids are not the only cause of anal bleeding.

Causes of symptoms

Patients tend to think out the causes of the problem, not relying on the results of the examination by a proctologist. It is still considered a shame in our country to go to a medical institution with such a thing. Many are openly afraid of the unflattering statements of a specialist. As a result, a person with anal bleeding is admitted to an appointment when the situation has worsened to the limit and fear for his life has already turned on.

What can a proctologist detect besides hemorrhoids?

• Anal fissure, or anal fissure.If a person has a tendency to constipation, a non-healing wound will form at the site of the mucosal injury. During bowel movements, she touches a lump of feces and begins to bleed.
• Colon diverticulum is a pathology that is characteristic mainly of middle-aged and older patients. The weakened intestinal wall protrudes and retains fecal masses “in a niche”, which leads to a focus of inflammation and bleeding.
• Diarrhea lasting up to 3 days may signal intestinal infections.
• Ulcerative colitis, Crohn’s disease – are expressed by foci of inflammation that can begin to bleed.
• Colon cancer.
• Heavy bleeding indicates possible problems in the upper intestines – urgent specialist intervention is required.

We remind you that the true cause of the appearance of scarlet blood can be established only after a complete examination by a specialist proctologist. Even if a person has chronic hemorrhoids, other diseases that can cause serious damage to health can develop against his background.

Concomitant symptoms

Blood during bowel movements can be either the only symptom or be accompanied by other signals of a problem in the body:

• pain – directly during bowel movements, while sitting, paroxysmal or accompanied by fever;
• the presence of mucus in the feces;
• diarrhea;
• constipation;
• fatigue, weight loss; decreased appetite.

Important: the oncological cause of anal bleeding is often almost asymptomatic and the blood in the stool will be rather hidden. Cancer can be indicated by sudden weight loss, fatigue, low-grade fever. In any case, regardless of the symptomatology, the proctologist must prescribe an examination and identify the cause of the bleeding.

Types of examination

Proctological examination reveals neoplasms at a shallow depth (up to 25 cm), signs of hemorrhoids and anal fissures.If a specialist suspects a malignant tumor, the patient is prescribed an examination for occult blood, special oncotests and colonoscopy. The latter procedure reveals almost all proctological problems. Irrigoscopy can also be prescribed – an x-ray with the introduction of a contrast agent.

How anal bleeding is treated

Depending on the cause that caused the presence of blood in the stool, the doctor may prescribe conservative and surgical methods to eliminate the problem.Most proctological patients are faced with the need to follow a diet. In the case of conservative treatment, it helps to normalize the stool and remove the causes of injury and excessive pressure on the intestinal walls during bowel movements. If surgery is performed, then the diet should contribute to the speedy healing of sutures and wound surfaces.

The patient needs to remember that suppositories and ointments work in the initial stages of the problem. Without a timely visit to a proctologist, the risk of being a patient of a surgeon increases every day.It is also important to follow all the recommendations of a specialist, especially in the postoperative period. Modern proctology has minimally invasive and gentle methods that allow you to quickly return to normal life.

You may also be interested in Proctologist’s consultation

The author of the article is a doctor proctologist, candidate of medical sciences

Alexey Kovalev

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90,000 Blood from the anus – causes, diagnosis and treatment of bleeding from the anus

The author of the article: Coloproctologist, surgeon A. I. Shchegolev
Work experience: 15 years

Published: 05-08-2016

Updated: 10-11-2020

Blood from the anus is a sign of diseases of the rectum or colon, indicating the presence of a source of blood secretion in these parts of the intestine.The color and nature of bleeding plays an important role in the diagnosis.

In the event of the appearance of such a symptom as blood from the rectum, both a man and a woman need to urgently consult a coloproctologist. Coloproctologist, proctologist will conduct an examination and make a preliminary diagnosis. If you need more detailed diagnostics, for example, anoscopy or sigmoidoscopy, then you can carry it out on the same day. For women in the Clinic of Proctology, women-proctologists are receiving appointments.

Prices for an appointment with a proctologist

Initial appointment with a proctologist (assessment of patient complaints, taking anamnesis, external examination of the anus, digital examination of the rectum, anoscopy according to indications)

Initial appointment – a visit to a doctor of a specific specialty for the first time.

To make an appointment

Causes of bleeding from the anus

If you notice blood on toilet paper after a bowel movement, even if the bowel movement is painless, you should definitely consult a proctologist for advice in order to establish the cause of the bleeding, start treatment in a timely manner and avoid possible complications.

Why does blood appear from the anus after stool, both in men and women:

• A fairly common factor – hemorrhoids (enlargement of the veins of the rectum). Red blood appears from the anus during bowel movements.
• Anal fissure is the second most common cause of rectal (rectal) bleeding. The disease is characterized by a burning sensation during bowel movements, sometimes accompanied by acute pain (patients describe it as cutting, and then compressing).Bloody discharge is manifested in both small and abundant portions.
• Inflammatory diseases of the colon.
• Presence of benign lesions (polyps). A characteristic symptom is the discharge of blood from the rectum after a bowel movement. The blood is darker, often with mucus.
• Presence of a malignant tumor of the rectum. Blood of various colors may be released. Quite often, the secreted blood does not differ in any way from the blood that is secreted, for example, from hemorrhoidal tissue.And if the presence of hemorrhoidal disease worsens only the quality of life (hemorrhoidal tissue never degenerates into a malignant tumor), then the presence of a benign tumor or malignant tumor can be harmful to health and danger to life, which is why you should not try to establish the source yourself.

Only a coloproctologist can determine the true cause of bleeding from the anus and choose the appropriate treatment. Timely diagnosis allows for effective conservative and minimally invasive treatment.

Discharge color and disease

• bright red, scarlet blood from the anus on toilet paper or underwear, drops at the end of the act of defecation (bowel movement) – hemorrhoids or anal fissure;
• red color of blood with anal bleeding – cancer, intestinal polyp;
• dark-colored blood clots – tumors of the distal colon, diverticulosis;
• cherry color of blood from the anus – colon pathology;
• black, tarry stools – diseases of the stomach, duodenum and small intestine.

IMPORTANT! Bleeding is a formidable symptom, after the appearance of which one cannot postpone a visit to the doctor. Unfortunately, blood from the anus can cause diseases such as swelling of the rectum or colon. And in the worst case, this tumor can turn out to be malignant. Blood can also occur as a result of an injury to a polyp – a benign tumor. Long-standing polyposis can be a sign of bowel cancer.

The nature of bleeding and disease

• Regular profuse blood circulation, not associated with bowel movement – diverticulosis, polyposis, Crohn’s disease, ulcerative colitis, rectal or colon cancer;
• Blood mixed with feces – cancer of the rectum and colon;
• Bleeding with diarrhea – dysbiosis, irritable bowel syndrome;
• Discharge of blood with mucus or pus – internal hemorrhoids, prolapse of the rectum or polyp;
• Heavy bleeding with mucus – proctitis, colitis, rectal cancer.

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Diagnostics and treatment

When faced with an intimate problem, especially such as bleeding from
anus during bowel movements, you can get confused, especially not knowing about the methods of diagnosing and treating such ailments or not understanding which doctor to turn to.

A proctologist or coloproctologist is a doctor who diagnoses and treats diseases of the colon, rectum and anus, as well as problems of the sacrum, coccyx and perineum.You should not postpone a visit to this specialist if blood is observed from the anus after stool.

The proctologist will listen to complaints and the history of their appearance, and to establish the cause of the appearance of blood from the rectum, he can carry out the following procedures:

Digital rectal examination: the primary research method that makes it possible to assess the condition of the anus, identify possible pathologies in the form of neoplasms, anal fissures, uncharacteristic discharge, bleeding.

After a digital examination, the coloproctologist, if necessary, prescribes further diagnostic methods using special equipment:

• Anoscopy. This is an examination of the last 3-7 cm of the rectum, it is in this area that almost half of the sources are located with visible bleeding. There are several types of anoscopes (straight, conical, with and without a cutout, transparent and non-transparent), each of them is used strictly according to indications, but any of these types allows you to perform a full examination of the anal canal and lower ampullar rectum.Anoscopy is used when performing minimally invasive methods of treating hemorrhoids (ligation, sclerotherapy), as well as performing a number of surgical interventions (bipolar coagulation). Preparation is generally not required to perform diagnostic anoscopy; preparation is required for therapeutic anoscopy.
• Sigmoidoscopy or rectoscopy (RRS or RRS) – diagnostic manipulation using a special device with a camera. It makes it possible at the initial admission to quickly and without pain visually assess the state of the rectal mucosa, identify the presence of mucosal formations and intestinal compression.With rectoscopy, up to 20 cm of the intestine is examined (the entire straight line and the place of its transition to the sigmoid one). Preparation is required for rectoscopy.
• Colonoscopy is the most informative, in comparison with others, method for examining the large intestine. It is performed using a flexible fibrocolonoscope equipped with a high-resolution camera that will show even the smallest sources of bleeding. The procedure is also prescribed for the purpose of endoscopic removal of colon masses. Colonoscopy is performed by an endoscopist.

The appropriate treatment for the disease is determined and prescribed by the physician. You should not engage in self-treatment and neglect contacting a coloproctologist.

How to prepare for the examination?

The own research of the specialists of the proctology department of the Altermed clinic made it possible to make a visit to the proctologist as easy and comfortable as possible. You no longer need to fast the day before and schedule your procedure in the morning. In the proctology departments of Altermed, a way has been found that allows you to successfully cope with all these difficulties.This is Microlax bowel preparation.

The use of Mikrolax microclysters makes fasting unnecessary, does not require special equipment and premises, and saves a lot of time. The laxative effect occurs within 5-15 minutes after drug administration. The quality of bowel cleansing is such that treatment can be started immediately after rectoscopy and anoscopy. If necessary, use during pregnancy and lactation Microlax does not require special precautions.

The Proctology Clinic carries out diagnostics using the most modern equipment.The best doctors of St. Petersburg – both men and women – and a delicate approach are at your service.

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90,000 Bloody stools – is this normal?

Bloody stool – is it normal?

An unexpected release of blood during the act of defecation scares every person, and excessive shyness makes them keep silent about the problem.In the vast majority of cases, the diseases that caused bleeding are not life-threatening if they are treated at an early stage, while refusal to visit a doctor increases the number of cancer patients.

Doctor-proctologist Mikhail Evgenievich Cherkasov from Medical Center “Global Clinic” tells what such a delicate problem can be connected with and how it can be, and most importantly, needs to be solved.

– What are the causes of rectal bleeding? Which doctor should I go to to make a diagnosis?

– There are many reasons leading to the release of blood from the anal canal.These can be diseases of the rectum, intestines, liver, infectious diseases, side effects of certain drugs, as well as the consequences of anal sex. In most cases, the cause of rectal bleeding are benign diseases of the rectum and anal canal, such as hemorrhoids, anal fissures, proctitis, cryptitis, polyps, etc. channel, which most often occurs if there is a wound or damage to the rectal mucosa.If such symptoms are found, it is necessary to first contact a proctologist to confirm or exclude proctological diseases.

– What are the statistics of proctological diseases?

Cherkasov Mikhail Evgenievich, Coloproctologist at the Global Clinic Medical Center.

– These diseases are currently not rare. The widespread prevalence is associated with numerous factors of modern life: this is a sedentary lifestyle, alcohol, tobacco abuse, unhealthy diet, heavy physical exertion.According to various sources, about 30-50% of all people over 25 suffer from proctological ailments, and about 30% more or less have experienced unpleasant symptoms. At the same time, a significant part of patients have two diseases at the same time. The worst thing is when the lack of timely assistance leads to the fact that a non-life-threatening disease develops into a cancerous tumor.

– Can rectal bleeding be a symptom of rectal cancer?

– I did not want to mention this, as patients in such situations tend to think of the worst diagnoses for themselves, although I perfectly understand their panic state when blood is found in the toilet room.I will not hide: rectal cancer is also accompanied by bleeding, and polyps of the anal canal and rectum can develop into a cancerous tumor. However, I want to reassure you a little, if you go to the doctor even at the first manifestations of the disease, even if the worst suspicions are confirmed and this is indeed rectal cancer, then at an early stage it can be successfully cured, and in a short time. Subsequently, the patient will simply be monitored by his doctor.

The main thing to know: normally, blood from the rectum can never be released.Any bleeding is always a pathology, therefore, it is necessary to establish the cause of rectal bleeding as soon as possible, and timely treatment will be the key to a successful outcome. And never try to heal yourself without knowing what exactly you are trying to cure.

– What kind of research is needed and how “unpleasant” is it?

– Of course, a visit to a proctologist cannot be called pleasant, but believe me, there is nothing terrible and painful in the examination either.Research methods have become more modern. If earlier the patient had to be in a knee-elbow position or lie on a gynecological chair for diagnosis, now the examination and treatment are carried out lying on the left side on a conventional medical couch. All procedures are absolutely painless thanks to the use of gels, sprays, ointments with an anesthetic component. There is even a special proctological underwear. Of course, such innovations contribute to the growth of visits to doctors-proctologists, as patients have become less shy and afraid.

The examination itself is quite simple and takes about 5-7 minutes in time. First, the doctor visually examines the anal canal area, conducts a digital rectal examination, then hardware diagnostics is carried out – this is videoanoscopy and rectoscopy. These studies are carried out under video control and allow the doctor to examine the rectum to a depth of 25 cm, as well as show the patient on the screen what problem he has, or, conversely, exclude proctological diseases and refer the patient to a doctor of another specialty.

– If the discharge of blood is associated with the presence of a proctological disease, how long does the treatment take, is it necessary to stay in the hospital?

– If patients come at the first manifestations of the disease with complaints of slight bleeding during and after defecation or some time after it, then the treatment is mainly carried out on an outpatient basis, using minimally invasive techniques. In the last stages of hemorrhoids, with advanced cracks or paraproctitis, you can also help without hospitalization in a hospital, but with the help of an operation.Radio wave surgery is used and, in the case of hemorrhoidal disease in the 3rd and 4th stages, a new method of “dearterization”. The essence of the technique is to search for arteries feeding hemorrhoids using a Doppler sensor and to suture these arteries using special bioabsorbable sutures, therefore, subsequent removal of sutures is not required. The whole procedure takes about 30-40 minutes on average.

Our patients tolerate this treatment quite well. About one to two hours after dearterization, they are in the ward of the day hospital, and then they go home, and return the next day only for a control examination.However, unfortunately, the method of dearterization is currently not widespread and is available only in leading clinics in large cities. Accordingly, patients from the region, from small towns, who can be helped on an outpatient basis, still receive referrals for surgery at the city hospital. I can say that many of them, especially those for whom anesthesia is in principle contraindicated, come to us in Nizhny Novgorod to undergo such treatment.

In cases where the bleeding is severe enough and patients cannot do without special pads, outpatient proctology cannot help.Help for such patients can only be provided in a hospital. Therefore, I appeal to those who have already encountered any problems with the rectum, be it bleeding, itching or just discomfort: it is better to spend a few hours on time for visits to the doctor than then “go under the surgeon’s knife” and stay for several weeks in hospital until complete rehabilitation.

Coloproctologist, Mikhail Evgenievich Cherkasov conducts an appointment at the Global Clinic Medicine Center, located at the addressNizhny Novgorod, st. Poltavskaya, house 39. You can sign up for a consultation or examination by calling (831) 428-08-18 (around the clock) or by filling out the form “make an appointment”, you can ask your question here.

Consult your doctor for possible contraindications .

Modern concepts of pathogenesis and treatment of hemorrhoids

V.L. RIVKIN , MD, professor, surgeon-proctologist, Multidisciplinary clinic CELT, Moscow

In the pathogenesis of hemorrhoids, the main role is played by thrombosis of special cavernous veins (bodies) of the rectum, which are filled with arterial blood.In the area of ​​the three terminal ramifications of the rectal artery, in the areas of the anal canal projected on the dial marks corresponding to 3, 7 and 11 o’clock, three main internal hemorrhoids with their external ramifications are formed from the cavernous veins. Hemorrhoids can be divided into asymptomatic stage, acute form, bleeding hemorrhoids without prolapse of nodes, and chronic bleeding hemorrhoids with prolapse of nodes. Traditional conservative treatment of hemorrhoids is now complemented by sclerosing injections and transanal ligation of internal nodes.Radical surgical treatment consists in the excision of three internal nodes in one block with the corresponding external nodes. Hemorrhoid treatment should be carried out only after colonoscopy in order not to miss colon tumors, the cases of which have sharply increased in recent years, especially in the elderly, who often suffer from hemorrhoids.

Hemorrhoids have been known since ancient times, the name of the disease is traditionally translated as bleeding from the rectum during bowel movements (from Latin hemo – blood and rrhoe – to flow out), although the clinic of the disease is much more diverse and wider.The most various theories of the occurrence of hemorrhoids (varicose veins of the rectum, rectal hemangioma, etc.), the history of methods of its treatment have been described many times, especially after the isolation of proctology as a separate medical specialty (R. Blanchard, 1938; A.N. Ryzhikh, 1956; A. M. Aminev, 1973), but only in the twentieth century. studied and explained, finally, the real morphological bases of the disease (Milligan et al., 1937). Hemorrhoids have long been considered a consequence of ectasia of ordinary rectal veins, but it turned out that it is based on a cluster (nodes, piles, from the Latin pila – ball) special, i.e.n. cavernous veins (bodies) of the rectum with multiple arteriovenous anastomoses (Stelzner, Staubezand, 1962) and filling with arterial blood. The anatomical basis of the formation of the cavernous bodies of the rectum, hemorrhoids is the terminal ramifications of the rectal artery on the right lateral, left antero-lateral and left posterolateral walls of the anal canal, i.e. in the projection of 3, 7 and 11 o’clock on the dial (with the body position on the back ). In these areas of the anal canal, in the submucosal layer, groups of cavernous veins are formed, interconnected by anastomoses and collaterals, incl.including direct arteriovenous fistulas (“cochlear arteries”, glomus anastomoses).

The same cavernous formations are found in humans in other organs – in the nose, in the ureters, in the genitals, and the reasons for their appearance and localization have not yet been specially studied. The cavernous bodies of the rectum are thrombosed, filled with blood constantly, outside the act of defecation, and communicate with the usual veins of the rectal mucosa. With the smallest injuries, for example, dense feces with constipation, with straining during childbirth, etc.n. the outer shell of the thrombosed internal hemorrhoid ruptures and arterial bleeding occurs in scarlet drops or an intense scarlet stream, usually during or immediately after a bowel movement. Bleeding, as a rule, stops on its own and in most cases does not anemize patients. The study of the gas composition and coagulation activity of blood from hemorrhoids, carried out by the aforementioned Stelzner, Staubezand and other researchers, confirms that this blood is close in composition to arterial blood.Note that, despite the cited scientifically grounded concept of the etiology of hemorrhoids, until now in some reputable publications, for example “Colorectal Surgery” (3rd ed., Trans. 2009), hemorrhoids for some reason are referred to as “small proctology “, and its etiology, according to the authors,” is associated with a lack of dietary fiber and stretching during bowel movements. ” If this is not a translation cost, then such an interpretation is both incorrect and does not explain anything. Probably, this means persistent constipation with a subsequent weakening of the function of anal holding, but this is not an etiology, but only one of the possible reasons for the loss of nodes, which are not formed due to constipation.

The second problem is the primacy of inflammation or thrombophlebitis in hemorrhoids. Studies show that acute hemorrhoidal thrombophlebitis is secondary. It is based on inflammation caused by damage (ulceration) of the mucous membrane of the anal canal with a sharp violation of blood circulation in areas with pathogenic intestinal flora. As for the danger of embolism in acute hemorrhoidal thrombosis, this is practically impossible, since the lumens of the cavernous veins are very small, less than the size of the smallest blood clots (L.L. Capuller, 1984). Thus, now the pathogenesis of hemorrhoids – both an acute painful attack and its chronic course with constant bleeding, has been studied in detail and taken into account by the majority of specialists. Further research can concern only individual links of this mechanism.

During preventive proctological examinations, quite often, mainly in elderly men and women who have given birth to many, during digital rectal examination painless moving areas are found on the walls of the anal canal – forming internal hemorrhoids, as a rule, do not bleed and do not fall out.This asymptomatic hemorrhoid, a “pre-disease”, does not need treatment; such persons should be combated with constipation and warn them about the possibility of bleeding during bowel movements.

Clinically, hemorrhoids most often begin with an acute attack – pain, falling out and pinching of nodes, which is usually facilitated by stool retention with straining during bowel movements. On external examination, in such cases, dense, painful when touched, cyanotic nodes around the entire circumference of the anus are determined. Digital (and all the more instrumental) research and, especially, attempts to reposition such nodes should not be taken at this time, it does not give anything but pain.A set of measures is needed – warm lying baths, Detralex and candles, which are produced in many. According to our personal experience, Ultraproct candles work better than others. This combined preparation, containing the anti-inflammatory component fluocortolone and the local anesthetic cinchocaine, provides a complex effect – anti-inflammatory, antipruritic, anti-allergic, antihistamine and local anesthetic. Included in the composition of cinchocaine is a local anesthetic of the amide type, tropic to the epithelium of the rectum.The glucocorticosteroid fluocortolone provides a rapid onset of action, leads to a decrease in inflammatory exudate and cytokine production, inhibition of macrophage migration, and a decrease in infiltration and granulation processes. When applied topically, fluocortolone improves microcirculation, reduces swelling and itching, and accelerates the regeneration of CO of the rectum. The instructions for the candles describe in detail the method of their use, but many years of practice allow you to give additional advice: the tip of the candle should be lubricated with any oil, the candle should be inserted shallowly into the anal canal, and hold it outside for at least a minute.

An important pathogenetic factor of acute hemorrhoids is a spasm of the anal sphincter, which occurs in pain and prevents the independent repositioning of the nodes. Baths and suppositories help relieve spasm, but in severe cases it is necessary to resort to a dosed posterior sphincterotomy used for anal fissure and some forms of paraproctitis (V. An, V. Rivkin, 2003). Conservative treatment, excluding salty and sour foods from food, thinning the stool (phytolax, prunes and other natural fruit preparations) for an average of one week lead to almost complete disappearance of symptoms, but the patient must be warned about the possibility of recurrence of inflammation and radically decide on the future treatment.If, after an acute attack, in the cold period, a digital examination does not reveal pronounced internal nodes, if the described conservative treatment turned out to be effective, then an acute episode of hemorrhoids can be considered a single, exclusive, and no specific therapeutic measures should be taken. But acute hemorrhoids occurs with already formed internal nodes, and the disease is prone to relapse or to the transition to the chronic stage, which must be warned about the patient.

The second option is bleeding hemorrhoids without the loss of nodes.With a digital rectal examination, slightly painful, soft, mobile areas in typical places are determined, traces of blood are not uncommon on the glove. Rigid anoscopy or rectoscopy, which were previously widely used in such cases, are inadequate, because no new data on the localization and state of hemorrhoids is determined, and for the diagnosis of concomitant pathology of the colon, primarily tumors, total fibrocolonoscopy is required (in recent years more and more often polyps and colon cancer are determined in the right sections of the colon, which are inaccessible with rectoscopy).Treatment of bleeding hemorrhoids without the loss of nodes is carried out by adjusting the chair, suppositories, etc.; such treatment is palliative, because the substrate of the disease remains and the nodes only increase with time. This led to the search for more effective methods of treating these numerous patients, and now, especially abroad, two effective outpatient methods are widely used, for some reason poorly perceived by domestic proctologists. The first method is sclerotherapy of internal nodes. After the usual digital anus divulsion, 1.5–2 ml of sclerosing solution (thrombovar, ethoxysclerol) is injected into the upper pole of each node (remember, there are usually only three of them) through an operating anoscope with an illuminated handle in the handle.All three nodes are sclerosed in one session. The treatment is painless, because the puncture of the nodes is carried out above the dentate line of the anal canal, where the mucous membrane does not have sensitive nerve endings. The effect comes quickly, bleeding stops for a long time. Sclerotherapy is used only in the chronic stage of hemorrhoids, without exacerbation of the disease and only with captive nodes. The second technique for this variant of the disease is transanal ligation of the legs of internal hemorrhoids with special rubber (latex) rings (washers).With the help of a special miniature instrument inserted through the operating anoscope, the top of the assembly is grasped with pins, pulled into the cylinder and a tight rubber ring is thrown onto the leg of the assembly by pressing a button. The node ceases to be supplied with blood and after a day or two, together with the washer ring, it painlessly stands out in the stool. These methods have been described in detail (O’Regan, 1995), and our own experience with these two new “semi-conservative” outpatient hemorrhoid treatments demonstrates their effectiveness (V.Rivkin et al., 2012). Surprisingly, until now, our surgeons and even proctologists have been treating such patients conservatively for a long time, for years, changing different suppositories and drugs, not paying attention to the incipient anemia. For some reason, neither sclerotherapy nor transanal ligation of nodes are included in widespread practice, while abroad these techniques prevail and their effectiveness is constantly being confirmed.

The third option, the most important in practice, is hemorrhoids with prolapse of nodes. In most cases, as mentioned above, three main internal nodes are formed, and the impression of a larger number of nodes is formed from visual observation of the distal parts (tops) of these three nodes, which look like separate formations (Fig.one). In such patients, the nodes are usually easily repositioned, but with the slightest straining they fall out again. With a digital rectal examination, usually almost painless, it is possible to determine the typical localization of the bases (legs) of the three main nodes. If the study is painful and the sphincter of the anus is spasmodic, then we are talking most often about a combination of hemorrhoids with an anal fissure: a linear, dense, painful scar is determined on the back wall of the anal canal. This combination is very common, it is explained by repeated inflammatory exacerbations of hemorrhoids.Just as often and for the same reason, chronic hemorrhoids are combined with inflammation of the walls of the rectum (proctitis) or rectum and sigmoid colon (proctosigmoiditis). Against the background of chronic hemorrhoids during colonoscopy in the colon, much higher than the hemorrhoids themselves, polyps and early forms of cancer are often detected for the first time in the elderly. This is completely unrelated to hemorrhoids, hemorrhoids do not become malignant (except, perhaps, very rare cases of anal melanoma), but colonoscopy in these, mainly elderly, people is necessary in itself, this is currently a very effective way of timely diagnosis of colonic tumors. intestines.

Radical treatment of chronic bleeding hemorrhoids with prolapse of nodes, operative. The most effective is, in our opinion, the operation developed by the above-mentioned English surgeons (Milligan et al.) Back in the 1930s. After ligation of the vascular pedicle, the boundaries of the internal node are outlined with a scalpel and excised with scissors “from outside to inside” with all external nodes. At the end of the operation, three open perianal wounds remain (in the form, as the authors figuratively described, “rubber fan blades”).In our modification, during this operation, the bottom of these three wounds is usually sutured (Fig. 2), which contributes, firstly, to their faster healing and, secondly, partially narrows the anus with linear scars, which contributes to its better sealing. Until now, many surgeons, who consider the treatment of hemorrhoids to be their competence, operate on patients with the old, obsolete method of simple ligation of external nodes, which often leads to serious complications, for example, to a persistent stricture of the anus, when the necessary wide mucocutaneous strip does not remain between the removed external nodes. fabrics.We had to treat such patients, and in one case, a complete cicatricial stricture of the anus developed, and the case ended with the imposition of a temporary colostomy followed by complex anal plasty. Despite the fully substantiated and effective methodology of Milligan et al., More and more new methods are constantly being proposed, described in detail by L.A. Grateful (1999), and there is a feeling of artificial, only for the sake of the notorious novelty, the development and attempts to introduce “new” techniques, sometimes completely inadequate, such as the dangerous and complex Whitehead operation and superradical resection of the anal canal (Longo operation).The vast world experience of Milligan et al. unequivocally testifies to her favor and irreplaceability. Only minor minor improvements are possible, for example, narrowing of three perianal wounds (Fig. 2e).

Radical surgery for hemorrhoids should be clearly justified; it has already been said above that in elderly patients with concomitant serious cardiovascular and other organopathology, conservative treatment with diet, suppositories, stool dilution gives a long-term beneficial effect.In many elderly people, chronic bleeding hemorrhoids are combined with persistent hypertension, and small, non-anemic hemorrhoidal bleeding may be useful for them.

We emphasize once again: it is impossible to start treating, let alone operate, hemorrhoids without a preliminary colonoscopy. We draw the attention of doctors of any specialty to the fact that bleeding from the anus, especially not associated with defecation, requires an urgent colonoscopy. In recent years, cases of colon tumors, polyps and cancer have sharply increased throughout the world, and cancer of the rectum and sigmoid colon is taking the first or second place in oncological pathology.Colon tumors, especially asymptomatic adenoma polyps (optional precancer), are found in more than 15% of people over 50 years of age (N. Yakutin et al., 2002). In Russia, colon cancer is diagnosed late, at inoperable stages (N.Yu. Zalit et al., 2003), and the analysis reveals that many of these patients were treated for hemorrhoids for a long time, sometimes for weeks or months, without prior examination of the colon. intestines. They had hemorrhoids, but there was also a tumor of the colon, the diagnosis of which was delayed due to long-term treatment of hemorrhoids.Nowadays, when flexible intestinal fibroendoscopy is available in every city, the treatment of rectal bleeding without a colonoscopy is not just a mistake, but a medical crime. Colon polyps and cancer are frequent in the elderly, including those suffering from hemorrhoids, and long-term treatment of hemorrhoids weakens the doctor’s attention and delays the necessary colonoscopy.

Literature

1. Blanchard R. Romance of Proctology. London, 1938.
2.Ryzhikh A.N. Rectum surgery. M., 1956.
3. Aminev A.M. Guidelines for proctology. T. 2. Kuibyshev, 1973.
4. Milligan E., Morgan S., Jones L., Officer R. Anatomy of the anal canal and the operative treatment of hemorrhoids // Lancet. 1937. No. 2. R. 1119-1123.
5. R. Phillips (ed.) Colorectal Surgery. Colorectal surgery / per. from English M .: GEOTAR, 2009. Ch. 14.P. 262–268.
6. Stelzner F., Staubesand J. Das Corpus Cavernosom Recti.// Archiv. Klin. Chir. 1962. No. 299. R. 302-312.
7. Capuller L.L. Hemorrhoids // Morphological bases of diseases of the stomach and intestines. M., 1998. S. 123-128.
8. An V.K., Rivkin V.L. Emergency proctology. M., 2003.
9. O’Regan P.J. Disposable device and minimally invasive technique for rubber band ligation of hemorrhoids // Dis. Colon. Rectum. 1999. No. 42. R. 623-625.
10. Rivkin V.L., Capuller L.L., Belousova E.A. Coloproctology. M., 2011.S. 77–98.
11. Grateful L.A. Clinical and pathogenetic substantiation of modern methods of hemorrhoid treatment. Dis. … Dr. med. sciences. M., 1999.
12. Yakutin N.A. [et al.] Diagnosis of precancerous diseases and early forms of colon cancer at the prehospital stage // Problems of Coloproctology: Collection of articles. M., 2002. S. 502–507.
13. Zalit N.Yu. [and others] The problem of colon cancer at the turn of the third millennium // Act. Coloproctology issues: Sat. Samara, 2003.S. 233–235. 90,050 9,0003 90,000 symptoms and complications. Removal of polyps

A colon polyp is a small collection of cells that forms on the lining of the colon. Most colon polyps are harmless. But over time, some polyps can develop into colon cancer, which is often fatal in its later stages.

Generally, the larger the polyp, the higher the risk of cancer, especially tumor polyps.

Symptoms of intestinal polyps

Colon polyps are often asymptomatic.You may not even know you have a polyp until your doctor finds it during a bowel exam.

Video endoscopy without pain. More details….

The best prevention for colon cancer is regular polyp screening.

But some people with colon polyps experience:

• Rectal bleeding. This could be a sign of colon polyps, cancer, or other conditions such as hemorrhoids or small tears in the anus.
• Changing the color of the stool. Blood can show up as red streaks in the stool or make the stool appear black. Discoloration can also be caused by ingestion of food, medications, and supplements.
• Constipation or diarrhea lasting longer than a week may indicate a large colon polyp. But a number of other conditions can also cause changes in bowel habits.
• Pain. A large colon polyp can partially block the intestines, leading to cramping abdominal pain.
• Iron deficiency anemia. Bleeding from polyps can occur slowly over time, with no visible blood in the stool. Chronic bleeding deprives your body of the iron it needs to make a substance that allows red blood cells to carry oxygen to your body (hemoglobin). The result is iron deficiency anemia, which can cause fatigue and shortness of breath.

When to see a doctor

See a doctor if you experience:

• Abdominal pain
• Blood in the stool
• Change in bowel habits that lasts longer than a week

You should be tested regularly for polyps if:

• You are 50 or older
• You have risk factors such as a family history of colon cancer.Some high-risk people should start regular check-ups much earlier than age 50.

Removal of intestinal polyps

Some colon polyps can become cancerous. The sooner polyps are removed, the less likely they are to become cancerous.

Colonoscopy is the most sensitive test for colorectal polyps and cancer. If a polyp is found, your doctor may recommend removing it immediately or taking tissue samples (biopsies) for analysis.

In our clinic, polyps are removed using a special manipulator using the following methods:

• cold loop polypectomy (cutting with a metal loop)
• endoscopic loop electro excision (polyp removed with electrosurgical loop)
• Removal with biopsy forceps.

Valentin Kutsenko, endoscopist of the International Innovation Clinic

90,000 Antidepressants for inflammatory bowel diseases

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a chronic inflammatory disease that affects the gastrointestinal tract (colon or small intestine, or both).IBD predominantly includes Crohn’s disease and ulcerative colitis. Symptoms of IBD include diarrhea, urgency to bowel movements (including fecal incontinence), abdominal pain, rectal bleeding, fatigue, and weight loss. When people experience symptoms of IBD, they are considered to have an active illness. When IBD symptoms stop, the disease is in remission. IBD is associated with a psychosocial burden, with depression in people with IBD twice as high as in the general population. Anxiety and depression that accompany IBD may be associated with poor quality of life, worsening IBD activity, higher hospital admissions, and decreased adherence to treatment.Up to 30% of people living with IBD take antidepressants, which are prescribed for mental health problems or bowel symptoms, or both.

What are antidepressants?

Antidepressants are medicines used to treat depression and other psychiatric disorders such as anxiety. Antidepressants are not currently approved by regulatory authorities for the specific treatment of anxiety and depression as part of the management of physical symptoms or for reducing bowel inflammation in people with IBD.However, some antidepressants have indications for treating pain in chronic conditions and are commonly used to treat functional bowel symptoms in conditions such as irritable bowel syndrome.

What did the researchers learn?

Previous studies of antidepressant therapy for IBD were reviewed. Data from some of these studies have been pooled using a technique called meta-analysis. In the analysis, people on antidepressants were compared to those on antidepressants in terms of anxiety and depression levels, as well as other metrics such as quality of life, side effects, and IBD activity.

What did the researchers find?

Researchers searched the medical literature up to 23 August 2018. Four published studies involving 188 people examined antidepressant therapy in people with IBD. The age of the participants ranged from 27 to 37.8 years. In three studies, participants had IBD in remission, and in one, participants had either active IBD or IBD in remission. Participants in one study had comorbid anxiety or depression.One study used duloxetine (60 mg per day), one used fluoxetine (20 mg per day), one used tianeptine (36 mg per day), and one used various antidepressants. Three studies had a placebo control group (such as sugar pills) and one study did not receive a control group.

Analysis showed that symptoms of anxiety and depression improved in those taking antidepressants compared with placebo. Participants who received antidepressants experienced more side effects than those who received a placebo.Side effects reported by those taking antidepressants included: nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood / anxiety, dry mouth, poor sleep, restless legs, and hot flashes. Several aspects of quality of life were improved, as well as the activity of IBD in the antidepressant group. The overall quality of the studies included in this review was low because the studies were small in number and included individuals with IBD who differed in key characteristics.In addition, different types of antidepressants have been evaluated, so the evidence for any one antidepressant was uncertain. Therefore, further research is needed to confirm these observations.

Conclusions

The results for the outcomes assessed in this review are uncertain, and no clear conclusions can be drawn about the benefits and harms of antidepressants for IBD. More research is needed to make clear conclusions about the benefits and harms of antidepressant use in people with IBD.

Causes of blood in feces in children. Clinical example of the disease of Markiaf-Mikeli Text of a scientific article in the specialty “Clinical Medicine”

UDC: 616.3-053.2

Causes of blood in feces in children. clinical example of Markiaf-Mikeli’s disease

© E. n. Fedulova, A.R.Bogomolov

Federal State Budgetary Institution “Nizhny Novgorod Research Institute of Pediatric Gastroenterology” of the Ministry of Health of the Russian Federation

Summary.The problem of the appearance of blood in the feces in children is serious and complex in relation to the diagnostic search. This symptom can be a sign of both gastroenterological diseases and diseases not associated with the pathology of the gastrointestinal tract. The variety of causes of blood flow in the stool creates certain difficulties in their diagnosis. Pediatricians are faced with the task of diagnosing the disease in a timely manner and determining the optimal volume of laboratory and instrumental methods for examining a child.The above observation of a rare cause of rectal bleeding in children, not associated with a disease of the gastrointestinal tract, indicates the need for further improvement of the algorithm for diagnosing this syndrome.

Keywords: children; blood in the stool; hemocolitis; differential diagnostics; Markiafava-Mikeli syndrome.

introduction

The problem of gastrointestinal bleeding has long attracted the attention of pediatricians.Chronic, non-intensive loss of blood in the feces slowly but surely damages the child’s body. They can be an episodic or persistent symptom, the causes of which are varied and not necessarily associated with proctological problems [6, 14].

There is no doubt that the study of the clinical features of diseases occurring with blood in the stool in children, and the isolation of differential diagnostic signs of the disease is an urgent direction in medical research.

The general principle of diagnostic measures in children with intestinal bleeding is complexity. Important information is provided by careful questioning of the parents and the child when clarifying complaints and taking anamnesis. It is necessary to strive to obtain comprehensive information about the onset of the disease, complicated by bleeding, the features of the condition preceding the appearance of blood in the stool. This stage of medical activity is so important that it essentially predetermines all diagnostic and therapeutic measures in the future [7, 8].

By the volume of blood in the stool, bleeding can be latent or obvious (moderate or massive). Sometimes patients report them only with careful questioning. Massive hemocolitis, in which hypovolemia, arterial hypotension, and tachycardia are observed, is much less common.

By the nature of the admixture of blood in the feces, it is possible already at the first stages of diagnosis to navigate the level of bleeding and its possible cause.The rule is considered fair, which states that the brighter the blood released from the rectum, the more distal the source is.

Scarlet blood, excreted in the form of drops, is characteristic of lesions of the rectum; streaks of scarlet blood in the feces of brown color – with damage to the sigmoid colon; dark red blood, evenly mixed with feces, in case of damage to the proximal colon; black tarry stools – damage to the small intestine and higher parts of the digestive tract [12].

In the presence of blood in the stool, it is important to find out whether it is mixed with feces (the source is located high) or is released in a relatively unchanged form at the end of defecation, which is more typical for low-lying bleeding tumors and hemorrhoids.

The nature of the disease also determines the color and amount of blood in the stool. So, unformed feces, mixed with liquid blood of different colors, often mixed with mucus, indicate an inflammatory lesion of the mucous membrane, which may accompany Crohn’s disease, ulcerative colitis or severe infectious colitis [1, 3, 20, 21, 22].Meckel’s diverticulum, bleeding tumors and polyps of the ileum, as well as high-lying hemangiomas are accompanied by a large amount of dark blood impurities in the stool [3, 8, 19]. Accumulations of liquid blood of dark cherry or scarlet color on the surface of feces usually at the end of the act of defecation indicate the presence of a bleeding polyp in the distal colon.

Blood streaks of dark or bright scarlet color, traced on the surface of feces along their entire length, are most often a sign of hemorrhoidal bleeding or cracks in the mucous membrane of the colon [5].In case of allergic and systemic diseases, a significant

degrees can vary both the volume of bleeding and the qualitative characteristics of the released blood [2, 16, 18].

The presence of abdominal pain is evidence in favor of inflammatory bowel diseases, acute ischemic lesions of the small and large intestine [13]. Sudden sharp pains in the abdomen, followed by intestinal bleeding, can be caused by intussusception of various departments, ulceration of Meckel’s diverticulum, hemorrhagic vasculitis [8].Pain in the rectum during the act of defecation or worsening after it is usually observed with a fissure of the anus or hemorrhoids [5]. Painless massive intestinal bleeding can be observed with intestinal diverticulosis, telangiectasia [3].

The presence of fever, arthritis, aphthous stomatitis, erythema nodosum, primary sclerosing cholangitis, eye lesions (iritis, iridocyclitis) is characteristic of chronic inflammatory bowel diseases [9].The detection of telangiectasias on the skin and visible mucous membranes may indicate the presence of the same changes in the intestinal mucosa [17].

It should be noted that in the literature, despite a detailed presentation of the clinic of various causes of rectal bleeding, there are no data on the comparative characteristics of various parameters of this sign, the directions of differential diagnosis and the use of laboratory-instrumental methods are not discussed.

The aim of this work was to improve the differential diagnosis of diseases occurring with the appearance of blood in the feces in children based on the determination of the structure of the causes of hemocolitis by referral to a gastroenterological hospital.

Materials and Methods

In accordance with the purpose of the work, the medical histories of 301 children (157 boys and 144 girls) aged from 1 month to 16 years old were retrospectively analyzed, who were admitted to the Nizhny Novgorod Research Institute of Pediatric Gastroenterology of the Ministry of Health of Russia from 1988 to 2001 with a symptom of hemocolitis (Fig.one). The children were divided into three main groups depending on the causes of bleeding. The first is inflammatory bowel diseases, which included patients with ulcerative colitis (82 children) and Crohn’s disease (35 children), the second, which unites patients with polyposis lesions of the colon (86 children) and anal fissures (94 children), and the group rare causes of rectal bleeding (4 children), including patients with solitary rectal ulcer syndrome, Randu-Osler-Weber disease, colon hemangioma and Markiafava-Micheli disease.All children underwent a comprehensive clinical and instrumental study [4].

90,044 results 90,003

When analyzing the case histories of our patients, attention is drawn to the high proportion of anal fissures – 31.4% (in 94 children). It should be emphasized that not enough attention is paid to this pathology in children by practical doctors. In our opinion, this diagnosis could be successfully made both in the conditions of a district hospital and by a doctor in a polyclinic.

The high percentage of detection of children with ulcerative colitis – 82 children (27.2%) and colon polyps – 81 patients (27%) is of certain concern.

Crohn’s disease 19.6%

Rare diseases 1.2%

Anal fissures 31.4%

1.6%

Diffuse polyposis

27.2% Ulcerative colitis

90,044 27.0% Polyps

Fig.1. The structure of diseases in children with blood in the feces, according to NNIIDG

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71

1988-1994

1995-2001

32;

Ulcerative colitis

p = 0.001

g and Rare diseases Crohn’s disease n, 00 / Anal fissures

Crohn’s disease Anal fissures

90,044 5.4% 26.2%

Polyps

p = 0.02

16.9% Polyps p = 0.001

Fig.2. Changes in the structure of diseases occurring with blood in the feces in children according to NNIIDG

It should be noted that if single polyps did not have clear clinical manifestations and their diagnosis became possible only with the use of instrumental research methods (recto, colonoscopy, etc.), then in ulcerative colitis, pronounced manifestations of the disease in the form of loose stools, blood in feces and pain syndrome could well serve as a basis for suspicion of this serious illness.The foregoing indicates the need to improve the early diagnosis of these forms of the disease.

Until recently, such a serious illness as Crohn’s disease was considered characteristic of adult patients and was described in the pediatric literature as isolated, rare cases. Our observations showed that Crohn’s disease occurs in 11.6% (35 children) among intestinal pathologies accompanied by hemocolitis syndrome. A rather high proportion of severe pathology with a recurrent course and an unfavorable prognosis indicates that the description of the clinical manifestations of Crohn’s disease and the identification of early diagnostic criteria are undoubtedly of great scientific and practical importance.

Rare bowel diseases in children include diffuse polyposis in 5 (1.2%) patients. This pathology requires special attention, since, according to the literature, it has a high risk of malignancy.

In 1.2% of cases (5 children), the examination revealed: rectal hemangioma, solitary rectal ulcer, Randu-Osler-Weber disease, Meckel’s diverticulum and Markiafava-Micelli disease.

Scientific and practical interest is the dynamics of the structure of diseases occurring

with blood in the feces. A retrospective comparative analysis of nosological forms of diseases in children for 1988-1994 and 1995-2001 was carried out (Fig. 2).

A significant increase in the incidence of Crohn’s disease was established – from 5.4% to 19.1% of cases (p = 0.001), diffuse polyposis from 0.6% to 2.9% (p = 0.001) and anal fissures from 5.4 % to 37.8% (p = 0.05).Rare diseases (solitary rectal ulcer, Randu-Osler-Weber disease, Meckel’s diverticulum and Markiafava-Micelli disease) were identified only in 1995-2001, probably due to improved diagnostics.

Despite significant differences in the incidence of diseases occurring with the appearance of blood in the feces, in recent years, we are aware that the revealed pattern does not reflect all aspects of the peculiarities of the course of diseases at the present stage.

Clinical Example

Let us illustrate the complexity of diagnosis in the presence of intestinal bleeding by our own observation of a child with Markiafava-Micheli disease (paroxysmal nocturnal hemoglobinuria) [23]. This disease is a relatively rare acquired form of hemolytic anemia associated with changes in the structure of blood cells, with signs of intravascular hemolysis.At the genetic level, point mutations of the membrane protein gene are detected, which is manifested by a defect in the membranes of erythrocytes (Fig. 3), neutrophils, platelets and cells of erythrocyte colonies of the bone marrow [15]. The most resistant cells in a healthy person – reticulocytes – are more fragile in Markiafava-Micheli disease.

Fig. 3. Scanogram of erythrocytes in Markiafava-Mikeli disease. 1.- hypochromic erythrocyte, 2.- erythrocytes with a membrane defect in the form of pores

The main role in the pathogenesis of this disease belongs to thrombotic complications due to intravascular hemolysis of erythrocytes and stimulation of blood coagulation factors.The common name “paroxysmal nocturnal hemoglobinuria” does not correspond much to the essence of the disease, since in this disease there are neither real paroxysms, nor obligatory hemoglobinuria [11].

The disease begins gradually. The patient complains of weakness, malaise, dizziness. Sometimes patients pay attention to a slight yellowness of the sclera. Often one of the first complaints is headache, abdominal pain of various localization.Hemoglobinuria is rarely the first symptom of the disease.

Intense attacks of abdominal pain are one of the characteristic symptoms of the disease. They are associated with thrombosis of small mesenteric vessels.

Symptom complex, which includes hemolytic anemia, hemosiderinuria, a positive Hem test and a sucrose test, which allows to reveal an increased sensitivity of erythrocytes to complement, is quite informative for the diagnosis of paroxysmal nocturnal hemoglobinuria [10].At the molecular level, cytofluorometric analysis is used with monoclonal antibodies to membrane proteins, the expression of which is impaired in this disease.

There are no pathogenetic treatments. In severe cases, bone marrow transplantation is indicated. The use of cytostatic therapy does not justify the hopes placed on it.

Patients are prescribed transfusion of washed erythrocytes according to indications.In some cases, a positive effect was obtained from the use of nerabol, tocopherol. To combat thrombosis, heparin is used in small doses, as well as indirect anticoagulants.

Diagnosis of Markiafava-Micheli disease presents a certain difficulty, especially at the initial stages of its development with the dominance of the abdominal syndrome in the clinical picture. Here is the case history.

Patient L., 14 years old, a resident of Omsk, was admitted to the clinic with suspected Crohn’s disease. On admission there were complaints of abdominal pain, which were paroxysmal in nature, without clear localization, sometimes – blood in the feces. Obstetric and early history was unremarkable. Until the age of 10, he grew and developed in accordance with age, rarely got sick. From the age of ten, attacks of acute abdominal pain appeared, accompanied by repeated vomiting with an admixture of bile, sometimes blood, periodically with an increase in body temperature to subfebrile digits, icteric staining of the skin, and the appearance of dark urine.The attacks usually lasted 2-3 days and were relieved by parenteral administration of analgesics and antispasmodics. The frequency of attacks is once every two weeks. In the interictal period, the boy felt good. At the age of 11, the child was examined at the Hematology Department with a diagnosis of transient thrombocytopenia. The boy was repeatedly excluded from acute surgical pathology. When re-examined in the gastroenterology department –

NII was diagnosed with erythematous gastritis, erosive gastroduodenitis.At the age of 14, during one of the attacks of abdominal pain, tarry stools appeared. In connection with the suspicion of Meckel’s diverticulum, a mid-median laparotomy with intestinal revision was performed. Intraoperatively revealed a thickening of the wall of the jejunum, the presence of dark contents, reminiscent of blood, in the lumen of the ileum. Meckel’s diverticulum was excluded. When the colon was revised, no pathological formations were found. With suspicion of Crohn’s disease, the boy was sent to the Nizhny Novgorod Research Institute of Pediatric Gastroenterology.

On admission, the condition of moderate severity. Physical development is normal, harmonious. The skin is pale, with an earthy tinge, single petechiae. Peripheral lymph nodes are small, elastic. The marginal icterus of the sclera was determined. Respiration and hemodynamics are not impaired. The abdomen is soft, painful in the epigastrium, the pilo-duodenal zone, the left iliac region. Liver along the midclavicular line – 11 cm, palpable 3 cm from under the costal arch, dense consistency, slightly painful,

sharp edge.The spleen was not palpable. The stool is regular, shaped, without visible pathological impurities. In the blood test: HB – 96 g / l, Er – 3.3 x 1012 / l, Lake – 4.3 x 109 / l, reticular cells – 1%, segmented leukocytes – 18%, lymphocytes – 67%, monocytes – 14%, platelets – 28 %% = 106.4 x 109 / l, ESR – 26 mm / h. When carrying out X-ray and endoscopic examinations of the esophagus, stomach, small and large intestines, the source of bleeding was not revealed. The boy was excluded: Crohn’s disease, ulcerative colitis.

On the 5th day of hospitalization, he developed intense abdominal pain and dark urine in the morning. During this period, the blood test revealed a drop in the level of hemoglobin, erythrocytes, leukocytes and neutrophils (Fig. 4, 5, 6, 7). The drop in the number of neutrophils turned out to be longer and deeper, which is characteristic of this disease. In addition, reticulocytosis took place – 57 %% (3 gr-12.2%, 4 gr-22.8%, 5 gr-65%).In the analysis of urine – a positive reaction to hemosiderin. There is a significant amount of red blood cells in the coprogram. The fecal occult blood reaction is positive. The child has hemoly-

Fig. 4. Falling hemoglobin level during exacerbation of the disease

Fig. 5. The fall in the number of erythrocytes during exacerbation of the disease

1 in 5 days in 14 days in 26 days in 3-4 days in-40 days

Fig.6. The fall in the number of leukocytes during exacerbation of the disease

1 in 5 days in 14 days in 26 days in 34 days in 40 days

Fig. 7. Drop in the number of neutrophils during exacerbation of the disease

tic anemia in combination with hemosiderinuria, thrombocytopenia, leukopenia, intense bouts of abdominal pain and blood in the stool syndrome gave rise to the assumption of Markiafava-Micheli disease.More research has been done. Myelogram: irritation of the red sprout of hematopoiesis. Hem’s test is positive: erythrocyte hemolysis – 32.56% (N up to 5%). Sucrose test for hemolysis of erythrocytes is positive: direct – 14.23% (N up to 2-3%), cross – negative, with the patient’s erythrocytes – negative. The results of additional research and consultation with a hematologist confirmed the presence of Markiafava-Mikeli disease in the boy.

conclusion

The variety of causes of blood excretion in the feces creates certain difficulties in the diagnosis of diseases.Pediatricians are faced with the task of making a diagnosis in a timely manner and determining the optimal volume of laboratory and instrumental methods of examining a child.

Reported observation of a rare cause of rectal bleeding in children, not associated with a disease of the gastrointestinal tract,

indicates the need for further improvement of the algorithm for diagnosing syndrome

hemocolitis.

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CAUSES OF BLOOD IN STOOL IN CHILDREN. DISEASE CLINICAL CASE MARCHIAFAWA-MICHELE

Fedulova E. N., Bogomolov A. R.

♦ Resume.In the literature, despite the detailed description of the clinic for various reasons rectal bleeding, there are no data on the comparative characteristics of the various parameters of this feature, do not discuss the direction of the differential diagnosis and the use of laboratory and instrumental methods … The aim of the present work was to improve the differential diagnosis of diseases associated with blood in the stool in children, based on the determination of the structure of reasons for gemokolita uptake in gastroenterology hospital, as well as illustration of diagnostic search the example of disease Mar-chiafawa-Mikkeli.

♦ Key words: blood in the stool; children; differential diagnosis; disease Marchiafawa-Mikkeli.

♦ Information about the authors

Fedulova Elvira Nikolaevna – Doctor of Medical Sciences Sci., Head of the Department of the Clinic of Colon Pathology. FSBI “Nizhny Novgorod Research Institute of Pediatric Gastroenterology” of the Ministry of Health of the Russian Federation.603950, Nizhny Novgorod, st. Semashko, 22. E-taN: [email protected].

Feduiova Elvira Nikolaevna – MD, PhD, Head, Department of Clinical Pathology Colon. Federal State Institution “Nizhny Novgorod Research Institute of Pediatric Gastroenterology” the Ministry of Health of the Russian Federation. 22, Semashko St., Nizhny Novgorod, 603095, Russia. E-mail: [email protected].

Bogomolov Andrey Romanovich – Cand.honey. Sci., Head of the Endoscopy Department. FSBI “Nizhny Novgorod Research Institute of Pediatric Gastroenterology” of the Ministry of Health of the Russian Federation.