Blood in Stool (Hematochezia): Causes, Diagnosis, Treatment

Blood in the stool can be frightening, whether you discover it while wiping after a bowel movement or from a test ordered by your health care provider. While blood in stool can signal a serious problem, it doesn’t always. Here’s what you need to know about the possible causes of bloody stools and what you — and your doctor — should do if you discover a problem.

Causes of Blood in Stool

Blood in stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for hidden blood in the stool). At other times it may visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.

Possible causes of blood in stool include:

Diverticular disease. Diverticula are small pouches that project from the colon wall. Usually diverticula don’t cause problems, but sometimes they can bleed or become infected.

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Anal fissure. A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut. Fissures are often caused by passing a large, hard stool and can be painful.

Colitis. Inflammation of the colon. Among the more common causes are infections or inflammatory bowel disease.

Angiodysplasia. A condition in which fragile, abnormal blood vessels lead to bleeding.

Peptic ulcers. An open sore in the lining of the stomach or duodenum, the upper end of the small intestine. Many peptic ulcers are caused by infection with a bacterium called Helicobacter pylori (H. pylori). Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.

Polyps or cancer. Polyps are benign growths that can grow, bleed, and could become cancerous. Colorectal cancer is the fourth most common cancer in the U.S. It often causes bleeding that is not noticeable with the naked eye.

Esophageal problems. Varicose veins of the esophagus or tears in the esophagus can lead to severe blood loss.

Blood in Stool Diagnosis

It is important to have a doctor evaluate any bleeding in the stool. Any details you can give about the bleeding will help your doctor locate the site of bleeding. For example, a black, tarry stool is likely an ulcer or other problem in the upper part of the digestive tract. Bright red blood or maroon-colored stools usually indicate a problem in the lower part of the digestive tract such as hemorrhoids or diverticulitis.

After getting a medical history and doing a physical exam, the health care provider may order tests to determine the cause of bleeding. Tests may include:

Nasogastric lavage. A test that may tell your doctor whether bleeding is in the upper or lower digestive tract. The procedure involves removing the contents of the stomach through a tube inserted into the stomach through the nose. If the stomach does not contain evidence of blood, the bleeding may have stopped or is more likely in the lower digestive tract.

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Esophagogastroduodenoscopy (EGD). A procedure that involves inserting an endoscope, or flexible tube with a small camera on the end, through the mouth and down the esophagus to the stomach and duodenum. The doctor can use this to look for the source of bleeding. Endoscopy can also be used to collect small tissue samples for examination under a microscope (biopsy).

Colonoscopy. A procedure similar to an EGD except that the scope is inserted through the rectum to view the colon. As with an EGD, colonoscopy can be used to collect tissue samples to biopsy.

Enteroscopy. A procedure similar to EGD and colonoscopy used to examine the small intestine. In some cases this involves swallowing a capsule with a tiny camera inside that transmits images to a video monitor as it passes through the digestive tract.

Barium X-ray. A procedure that uses a contrast material called barium to make the digestive tract show up on an X-ray. The barium may either be swallowed or inserted into the rectum.

Radionuclide scanning. A procedure that involves injecting small amounts of radioactive material into a vein and then using a special camera to see images of blood flow in the digestive tract to detect where bleeding is happening.

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Angiography. A procedure that involves injecting a special dye into a vein that makes blood vessels visible on an X-ray or computerized tomography (CT) scan. The procedure detects bleeding as dye leaks out of blood vessels at the bleeding site.

Laparotomy. A surgical procedure in which the doctor opens and examines the abdomen. This may be necessary if other tests fail to find the cause of bleeding.

Health care providers also order lab tests when there is blood in stools. These tests may look for clotting problems, anemia, and the presence of H. pylori infection.

Associated Symptoms

A person with blood in the stool may be unaware of bleeding and might have reported no symptoms. On the other hand, they may also have abdominal pain, vomiting, weakness, difficulty breathing, diarrhea, palpitations, fainting, and weight loss depending on the cause, location, length, and severity of the bleeding.

Blood in Stool Treatments

A doctor may use one of several techniques to stop acute bleeding. Often endoscopy is used to inject chemicals into the site of bleeding, treat the bleeding site with an electric current or laser, or apply a band or clip to close the bleeding vessel. If endoscopy does not control bleeding, the doctor may use angiography to inject medicine into the blood vessels to control bleeding.

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Beyond stopping the immediate bleeding, if necessary, treatment involves addressing the cause of bleeding to keep it from returning. Treatment varies depending on the cause and may include medications such as antibiotics to treat H. pylori, ones to suppress acid in the stomach, or anti-inflammatory drugs to treat colitis. Surgery may be needed to remove polyps or the parts of the colon damaged by cancer, diverticulitis, or inflammatory bowel disease.

Depending on the cause, however, treatment may involve simple things you can do on your own. These including eating a high-fiber diet to relieve constipation that can cause and aggravate hemorrhoids and anal fissures, and taking a Sitz bath, which means sitting in warm water to relieve fissures and hemorrhoids.

Your doctor will prescribe or recommend treatment based on the diagnosis.

Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

What Is Ischemic Colitis?

Ischemic colitis is inflammation in your large intestine, or colon. It results from a lack of blood flow to the area, usually because an artery is blocked or narrowed.

You need blood flow to your colon because it brings oxygen that keeps your tissues alive. If the blockage goes on for too long, it can cause serious problems. But if you get treatment soon, you should heal quickly. Ischemic colitis is more common in people over 60, but younger folks can get it, too. You may hear your doctor call it ischemic bowel disease.

Ischemic Colitis Symptoms

You may notice:

Ischemic Colitis Causes

Doctors often can’t pinpoint the cause of ischemic colitis. But these things can raise your odds of getting it:

• Chronic constipation. This raises pressure inside your colon and makes it hard for blood to flow. If you have irritable bowel syndrome with constipation, you may be at even more risk.
• Hardening of the arteries (atherosclerosis). Fatty gunk can build up and clog the arteries in your intestines.
• Very low blood pressure or flow. This causes colon arteries to tighten and send more blood to your brain. A number of health problems can cause low blood pressure. But dehydration, heart failure, large blood loss, and shock are the leading reasons.
• A blood clot. One can form inside an artery wall or break off from somewhere else and move toward your colon. Certain health problems you get from your parents at birth can cause blood to clot too easily. Your doctor may give you tests to see if you have one of these conditions.
• Bowel blockage. This can result from a hernia, scar tissue, or a tumor.

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Surgery to repair an aortic aneurysm (a bulge in the artery) can lead to ischemic colitis. Other operations in your belly or your circulatory system can also cause problems.

The risk also goes up if you’re a long distance runner. During a marathon, blood flow may shift away from your gut to meet the oxygen needs of your leg muscles. Dehydration could play a role, too.

It’s rare, but some medications can trigger an ischemic colitis attack. These include:

Ischemic Colitis Diagnosis

Ischemic colitis is a master of disguise. Its symptoms can mimic other conditions, including a flare of ulcerative colitis or Crohn’s disease. Those long-lasting conditions result from a problem with your immune system, not low blood flow.

Doctors may ask for any of these tests to decide if you have ischemic colitis:

• Imaging tests, like CT scans and angiograms. These use X-rays at different angles to get a detailed image of your colon and blood vessels.
• Stool samples. Doctors look for infections that may be causing your symptoms.
• Colonoscopy. This test looks inside your colon. The doctor also may take tissue samples to confirm a diagnosis.

Ischemic Colitis Treatment

If you have a mild case — and most cases are mild — the inner lining of your colon is inflamed, sore, and bleeding. It usually heals on its own, but you may get antibiotics to prevent infection.

You’ll probably get IV fluids to keep you hydrated. To give your colon a rest while it heals, you won’t be able to drink or eat anything for a few days.

If you have a more serious case, a surgeon may need to remove dead tissue or repair your bowel.

After your treatment, you may need another colonoscopy to make sure there are no lasting problems.

For most people, an ischemic colitis attack is a one-time thing — it never happens again. In others, it can become an ongoing problem.

You might be able to prevent another episode. To stack the odds in your favor:

• Stay hydrated.
• Discuss your medications with your doctor. If one med triggered the problem, the doctor may know of others that will work better for you.
• Stop smoking. It damages virtually all your organs, including blood vessels.

Ischemic Colitis Diet

This condition results from a blocked artery. If you have it, you should eat a low-fat diet similar to what people with heart disease eat. Multiple small meals may be a better option, too. You may notice pain after you eat a fatty meal.

Is Ischemic Colitis Fatal?

If you have ischemic colitis and have pain on your right side or sudden belly pain that’s so severe you can’t find a comfortable position, head to the ER or call 911.

The artery feeding the right side of your colon also feeds part of the small intestine. A blockage there can quickly damage or kill tissue. If this life-threatening situation occurs, you’ll need surgery to clear the blockage and to remove the damaged part of the intestine.

Esophageal Varices Symptoms and Endoscopic Treatments for Cirrhosis

Varices are dilated blood vessels in the esophagus or stomach caused by portal hypertension. They cause no symptoms unless they rupture and bleed, which can be life-threatening.

Someone with symptoms of bleeding varices should seek treatment immediately. Doctors can stop the bleeding and help prevent varices from coming back.

Symptoms of Bleeding Varices

Symptoms include:

Bleeding from varices is a medical emergency. If the bleeding is not controlled quickly, a person may go into shock or die.

Even after the bleeding has been stopped, there can be serious complications, such as pneumonia, sepsis, liver failure, kidney failure, confusion, and coma.

Cause of Bleeding Varices

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). It’s often due to scarring of the liver, or cirrhosis.

This increased pressure in the portal vein causes blood to be pushed away from the liver to smaller blood vessels, which are not able to handle the increased amount of blood. This leads to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, and umbilical area (around the belly button). The varices are fragile and can rupture easily, resulting in a large amount of blood loss.

Treatments for Bleeding Varices

In severe cases, a person may need to be placed temporarily on a breathing machine to prevent the lungs from filling with blood. Antibiotics are also given immediately to reduce the risk of sepsis, a life-threatening blood infection.

Aside from the urgent need to stop the bleeding, treatment is also aimed at preventing more bleeding. Procedures that help treat bleeding varices include:

• Banding. A gastroenterologist places small rubber bands directly over the varices. This will stop the bleeding and get rid of the varices.
• Sclerotherapy. A gastroenterologist directly injects the varices with a blood-clotting solution instead of banding them.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS). A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent connects the hepatic vein with the portal vein. This procedure is done by placing a catheter through a vein in the neck. It is done to relieve the high blood pressure that has built up in the portal vein and the liver.
• Distal Splenorenal Shunt (DSRS). A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in the varices and control bleeding.
• Liver transplant. A liver transplant may be done in cases of end-stage liver disease.
• Devascularization. A surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt isn’t possible or unsuccessful in controlling the bleeding.
• Esophageal transection. A surgical procedure in which the esophagus is cut through and then stapled back together after the varicies have been tied off. Sometimes there is bleeding at the staple line

Can Bleeding Varices Be Prevented?

Treating the underlying cause of bleeding varices can help prevent their return. Earlier treatment of liver disease may prevent them from developing.

Certain medications, including the class of heart drugs called “beta-blockers,” may reduce elevated portal pressure and lower the likelihood of bleeding. Long-acting nitroglycerines are also used for this purpose.

Also, talk with your doctor about possible procedures that can be done and that have an effect on bleeding.

Causes, treatments, and what to know

When a person finds blood in the stool, it may be bright red, dark, or black. The color of the stool or blood may indicate where exactly the bleeding is in the digestive tract.

Doctors may perform a colonoscopy or endoscopy to find the source of blood clots in the stool. Once the doctor determines the location and the cause of the bleeding, they will attempt to stop the bleeding and prevent it from recurring.

Read on to learn more about the different causes of blood clots in the stool, some other symptoms that may occur, and some possible treatments.

Peptic ulcer disease is characterized by disruptions in the protective lining of the stomach, esophagus, and small intestine.

The cause of peptic ulcer disease is acidic gastric secretions or pepsin damaging the inner layers of the wall of the upper digestive system.

Improved hygiene and sanitation practices, along with effective treatments and awareness of the negative impact of certain drugs on the digestive system, have lowered the prevalence of peptic ulcer disease.

Symptoms

The symptoms of peptic ulcer disease may vary depending on the location and severity of the ulcer. Some symptoms may include:

• abdominal pain
• blood clots in the stool
• weight changes
• bloating
• recurrent episodes of blood in the vomit

Treatment

Doctors often prescribe antisecretory drugs, including h3-receptor antagonists and proton pump inhibitors, for people with peptic ulcer disease.

For some people, drug therapy alone is insufficient to treat peptic ulcer disease, so surgery may be necessary.

People with diverticulosis have multiple sacs, or diverticula, that develop along the digestive tract. If these sacs become inflamed or infected and bleed, the condition becomes known as diverticulitis.

Symptoms

Often, people with diverticulosis do not have any symptoms.

If symptoms do occur, they may include:

• cramping
• abdominal pain
• alterations in bowel habits
• blood in the stool
• fever

Treatment

Increasing fluid and fiber in the diet can help prevent diverticulitis. However, if any symptoms of diverticulitis occur, it is very important to seek medical attention. In severe cases, inflamed or infected diverticula can burst, causing severe pain and possibly leading to death.

Treatment for diverticulitis may include anti-inflammatories for mild cases or antibiotics, a liquid diet, or surgery for more serious cases.

Hemorrhoids may develop inside or outside of the anus. Hemorrhoids are veins in the anus that become swollen, or dilated, due to excessive pressure. This may be due to straining during bowel movements, pregnancy, standing, or frequently sitting still for long periods of time.

Symptoms

People may experience symptoms of swollen hemorrhoids. These may include:

• itching
• bleeding
• pain
• burning
• prolapse
• mucus discharge
• swelling
• difficulty keeping the anus clean

Treatment

The first step in treating hemorrhoids includes making dietary and lifestyle changes. These include:

• minimizing straining during bowel movements by adding more fiber, hydration, or stool softeners to the diet
• increasing minimally strenuous exercise, such as walking
• not spending excess time on the toilet
• avoiding aggressive wiping
• walking around more, which will keep the blood moving and prevent clotting

When lifestyle and dietary changes do not help, or if a person’s hemorrhoids are particularly painful, it is best to seek medical attention. A doctor may prescribe topical medications to help with swelling, pain, or itching. Over-the-counter medications may also help.

If the hemorrhoids are particularly large, seem swollen, or do not respond to other treatments, a doctor may recommend procedures such as rubber band ligation, laser therapy, or cryotherapy. Some people may require surgery.

Home remedies may also help treat hemorrhoids. Learn more about them here.

Ischemic colitis occurs when there is at least a 75% reduction in blood flow to the intestine for more than 12 hours. Ischemia can occur in the small or large intestine.

Symptoms

The symptoms of ischemic colitis include abdominal pain, abdominal tenderness, and bloody diarrhea.

Treatment

The majority (80.3%) of cases are manageable without surgery.

Some treatment options include:

• bowel rest
• intravenous fluids
• broad-spectrum antibiotics

However, ischemic colitis has a high mortality rate if it gets to a point where surgery is necessary. For this reason, a doctor must intervene as quickly as possible.

Rarely, a person may need a blood transfusion. At other times, a doctor may prescribe antibiotics to prevent sepsis. Opioids may help with the pain.

Learn more about ischemic colitis here.

There are two types of inflammatory bowel disease (IBD): ulcerative colitis and Crohn’s disease. Ulcerative colitis typically affects the rectum but may extend farther up into the large intestine. Crohn’s disease can affect any part of the intestine.

IBD occurs in genetically predisposed people who experience an inappropriate immune response to the naturally occurring bacteria in the colon.

Symptoms

People with ulcerative colitis may have bloody diarrhea with or without mucus. They may also experience abdominal pain and a feeling of incomplete evacuation after bowel movements.

Crohn’s disease is associated with different symptoms that may not always include blood clots in the stool.

Treatment

Since IBD is an immune condition, doctors may prescribe immune-suppressing medications. The goals of treatment are to reduce flare-ups and induce remission.

Some drugs for IBD include:

• aminosalicylate agents
• oral glucocorticoids
• TNF-alpha monoclonal antibodies

Around 25% of people with IBD require surgical removal of the intestine.

People with colon cancer or growths in their colon, called polyps, often require a colonoscopy. During a colonoscopy, a gastroenterologist may remove the polyps or growths by polypectomy.

Polyps do not usually cause any symptoms, but sometimes, a person may notice blood clots in the stool or when wiping after a bowel movement.

Some people may see blood clots in the stool from the polyp removal. However, bleeding after polypectomy is common and usually resolves spontaneously without medical intervention.

Symptoms

Some people do not experience any symptoms of colon cancer. Doctors suggest that some people may experience:

• a change in bowel habits
• a constant urge to pass a bowel movement
• rectal bleeding with bright red blood
• black or dark colored stool
• cramping or abdominal pain
• weakness and fatigue
• unintentional weight loss

Anyone who experiences any of these symptoms should speak with a doctor or other healthcare provider about testing for colon cancer.

Treatment

In early stage colon cancer, a surgeon may operate on the colon to remove the cancerous lesions and surrounding tissue. Sometimes, people may require both surgery and medication.

Depending on the characteristics of the cancer cells, a doctor may choose from the following anticancer therapies:

Colon cancer is preventable and highly treatable with early diagnosis. This is why the American Cancer Society recommend that people begin regular screening for colon cancer at 45 years until they reach 75 years.

A person should undergo screening to catch any early signs of the condition. It is most treatable at this stage.

Gastric antral vascular ectasia is a rare cause of upper digestive system bleeding.

Around 71% of people with gastric antral vascular ectasia are female, and the average age of people who have it is 73 years old.

Symptoms

People with gastric antral vascular ectasia may experience blood clots in the stool from bleeding in the stomach. They may also experience vomiting and abdominal pain.

To check the appearance of the stomach and upper intestine, a doctor will perform an endoscopy.

People with gastric antral vascular ectasia may have “a watermelon stomach,” which is characterized by small dilated blood vessels and patchy red areas in the stomach.

Treatment

Researchers are still studying potential treatment methods for gastric antral vascular ectasia.

People with severe bleeding may require a blood transfusion. Surgery and medications are also options. Medications, however, have yet to show any satisfactory or effective long-term results.

If a person finds blood in their stool, they should seek medical attention in order to rule out any life threatening or serious conditions.

If the blood appears in the form of blood clots, the person may have had an internal bleed for a while.

Bright red blood may indicate bleeding closer to the anus and rectum. Dark blood may indicate bleeding in higher areas of the digestive system, such as the stomach.

People who find blood clots in their stool should consult a doctor or other healthcare provider immediately.

Although some causes of blood clots in the stool are non-life-threatening, such as hemorrhoids, some causes are more serious.

For cancer, early detection is necessary to try to prevent worsening and spreading.

Once a doctor determines the cause of blood clots in the stool, they will direct the person to the most appropriate treatment.

Blood in Stool | Primary Care

Causes of blood in stool

Less serious causes of blood in the stool include:

• Food poisoning — harmful bacteria in food can cause bloody stool
• Hemorrhoids — swollen blood vessels in the rectum or anus
• Anal fissure — a tear in the lining of the anus

More serious causes of bloody stool include:

• Chronic inflammatory bowel diseases such as Crohn’s disease or Ulcerative Colitis
• Colon polyps — These usually harmless, benign growths form on the lining of the colon and can sometimes grow or become cancerous
• Colon or anal cancer

Risk factors for blood in stool

The risk of finding blood in your stool could increase if you have:

• A history of stomach bleeding or hemorrhoids
• Had previous peptic ulcers (open sores in the upper digestive tract)
• Undiagnosed or diagnosed inflammatory bowel disease
• A genetic, pre-disposed risk for colorectal or upper GI cancers

Symptoms of blood in stool

Blood present in the feces can appear bright red or black and tarry.

Symptoms that are often present in conjunction with blood in your stool are:

• Abdominal pain
• Fatigue
• Weakness
• Shortness of breath
• Pale skin

Diagnosis of blood in stool

A primary care doctor should evaluate you if you find blood in your stool. During a physical exam, your physician will ask a series of questions to try and determine the location of the bleeding. If the blood is bright red or maroon-colored, it could indicate a digestive tract issue such as hemorrhoids. If the blood is black or tarry, it could indicate an ulcer or other upper GI condition.

To confirm the diagnosis, your doctor may order a series of diagnostics including:

• Hemoccult test — this simple test may detect hidden blood in your stool, but cannot determine where the cause of bleeding.
• Esophagogastroduodenoscopy (EGD) — during this procedure, your doctor inserts an endoscope into the stomach to determine the source of the bleeding.
• Nasogastric lavage — helps your doctor see where the bleeding is occurring; during the procedure, the contents of the stomach are removed to determine if the stomach is bleeding, if there is not evidence of bleeding in the stomach, the cause of the bleeding is likely in the lower digestive tract.
• Colonoscopy — your doctor will insert a scope into the rectum to view the colon and collect tissue samples for biopsy.
• Enteroscopy — checks the small intestine for any abnormalities; your doctor will insert a tube with a camera attached into your mouth or rectum and threaded to the upper or lower digestive tract, as the camera passes through the digestive track, it takes images to help diagnose the location of the bleeding.
• Barium x-ray — barium is swallowed or inserted into the rectum, helping display the digestive system on an x-ray.
• Angiography — can determine the location of the bleeding in the digestive tract; during the procedure, a dye is injected into a vein so the vessels will show up on an x-ray or CT scan.

Treatment for blood in stool

Initial treatment for blood in the stool is to stop the bleeding. Once the bleeding has stopped, your doctor will develop a plan to treat the cause of the bleeding.

Depending on the cause, your doctor may recommend:

• Medication — antibiotics, anti-inflammatories or medications to suppress stomach acid are commonly prescribed to stop rectal bleeding
• Surgery — could be required to repair or remove digestive tract abnormalities

What to Do If You Have Rectal Bleeding (With or Without Pain) – Health Essentials from Cleveland Clinic

Whenever you discover you’re bleeding, it gets your attention. And it’s often easy to find the source of the blood. But when it’s rectal bleeding, the source isn’t so easy to pinpoint. And this can make anyone worry. So what are the most likely sources of rectal bleeding?

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Colorectal surgeon Massarat Zutshi, MD, discusses likely causes of rectal bleeding and explains why you should work with your doctor to find the cause if it happens to you.

What causes rectal bleeding?

1. Hemorrhoids. It’s normal for everyone to have hemorrhoids inside and outside of the anus. But there are several reasons they may become irritated. If you notice blood on your toilet tissue or in the toilet, the factors that may point to hemorrhoids include:

• Constipation.
• Diarrhea.
• Low-fiber diet.
• Heavy lifting.
• Hard stools.

2. Anal fissures. If there are tears in the tissue of the anus, then you may experience both rectal bleeding and pain during and after a bowel movement. Typical causes of anal fissures include:

• Chronic constipation.
• Diarrhea.
• Straining.
• Anal intercourse.

3. Diverticulosis. When tiny pockets, or diverticula, form in the lining of the bowel, you have diverticulosis. Pressure on weak spots in the intestinal wall may cause these tiny pockets to form.
4. Colon cancer. In a very small number of cases, rectal bleeding is a sign of colon cancer. You also may notice other symptoms, such as unexplained weight loss or pain in your abdomen.

Colon cancer typically starts with polyps in the colon. Early detection is the goal here, Dr. Zutshi says. Polyps are typically benign at first, and a surgeon can remove them before they become cancerous if you catch the problem early.

Dr. Zutshi emphasizes that hemorrhoids and anal fissures are responsible for rectal bleeding about 98 percent of the time. However, it’s important to let your doctor know if you experience rectal bleeding so he or she can rule out any other problems.

What will your doctor need to know?

It’s helpful if you can make a note of how long you’ve been experiencing rectal bleeding, if it stops then starts again, and how long it lasts.

Other important information your doctor should know includes:

• Do you see the blood in the stool and/or in the toilet bowl?
• What color is the blood?
• Does the blood always show up with a bowel movement?
• Are you experiencing pain?
• What is your family medical history?

Plan to start screenings after age 50

Even if you aren’t experiencing problems or noticing any rectal bleeding, Dr. Zutshi emphasizes that it’s vital to begin having colon cancer screenings when you turn 50. She adds that you should start having regular screenings earlier (10 years before the age of the relative when they were diagnosed with cancer) if you have any history of colon cancer in your family.

Eating a high-fiber diet and staying well hydrated can help address rectal bleeding, she says. And, you should continue those healthy habits after the bleeding stops to help keep it from recurring.

Stools with blood | University of Iowa Hospitals & Clinics

Stools with blood can be caused by many different conditions. If you are experiencing bloody stools or bleeding from a bowel movement, you may need to see a doctor. 

Seek immediate medical attention if you are experiencing fever, excessive weakness, vomiting, or seeing large amounts of blood in your stool. 

What does a bloody stool look like?

• Red blood mixed with the stool
• Red blood covering the stool
• Black or tarry stool
• Dark blood mixed with the stool

If you stool is red or black, it might not be from blood. Certain foods may cause your stools to look red. These include cranberries, tomatoes, beets, or food that is dyed red. Other foods may cause your stools to look black. These include blueberries, dark leafy vegetables, or black licorice. 

Common causes

Hemorrhoids

Blood vessels near the anus that become swollen, due to increased pressure, can bleed or prolapse. Typically, the amount of bleeding from hemorrhoids is small and may be a few drops that appear on toilet paper after passing a stool. Hemorrhoids can occur inside the anus or under the skin around the outside of the anus. The condition is very common, normally painless, and does not lead to cancer. 

If bothersome enough, hemorrhoids can be removed by your doctor. Your doctor may first treat any underlying causes, such as constipation. 

Anal fissures

Small tears in the lining of the anus, typically from constipation or diarrhea, can cause blood with stools. They are painful during and following bowel movements. If you have anal fissures, take measures to prevent constipation or diarrhea. Over-the-counter fiber supplements can help. Your doctor can prescribe additional options to treat an anal fissure that isn’t healing on its own.

What else could it be?

Your doctor can determine the exact cause of stools with blood. Underlying disorders and complications of this condition can be serious. If you’re concerned, always err on the safe side and see a doctor.

Pay attention to what the blood in your stool looks like. 

• How much blood is there? 
• How often does it occur? 
• What color is the blood? 

This will help your doctor zero in on the problem. 

Blood in stools can come from any area of the gastrointestinal tract. 

This includes 

• Esophagus 
• Stomach 
• Small intestine 
• Large intestine 
• Rectum 

If the blood is red it typically means it came from the lower digestive tract or rectum. If the blood is darker or black, it typically means it came from the upper digestive tract. Whether or not the blood is mixed with the stools or covering it, can also help determine where it came from and what is causing it. 

Additional causes of stools with blood include

Your doctor will need to do an evaluation to determine if any of these conditions are the underlying cause. 

Tests to find the cause

If you are experiencing stools with blood, your doctor may perform one or more of these tests.

• Colonoscopy- A small device with a camera is inserted in your colon to look for abnormalities.
• Upper endoscopy-A small device with a camera is used to look inside the upper digestive tract.
• Stool culture- A sample of your stools is taken to look for abnormalities.
• Blood test- A sample of your blood is tested for a number of different potential issues.
• Capsule endoscopy- A tiny capsule, with a camera inside, is swallowed to take pictures of your digestive track. 

All causes of bloody stools should be determined and monitored by your doctor.

90,000 Blood in the stool – Coloproctology – Day (surgical) hospital – Departments

Blood in stool

The appearance of blood in the stool is one of the most serious and alarming signs of bowel disease. Blood in the feces is a signal of a violation of the integrity of the intestinal mucosa and blood vessels. Tentatively, when questioning the patient and by the nature of the complaints, one or another disease can be assumed.

Scarlet blood, not mixed with feces.
Typical for internal hemorrhoids, anal fissures.

Scarlet blood on toilet paper.
Typical for internal hemorrhoids, anal fissures, rectal cancer.

Blood and mucus on linen.
Typical for late stages of hemorrhoids, rectal prolapse.

Blood on linen without mucus.
Typical for rectal cancer.

Blood and mucus mixed with feces.
Typical for ulcerative colitis, proctitis, polyps and rectal tumors.

Massive bleeding.
May be with colon diverticulosis, ischemic colitis.

Black feces (melena).
Characteristic for bleeding from dilated veins of the esophagus with cirrhosis of the liver, ulcers and stomach cancer.

In most cases, the causes of blood in the stool are relatively benign – with hemorrhoids, cracks in the anus. But this can be a manifestation of very serious diseases – polyps, intestinal tumors.In this regard, it is absolutely imperative that at the first appearance of blood in the stool, you will turn to a doctor, preferably proctologist and undergo the necessary examination, currently, first of all, colonoscopy . This is the key to timely treatment and a successful outcome.

In the Polyclinic it is possible to perform gastro- and colonoscopy under conditions of medication sleep (under general anesthesia). The examination without pain and discomfort allows the doctor to diagnose with greater accuracy and efficiency.

Proctology

Proctology (from the Greek proktos – ‘anus’, logos – ‘teaching’) is a branch of medical science that deals with the diagnosis, treatment and prevention of diseases of the perineum, rectum and other parts of the large intestine.

Modern proctology combines all the latest achievements of medical science in the field of diagnosis and treatment of various diseases. Unfortunately, according to statistics, the number of people facing similar problems is increasing every day.Around the world, millions of patients seek medical help with ailments such as:

• hemorrhoids
• anal fissure
• colitis
• paroproctitis
• constipation
• diarrhea
• dysbiosis
• rectal polyps
• coccygodynia condyloma
• anal opening
• rectal cancer

Only a highly qualified proctologist can solve these problems in a modern medical institution.Among the diagnostic techniques used in modern proctology, it should be noted such as: anoscopy, rectoscopy, sphincterometry, colonoscopy, ultrasonography, irrigoscopy, fistulography, biopsy, laboratory blood tests and stool analysis, as well as DNA diagnostics.

Screening (“screening” examination) of diseases of the colon is based on fecal occult blood samples and digital rectal examination. The best method for detecting early forms of colon tumors is primary colonoscopy, which is required for all people over 40 years of age.

Proctological diseases during screening are detected in every fourth adult who considers himself practically healthy. In most cases, these are asymptomatic colon polyps.

Who needs to visit a coloproctologist

• patients complaining of pain in the abdomen and rectal area, constipation, unstable stools, blood and mucus in the stool
• people over 40 years old
• women before childbirth and pregnancy

90,058 people with a burdened family history (tumors and polyps, inflammatory diseases of the colon in relatives) 90,059 90,058 patients with previous coloproctological diseases

• people having anal sex
• people exposed to harmful factors: a sedentary lifestyle, occupational hazards (drivers , people working with hazardous substances and conditions of increased dustiness)
• with injuries of the perianal region and rectum (foreign objects)
• with frequent temperatures to low numbers (subfebrile) 37.1 – 37.5
• when changing blood tests: new a decrease in the level of leukocytes, increased ESR, anemia.

Symptoms

Clinical manifestations of diseases of the colon are diverse and not always clearly expressed. In most of them, a period of latent (asymptomatic) course is noted, then weak signs of the disease appear, which are almost not recorded by the patient himself and most often expressed by “intestinal discomfort”: there are periodic increases in stool frequency or delay, discomfort in the lower abdomen or a feeling of swelling, sensation foreign body in the rectum, etc.n. These initial manifestations of diseases of the large intestine become intense and constant over time and are accompanied by acute pain, severe constipation or diarrhea, mucus and blood, itching in the perineum, fever, exhaustion, intoxication, etc.

• Pain in abdomen is a fairly characteristic symptom of diseases of the colon and ampullar rectum, but they cannot be considered an early manifestation. Pain can be constant or cramping. Cramping pains usually indicate a limited narrowing of the intestine as a result of various pathological processes. Less often, they are noted with intestinal dyskinesia with a predominance of the spastic component.Persistent abdominal pain is more characteristic of progressive inflammatory lesions; they are observed in granulomatous and nonspecific ulcerative colitis, irritable bowel syndrome, bowel tumor with perifocal inflammation, diverticulosis with diverticulitis and the formation of an inflammatory infiltrate or the development of peritonitis.
• Pain in the anus and perineum is often constant, bursting, or twitching and burning. With an acute anal fissure, acute thrombosis of hemorrhoids, acute paraproctitis after an act of defecation, they can become intolerable.A number of diseases of the rectum (benign tumors, chronic fistulas, cancer, etc.) can proceed for a long time without pain. With the most common disease of the rectum – uncomplicated hemorrhoids – pain usually does not occur or they are mild (a feeling of swelling).
• The discharge of mucus and pus from the anus can be noted only during bowel movements or be permanent (with rectal fistulas and anus sphincter insufficiency). In the latter case, maceration of the perianal skin often occurs, multiple erosions and poorly healing deep cracks occur, which is accompanied by itching, burning and sharp pain.An admixture of mucus and pus to feces is usually observed in chronic and acute proctitis, proctosigmoiditis, ulcerative and granulomatous colitis, as well as in villous tumors and cancer of the rectum and sigmoid colon. The secretion of mucus and pus in these cases is often combined with an admixture of blood.
• Bleeding or blood in the stool is one of the most common and serious symptoms of diseases of the rectum and colon. Admixture of blood during bowel movements can be a symptom of a malignant tumor! Discharge of drops of scarlet blood or even jet bleeding, more often at the end of the act of defecation, is characteristic of hemorrhoids and anal fissures.Sometimes such hemorrhage leads to a loss of 100-200 ml of blood per day and, with frequent repetitions, causes the development of anemia. Macroscopically determined blood streaks and blood clots in the feces are usually observed in inflammatory processes (colitis), diverticulosis and tumors. The more proximal is the source of bleeding in the colon, the more homogeneous the admixture of blood to the feces and the darker their color. With bleeding from the cecum and the ascending intestine, the blood can be so strongly changed under the influence of intestinal enzymes that the feces take on a typical tarry appearance, as with bleeding from the upper gastrointestinal tract.
• Slightly altered blood in a liquid state or in the form of clots can be released during bowel movements in patients with ulcerative colitis and Crohn’s disease of the colon, with diverticulosis, as well as with disintegrating and ulcerated villous and cancerous tumors. Profuse bleeding is rarely observed in diseases of the colon. They can occur with diverticulosis of the colon, less often with ulcerative colitis and Crohn’s disease of the colon.
• Anemia in diseases of the colon develops more often due to chronic or acute blood loss.In cancer localized in the right sections of the colon, anemia is often observed and is caused by both chronic blood loss and impaired hematopoiesis due to intoxication, which develops early and rapidly at this localization of the tumor.
• Constipation – difficulty in the act of defecation and stool retention up to the absence of it for several days and weeks – is a common symptom of both functional and organic diseases of the colon. Functional constipation can be atonic and spastic and, depending on this, proceed with less or more severe pain syndrome.With organic narrowing of the colon (cicatricial strictures, tumors, external compression, etc.), constipation usually precedes or is one of the symptoms of partial intestinal obstruction, often progressing to complete obstruction. The alternation of constipation and diarrhea is often a symptom of irritable bowel syndrome.
• Colon obstruction is a syndrome of violation of the passage of contents through the large intestine, manifested in the absence or delay of stool, difficulty in passing gas, bloating and distension of the abdomen, persistent and cramping pains, an increase in other dyskinetic phenomena (impaired appetite, nausea, vomiting, etc.).P.). Obstruction can be partial or complete and is more often observed with tumor lesions of the colon, but it also occurs with functional (atonic and spastic constipation, coprostasis, etc.). With the progression of colon obstruction, it grows as local (bloating, signs of inflammation of the peritoneum ) and general (symptoms of intoxication and metabolic disorders) disorders. Partial obstruction of the large intestine is characterized by periodic but incomplete passage of stool and gases, sometimes a change of constipation with diarrhea, temporary cessation of pain and bloating, short or long periods of remission with an improvement in general condition, especially under the influence of therapeutic measures (enemas, light laxatives).
• Bloating can occur not only with constipation and intestinal obstruction. It is often associated with flatulence caused by alimentary disorders, congenital or acquired enzymatic insufficiency (especially in the upper gastrointestinal tract), as well as colon dysbiosis, irritable bowel syndrome. In modern conditions, dysbiosis occurs especially often due to the widespread use of various antibacterial and antiseptic drugs.There is also reason to believe that dysbiosis and associated bloating are largely determined by inappropriate nutrition, especially among the urban population (the predominance of high-calorie animal products with a high content of fats and proteins, a small amount of vegetable fiber).
• Diarrhea – frequent loose stools – is a characteristic symptom of a number of non-infectious diseases of the colon (colitis, diffuse polyposis). In nonspecific ulcerative and granulomatous colitis, diarrhea is often accompanied by tenesmus.Diarrhea can be a symptom of dysbiosis, irritable bowel syndrome.
• Tenesmus – frequent false urge to defecate (without excretion of feces or with the separation of a small amount of mucus, blood or liquid intestinal contents) – exhaust patients and may be accompanied by maceration of the perianal skin, the formation of cracks and erosions. Tenesmus is a consequence of reflex excitation of motor activity in the distal colon, especially the rectum, as a result of inflammatory changes in the sensory zone of the mucous membrane of the anal rectum, often the main symptom of a tumor in the lower ampullar rectum.
• Fecal and gas incontinence is observed with congenital or acquired anatomical lesions of the sphincter apparatus of the rectum or a violation of its reflex regulation of the central, including psychological, or peripheral nature. Most experts distinguish between three clinically determined degrees of insufficiency of the sphincter of the anus: I degree – incontinence of gases, II degree – incontinence of gases and liquid feces, III degree – incontinence of gases, liquid and solid feces.

Many pronounced forms of diseases of the colon of an inflammatory and tumor nature (diffuse polyposis, cancer, malignant lymphomas, hemangiomas) occur with significant metabolic disorders, which is clinically expressed in an increase in weakness, exhaustion, slowdown in the growth and development of the patient, dysfunction of the genital organs …

90,000 ᐈ BLOOD IN THE FEEL from the anus during bowel movements: causes, treatment – Mediland

Blood from the anus during bowel movements is a fairly common problem for which patients go to the doctor.Immediately, we note that not a single qualified proctologist can tell you the reason for this phenomenon without a proctological examination and, possibly, a subsequent examination – this is a colonoscopy and ultrasound with a rectal sensor.

Why? The answer is simple – blood in the stool is a symptom of a whole list of diseases of the rectum and anal canal, as well as diseases outside the colon.

The cause of the appearance of blood in the stool can be diseases of the rectum and anal canal, such as:

In addition, an admixture of blood in the feces can appear in diseases localized outside the colon:

• cancer of the overlying parts of the digestive tract,
• gastric or duodenal ulcer,
• varicose veins of the esophagus, etc.

Abundant admixture of dark blood in liquid feces may indicate massive bleeding in the upper digestive tract. And abundant discharge of light blood from the rectum is more typical for diseases of the colon.

Blood in the stool is a symptom of very dangerous diseases, so we strongly recommend that you consult a proctologist for these symptoms.

The proctology office of the Mediland medical center is equipped with modern equipment, which allows making the correct diagnosis and drawing up an individual treatment plan.

Doctors, proctologists, MC “Mediland”

Mishchenko Mikhail Vladimirovich

Doctor proctologist of the highest category, surgeon

Zheltonozhskaya Yulia Borisovna

Surgeon, proctologist

Bakhtizin Maxim Andreevich

Surgeon, proctologist

It is important to know

What to do

The behavior of the patient upon detection of blood in the stool depends on its quantity.

If the amount of blood is significant, accompanied by a sharp (frequent) urge to defecate and loose stools – this may indicate significant intestinal bleeding and requires an immediate call to an ambulance.

In the presence of streaks of blood in the feces, in the presence of feces mixed with blood (without diarrhea), traces of blood on toilet paper, drops of blood in the toilet after a bowel movement – you must consult a proctologist (coloproctologist).

What not to do

Never waste time with profuse rectal bleeding. This delay endangers the patient’s life.

Do not consult with friends and acquaintances about what to do with small impurities in the feces.Indeed, without a special examination, even a doctor will not be able to say for sure what the problem is. That is why competent and responsible doctors do not treat the patient “over the phone”, and even if they give remote recommendations, they still insist on a personal examination in the future.

Do not be afraid of a visit to a doctor and diagnostic procedures. Remember that in the hands of a qualified specialist, all diagnostic and therapeutic procedures are performed correctly and do not cause severe physical and mental suffering to the patient.

Don’t read scary stories about proctologists on the Internet. Very often the problems described in them are of a subjective nature and are associated with a low level of culture and qualifications of the specialist, based on the results of the visit to which a review was written. Don’t extrapolate negative examples to medicine in general.

Remember, the loss of time in matters of diagnosis and treatment very often turns simple cases of diseases into big health problems!

90,079 90,000 ✔ Blood in feces – causes, diagnosis and treatment

Blood in the stool or discharge of blood from the anus is a symptom of many diseases of the anal region, anal canal, rectum and colon.Blood in the stool indicates any damage to the intestinal mucosa or vessels. This is one of the first symptoms of the first degree of hemorrhoids (at a young age) and bowel cancer after 45 years. If this symptom appears, an urgent need to consult a doctor. Try not to panic, just don’t postpone your visit to the proctologist.

IMPORTANT: the absence of other symptoms, except such as blood in the stool, does not exclude a disease more serious than hemorrhoids, requiring urgent treatment.

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.

Make an appointment

What diseases can there be blood in the stool?

• Anal fissure;
• Hemorrhoids;
• Cryptite;
• Proctitis;
• Polyps of rectum, colon;
• Cancer of the rectum, colon;
• Cancer of other parts of the intestine and stomach;
• Intestinal diverticula;
• Ulcer of the stomach or duodenum;
• Ulcerative colitis;
• Terminal ileitis of various nature;
• Crohn’s disease;
• Varicose veins of the esophagus;
• Injury of the anus;
• The consequences of anal sex.

Blood in the stool is one of the main symptoms of colon cancer, which does not exclude hemorrhoids. Self-diagnosis and even more self-medication in this case are not only inappropriate, but also pose a direct threat to the patient’s life.

Make an appointment

Whom to contact, how to prepare for the examination?

If blood is found in the stool, you should immediately contact a coloproctologist. If you are concerned about this particular symptom, then you do not need to carry out a thorough bowel preparation.It is advisable to put a small cleansing enema (the so-called “pear”) only 1-2 hours before the initial examination. There are no restrictions on food intake. If you make an appointment after work in the evening, and there is no opportunity to prepare, then a cleansing enema can be given after the morning chair.

If during the initial examination such diagnostic methods as sigmoidoscopy are planned, you need to prepare more carefully. How to prepare for examination by a proctologist with sigmoidoscopy read here.

Preparation for admission to the Proctology Clinic

Preparation for examination by a proctologist and sigmoidoscopy can be carried out directly at the Proctology Clinic of the Altermed network. If self-preparation of the intestines is difficult for you for some reason or you can come to the doctor’s appointment only in the evening, after work, we have the opportunity to prepare in a specially equipped room. Such preparation will lengthen the reception by about 20 minutes, but it will save you from fasting and other problems associated with self-preparation.

IMPORTANT: normally, blood from the rectum cannot be released. Feces with blood is always a sign of a disease. Therefore, your visit to the doctor must be urgent!

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.

Doctors

All doctors

90,000 Blood in the stool and similar to hemorrhoids.What you need to know about Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are complex diseases about which we know little criminally. Of course, the topic of conversation is not the most pleasant: it is not customary to speak out loud about symptoms like diarrhea, flatulence and blood in the stool. But how to live with it? What is it like to treat people who are difficult to help? The chief freelance gastroenterologist of the Ministry of Health of the Republic of Belarus, Professor of the Department of Gastroenterology and Nutritionology of the BelMAPO Yulia Gorgun, on May 19, on the day of awareness of inflammatory bowel diseases, told in what cases it is not worth postponing visits to the doctor, how can these difficult diseases be treated and why excessive hygiene is not always good.

Crohn’s disease is an inflammation of parts of the digestive tract. It is accompanied by permanent bleeding in the intestines, diarrhea, and abdominal pain. Sometimes the patient has to go to the toilet up to 20 times a day.

Ulcerative colitis – inflammation of the colon mucosa. The disease is chronic. It is due to both genetic predisposition and the influence of the external environment. In general, its symptoms are similar to Crohn’s disease: frequent loose stools with purulent and bloody discharge, loss of weight and appetite, pain in the left abdomen, and frequent urge to defecate.

– What is this group – inflammatory bowel disease (IBD) – and what symptoms does it manifest itself?

– This group of diseases, which mainly affect the intestines, includes ulcerative colitis and Crohn’s disease. They share both common characteristics, for example, the development of chronic inflammation in the intestine, and differences. So, with ulcerative colitis, the large intestine is affected, with Crohn’s disease – any part of the intestine: the large, small and even other organs: the stomach, duodenum, esophagus.

The most common symptom is diarrhea, and stools become more frequent and thinner. Sometimes blood may appear in it. This is always an unfavorable sign. There are other symptoms: abdominal pain, discomfort, flatulence, dramatic weight loss. Sometimes there are signs of general inflammation: an increase in temperature, changes in the blood test (an increase in the level of leukocytes, erythrocyte sedimentation rate – what usually indicates inflammation). If a person is sick for a long time, anemia may develop.

Photo: Alexander Vasyukovich

– How large is the IBD problem in Belarus?

– If you look at the official statistics, by the end of 2016 we had about 3000 patients with ulcerative colitis and about 600 with Crohn’s disease.Whether it is a lot or not – in my opinion, the situation is relative. Now it is not the absolute number of patients that is more relevant, but the fact that the incidence is growing. We have been keeping official statistics since 2008. During this time, the number of patients with similar diseases has more than tripled.

Perhaps the leap is simply due to improved diagnosis and case reporting. We can identify them due to the fact that new research methods have appeared, doctors have become more informed about the disease. At the same time, along with the improvement in diagnostics, there is probably a true increase.A similar situation is observed in other countries of Eastern Europe, while in Western Europe the number of such patients is much higher than in our country.

Ulcerative colitis and Crohn’s disease are called diseases of civilization. The more highly developed a country is, the higher the standard of living in it, the more often these diseases occur.

– Where does this pattern come from?

– This is not known entirely. Ulcerative colitis and Crohn’s disease are diseases of unknown etiology, that is, it is not clear what is their immediate cause.But it is known that there is a genetic predisposition to these diseases. However, one genetic background is not enough – the disease develops if other unfavorable factors are still superimposed on genetics: dietary habits, intestinal infections, frequent use of certain medications, smoking and others. The combination of these factors triggers chronic inflammation.

Why are IBD more common in Western countries? Perhaps because, among other things, there are certain dietary habits – what we call the Western diet, When eating fewer vegetables, fruits, organic foods, more junk food, trans fats, salt and sugar, and processed red meat.

In developed countries, the prevention of infectious diseases is being actively pursued. Much attention is paid to sanitary and hygienic conditions, vaccination is carried out. On the one hand, this is good – we suffer much less from infections. But instead, other diseases appear, including ulcerative colitis and Crohn’s disease. There is evidence that poor hygiene may play a protective role in inflammatory bowel disease.

Research shows that the development of inflammatory bowel diseases may be based on an inappropriate response of the immune system to a person’s own microflora.Immunity perceives those microorganisms that live in the intestines and are normal, as their enemies and begins to fight with them. This is still an assumption, the study of the causes of these diseases continues.

– If we talk about Belarusian patients, at what stage of the disease do they usually go to the doctor?

– It depends on the patient, how alert he is in terms of taking care of his health. Often, a person turns to already at an advanced stage of the disease.At the same time, in a conversation it turns out that he has been living with symptoms for several years, he simply did not pay too much attention to them, because they did not interfere much. As is usually the case, people think that “it will go away by itself,” because there is no time to go to the doctor because of work. Even with a symptom such as blood in the stool, patients often do not rush to see a doctor.

Sometimes a misinterpretation of clinical signs may be the reason why a patient gets late to a specialist. For example, the discharge of blood from the anus is considered by many to be a manifestation of hemorrhoids.Yes, both hemorrhoids and anal fissure are widespread problems. But you need to remember that the appearance of blood in the stool is an abnormal situation and must be clarified, especially if the appearance of blood is accompanied by a change in the nature of the stool. These can all be the first manifestations of ulcerative colitis or Crohn’s disease. And the sooner you start treating them, the greater the chance of success.

– Is there an explanation as to why the disease most often affects young people? And why, as a rule, from the Nordic countries?

– If we take the peak age at which people most often get sick, then there is a difference of about 10 years between ulcerative colitis and Crohn’s disease.In Crohn’s disease, the peak incidence occurs at 20-25 years, in ulcerative colitis – 30-35 years. Now there are more and more cases when, unfortunately, diseases are detected in children. There is a second trend: a second peak appears. It is 50 years old. In Western countries, where people live longer, there is also a third – 70 years.

Indeed, the disease is more common in northern countries. There is such a pattern, but it is difficult to explain it. In addition, there is a gradient in terms of the West-East distribution.As in the north, the disease is more common than in the south, and in the west there are more of them than in the east.

Photo: Alexander Vasyukovich

– How does a disease change a person’s lifestyle when he is diagnosed with ulcerative colitis or Crohn’s disease?

– After diagnostic procedures, the patient is prescribed treatment. The further situation depends on how favorable his form of the disease is. If it is sufficiently favorable (in 50% of cases it is so), one can count on a good effect of treatment and on the fact that it will be possible to achieve remission – to eliminate the symptoms of the disease.During the period of remission, the patient usually feels healthy and can lead a normal life. Since the disease is chronic, a person will have to live with it all his life. But it should not become a sentence and make a disabled patient out of the patient.

– But does this stage of remission need to be maintained somehow?

– With the help of supportive therapy. Today, the most effective way is medication. Certain medications must be taken in remission as well.If these are traditional drugs that have an anti-inflammatory effect or suppress the abnormal activity of the immune system, then they are taken every day. And if we talk about new methods of therapy based on drugs of biotechnological origin, then they are used according to a certain scheme. The frequency depends on whether it is a maintenance therapy or aimed at achieving remission, from 1 time in 2 weeks to 1 time in 2 months.

– What are the features of biological therapy? Is it already used in Belarus?

– Yes, of course.It involves the use of medicines that are not created chemically, but as a result of biological processes. The active substance of such a drug is proteins, which are antibodies to certain substances in the body that are involved in the development of the inflammatory process. Once in the body, antibodies block these substances that support inflammation, the manifestations of the disease are reduced.

An essential feature of this therapy is its ability to modify the course of the disease.Sometimes, according to certain signs, from the very beginning, it can be assumed that the disease will be difficult, and surgical treatment will be required. This scenario is called a poor prognosis in medicine. As a rule, the possibilities of influencing this prognosis with the help of traditional drugs are limited: symptoms decrease, but complete healing of the mucous membrane is difficult to achieve and the disease continues to progress. Biological therapy can help to reduce the disease to a milder form and prevent complications, save a person from surgery and bring him into long-term remission.

Of course, biological therapy is not suitable for everyone, because it also has its own characteristics of application and side effects. Always, when it comes to prescribing medications, you need to balance benefits and risks: how likely is it that we will help the patient, and is there a danger that we will harm him with side effects.

If the course of the disease is mild, there is no need to prescribe powerful drugs that seriously “interfere” with the functioning of the immune system and can cause serious side effects.Biological therapy is a rather strong intervention in the body, although it is effective in relieving inflammation. It is prescribed only with an unfavorable course of the disease, which does not lend itself to other influences.

– What side effects can it have?

– Substances that support inflammation also have a protective function. In general, inflammation primarily helps the body get rid of bacteria and viruses that can harm it.If we suppress inflammation, then in this way we suppress the body’s defenses. Therefore, the most common side effect is an increased susceptibility to infectious diseases. One should be very wary of the possibility of developing tuberculosis. If a person has a latent tuberculosis infection, but he does not yet know about it, against the background of an additional immunosuppressive effect, it can be activated. Therefore, always before the appointment of such therapy, a study for latent tuberculosis is carried out.If the patient suffers from chronic viral hepatitis, the disease can also acquire an unfavorable course against the background of suppression of the activity of the immune system.

New selective biological therapies are currently being found to reduce the likelihood of these side effects.

Photo: Alexander Vasyukovich

– What research methods are used to diagnose inflammatory bowel diseases?

– Any diagnosis begins with an assessment of symptoms.It is important to first come to a therapist or gastroenterologist and talk about your symptoms. Then the doctor, knowing them, can advise which diagnostic methods to start with. The next stage is a general and biochemical blood test. This is to see if there are signs of inflammation and anemia. In addition to a blood test, a feces analysis is prescribed. In recent years, a research method has appeared, with the help of which markers of inflammation can be determined in feces.

A study is also being conducted on intestinal infections, since inflammation in the intestines can be infectious in nature.

The most important method is endoscopy – examination of the intestinal mucosa with an endoscope. If it is assumed that the inflammation is localized in the large intestine, then a colonoscopy is performed. The device is inserted into the intestine through the anus, the mucous membrane is examined. The doctor can see if there are signs of inflammation, redness, swelling, erosion or ulceration. A biopsy is also performed – pieces of tissue are pinched off and sent for examination under a microscope.This makes it possible to clarify what kind of inflammation takes place, for which disease it is more typical, whether there are signs of tumor lesion.

With the help of endoscopy, you can also examine other parts of the intestine. Sometimes ultrasound, computed tomography is used in diagnostics.

– Does IBD “attack” only the intestines, or does it affect other organs as well?

– Inflammatory bowel disease can have manifestations from other systems and organs. For example, joint damage is most common.They can just hurt or sometimes even become inflamed, swelling, arthritis develops. The joints of the spine can also be affected. It often happens that joint inflammation even comes to the fore. The patient does not feel intestinal problems and heals, for example, knees for a long time. And only then, after a few years, diarrhea appears, and it turns out that all these years he lived with Crohn’s disease.

In addition to the joints, the skin may be affected. Inflammatory eye diseases sometimes occur.

– If IBD is left untreated, what can it lead to?

– To rather serious consequences. If ulcerative colitis is not treated, then in addition to diarrhea, which simply interferes with the patient’s life, severe intestinal bleeding may occur, which cannot be stopped with medication, and surgery has to be performed. Intestinal perforation may develop, which is accompanied by peritonitis.

Some situations do not seem to present problems for the patient today, but in the future they can turn into serious complications.For example, when stools are of low frequency, blood rarely appears, the person feels acceptable and does not always care about achieving complete remission. At the same time, the inflammatory process in the intestine continues, and the longer it lasts, the higher the risk of developing intestinal cancer. In such patients, cancer can develop even at a young age, so the inflammation must be completely stopped, and not only relieved of the symptoms.

Patients with Crohn’s disease may have more complications because the disease itself is more complex.As already mentioned, narrowing of the intestines and intestinal obstruction can form, which leads to abdominal pain, vomiting, and lack of stool.

Intestinal perforation may also occur, bleeding may develop, purulent processes in the abdominal cavity or pelvic cavity. Fistulas can form – passages that go from the intestine to other organs.

Due to prolonged inflammation, the body is depleted, it lacks nutrients – anemia develops (a decrease in hemoglobin), associated with a lack of iron or vitamins, a deficiency of protein and calcium may occur.Decreases body weight, deteriorates resistance to infections.

Sometimes, due to the fact that Crohn’s disease does not respond well to drug treatment, or if the patient is not disciplined in following the recommendations, it is necessary to resort to surgery. Sometimes not one. Part of the intestine has to be removed, it is shortened. And this is also a serious problem, because the absorption of nutrients is disturbed, the patient loses mass.

Photo: Alexander Vasyukovich

– In what cases does a patient need surgery?

– Surgery is more a means of stopping complications, rather than treating the disease itself.It is sometimes used when medication is impossible or ineffective.

– What possibilities of drug treatment are there at the moment?

– The most traditional and longest-used method is the use of anti-inflammatory agents. They act in the intestinal lumen on the mucous membrane and stop the process of inflammation there. These drugs rarely cause serious side effects, but, unfortunately, they are not always effective.The so-called hormones have a stronger anti-inflammatory effect, but they affect the entire body and have a number of adverse effects, so they are usually used for a limited period of time. For a long time, including with a supporting purpose, drugs from the group of immunosuppressants are prescribed – they allow you to control inflammation. And also biological drugs are used, including selective action, which we talked about earlier.

– Have there been any patients in your practice who refused treatment?

– Yes, of course.Unfortunately, this is not so rare. Many patients justify this by the fact that the disease may be associated with improper diet, the presence of an infection in the body, or some other reason that they certainly want to find and eliminate.

Of course, this would be ideal, but the current level of development of medicine, including abroad, does not yet allow it to be done. In pursuit of the cause of the disease, such patients miss the period when the disease is at a sufficiently early stage and when they could be effectively helped.In the future, they still have to seek traditional medical help, but by this time complications are already developing and the disease acquires an uncontrolled course.

– Fistulas, intestinal obstruction, malignant tumor. How often do Belarusians bring themselves to such forms?

– This cannot be said to be the patient’s fault. Of course, this can be facilitated by a late visit to the doctor or unwillingness to receive treatment. But often the patient is not to blame, and the very course of the disease can lead to the development of complications.In some, it is initially severe, although the patient came to the doctor in a timely manner, and the diagnosis was made quickly, and the treatment was prescribed adequate. This, unfortunately, happens too, therefore, research is underway to find innovative medicines that would be both more effective and, on the other hand, sufficiently safe. In recent years, the spectrum of drugs has begun to expand faster.

– Some say that traditional medicine, in particular herbs, is a necessary part of the treatment? What do experts think about this?

– Herbs cannot be called a necessary part.Moreover, patients often have the misconception that drugs are always harmful, because they are of synthetic origin, and herbs are useful and do not harm the body.

This is not at all true. Herbs can be effective because they contain a number of biologically active substances. Their effect can be both therapeutic and side effects. In some cases, herbs lead to the development of toxic hepatitis, renal failure, and can interfere with the metabolism of drugs.If you take antibiotics, drugs to lower blood pressure or to treat the same ulcerative colitis, and then wash them down with a collection of herbs, it is quite possible that the collection will not only not have a therapeutic effect, but also interfere with the metabolism of drugs and they will act worse. The literature describes such cases when a patient received a kidney transplant and he took herbal medicine along with immunosuppressive therapy. The latter contained a component that disrupted the work of the immunosuppressant. As a result, the graft was rejected.Traditional medicine can have such serious effects. You should always remember about the balance of benefits and risks.

Photo: Alexander Vasyukovich

– You spoke about how to bring the patient into remission. And can something – a wrong way of life, stress – disrupt it?

– Just as it is unclear why the disease occurs, it is equally unclear what can provoke an exacerbation in a person who is in remission. The situation is complicated by the fact that the disease itself can have an undulating course.This, by the way, often discourages the patient from seeking medical help. He has the first episode of ulcerative colitis – diarrhea, blood in the stool, feeling unwell – he thinks that he needs to go to the doctor. But while he chooses the time, orders a coupon, sees that the symptoms seem to begin to fade and even completely disappear. The patient does not go to the doctor, and after a few months or years the disease returns again. And the next episode may not be so harmless. What factors determine the onset of exacerbation is difficult to say.It may be taking certain medications – non-steroidal anti-inflammatory drugs, antibiotics. In women, pregnancy or childbirth can be such provocateurs. But in most cases, it is not possible to identify any obvious provoking factor.

By the way, since we have already remembered pregnancy, it should be noted that with ulcerative colitis or Crohn’s disease, normal pregnancy and the birth of a healthy child are possible. The main thing is that a woman should be conscious of this process.The best results will be when the pregnancy is in remission, then, as a rule, during all 9 months the disease remains inactive and does not interfere with the process. gestation and birth.

90,000 causes of occurrence, what to do and which doctor to contact

The appearance of visible blood impurities in the feces is always of great concern, since for some reason it is generally accepted in society that this is the main symptom of colon cancer.Blood in the feces is indeed an alarming signal that cannot be ignored, however, this symptom can be observed not only in intestinal oncology, but also in a number of other diseases.

Causes of blood in feces

Feces with blood visible to the naked eye are most often observed in hemorrhoids, anal fissure, colorectal cancer and colitis. It is noteworthy that the nature of rectal bleeding in each of the listed diseases has certain differences.

Hemorrhoids

Inflammatory disease of the hemorrhoidal veins of the rectum, accompanied by the expansion and thrombosis of hemorrhoids.

Bloody discharge is usually scanty, bright scarlet or bright red. In rare cases, dark-colored blood or bloody clots are observed. Most Outrageous Feature: Blood is not mixed with feces.

Other symptoms of hemorrhoids: pain, itching, a feeling of fullness in the rectum, prolapse of hemorrhoids outward.

Anal fissure

Rupture of the mucous membrane of the anal (anal) canal, most often of traumatic origin.

The bleeding pattern resembles the symptoms of hemorrhoids: scarlet or red blood, not mixed with feces. The amount of blood is usually small, although with large fissures, blood loss can be significant.

Other symptoms of anal fissure include: pain during bowel movements that subside quickly after a bowel movement; occasionally, if the gap is inflamed – a feeling of fullness.

Colorectal cancer

Malignant tumor of one or more parts of the colon.

The blood can be red or pronounced black. A distinctive feature: blood is released at the beginning of the act of defecation, and not at the end, as with hemorrhoids or anal fissure. In some cases, all excreted feces can acquire a bloody color as a whole.

Other symptoms of colorectal cancer: the presence of a large amount of mucus or pus in the stool, a specific smell of stool, soreness in the abdomen, abnormal stools, a feeling of incomplete emptying of the intestines, flatulence, constant weakness and fatigue, sudden weight loss.

Ulcerative colitis

Inflammation of the mucous membrane of the large intestine with ulceration (wounds).

Blood is always mixed with feces, but more often in the form of subtle blotches or bloody mucus. In the later stages of the disease, blood or bloody mucus may be released even outside the act of defecation.

Other symptoms of ulcerative colitis: frequent and loose stools, with a fetid odor, sometimes with an admixture of pus; the urge to defecate is frequent; cramping pain in the abdomen, often on the left side; constant flatulence; general weakness and severe emaciation.

Other reasons

The presence of blood in the stool can be observed in some other diseases:

• stomach and duodenal ulcer;
• Crohn’s disease;
• intestinal polyps;
• syphilitic ulcers of the rectum;
• gonorrheal proctitis, etc.

A separate group of causes of bloody impurities in feces should include various intestinal infectious diseases of a viral, bacterial or protozoal (parasitic) nature: dysentery, salmonellosis, botulism, enterovirus, rotavirus, cytomegalovirus, amebiasis, and others.Each intestinal infection has its own specific clinical picture, but in general terms, the course of development of most intestinal infections resembles ulcerative colitis.

What to do if there is blood in the stool

There can be only one correct solution in such a situation – immediately visit a proctologist who will conduct an examination, prescribe the necessary laboratory or instrumental studies, after which he will make an accurate diagnosis and prescribe the appropriate treatment.As statistics show, about 60-70% of rectal bleeding is caused by hemorrhoids, which can be successfully treated by modern medicine, and therefore one should not immediately suspect cancer and postpone a visit to the doctor for fear of “hearing a bad diagnosis.”

Attention: any attempts to establish the cause of the stool with blood on your own (so to speak, “by symptoms”), followed by self-medication, will only lead to an aggravation of the disease and a deterioration in the overall clinical prognosis, and therefore the Medical Center “Health Formula” strongly does not recommend postponing a visit to a doctor. if blood began to be observed in the feces after stool, even in the smallest quantities.

Anal fissure in children – causes, symptoms, diagnosis and treatment of anal fissure in a child in Moscow at the SM-Doctor clinic

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Contents:
Description of the disease
Symptoms
Causes
Expert opinion
Diagnostics
Treatment
Prevention
Rehabilitation
Questions
Anal fissure in children is a disease of the rectum, which is accompanied by the formation of a defect in the mucous membrane in the anus.The problem is identified and treated by a pediatric proctologist or surgeon.

Description of the disease

Anal fissure develops less frequently in children than in adult patients. This is due to the small number of provoking factors and the rapid recovery of the mucous membrane against the background of proper treatment.

The disease affects boys and girls equally. Anal fissure is rarely encountered by children under the age of 3-5 years, whose feces are rarely thick. An exception may be cases of congenital malformations of the rectum.

Depending on the nature of development, an anal fissure can be:

• acute;
• chronic.

The latter option is most often found in adolescents in the absence of proper treatment for the disease at the earliest stages of its development. In such cases, sometimes it is even necessary to carry out surgical removal of the affected tissues, and only then to carry out conservative therapy.

Depending on the location, anal fissures are divided into 3 types:

• rear;
• front;
• lateral.

The pathological process can occur with or without spasm of the anal sphincter. Prolonged tonic contraction of the annular muscles of the anus aggravates the course of the disease. Against the background of a spasm, the child empties less often. This leads to hardening of feces, which subsequently further injure the rectal mucosa. The child has a fear of going to the toilet. Thus, a vicious circle is closed, causing a deterioration in the patient’s well-being.

Symptoms of anal fissure in children

The clinical picture of the disease depends on the stage of development, the individual characteristics of the child and the size of the mucosal defect.

Classic anal fissure symptoms:

• Pain in the anus during bowel movements. This is one of the most common signs of the disease, which is caused by mechanical damage to the inner surface of the intestine. Between bowel movements, the baby can behave absolutely normal and not make any complaints.
• Blood in the stool. This is the most common reason parents turn to a pediatric proctologist, who notice streaks of scarlet blood during the next diaper change or while cleaning the pot.Its appearance is due to the presence of a defect in the mucous membrane and injury to small vessels.
• Constipation-type stool disorder. Due to pain in the anorectal region, the child tries to suppress the reflex of the act of defecation. There is a fear of emptying the intestines.
• Anxiety, sleep disturbance, moodiness. All these symptoms are due to irritation of the child, which develops against the background of pain in the anus and stool disorders.

If the above signs occur, you should seek help from a pediatrician, proctologist or pediatric surgeon.This will allow you to identify the problem at the early stages of its development and begin adequate treatment without delay.

Causes of anal fissure

The pathogenetic basis for the development of anal fissure in children is a violation of the integrity of the mucous membrane of the anus. The reason for this defect may be:

• Tearing of tissues due to the passage of too thick stool.
• Incorrect setting of cleansing enemas or gas outlet tubes, when the mucous membrane is injured by the rigid elements of medical products.
• Incorrectly performed surgical interventions in the anorectal region.

It is important to understand that a violation of the integrity of the mucous membrane in the situations described does not always occur. The risk of developing the problem is increased by provoking factors:

• Genetic predisposition or the presence of congenital malformations of the anorectal region or the entire gastrointestinal tract (GIT).
• Chronic intestinal infections accompanied by diarrhea.In such cases, the mucous membrane becomes thinner and becomes more vulnerable to the mechanical effects of thick feces.

The situation is further aggravated by the presence of a local inflammatory process.

• Proctitis and other diseases of the rectum, which directly reduce tissue resistance.
• Metabolic disorders. Diabetes mellitus, abnormal absorption of certain food components create conditions for defecation disorders and changes in the normal tissue architecture.
• Traumatic injuries of the anorectal zone – falls, blows, scratching of the anal area against the background of helminthic invasion.

Expert opinion

Anorectal fissure in a child is a relatively favorable condition in comparison with adults. With timely referral for specialized help, the problem can be eliminated conservatively in a short time. Due to the good ability to restore the mucous membrane in children, therapy can take as little as 4-5 days.The main thing is not to ignore the first signs of the disease. Otherwise, an acute crack turns into a chronic form, becomes the cause of daily discomfort for the patient, and already requires surgical intervention.

Diagnosis of anal fissure

An anal fissure is diagnosed by a pediatric proctologist or surgeon. Even at the initial address of parents to a doctor, a specialist may suspect the presence of this disease. The doctor draws attention to the characteristic complaints of the child, the influence of provoking factors, the history of the development of the pathological process.

A digital rectal examination is required for a definitive diagnosis. However, in order not to cause psychoemotional discomfort in the presence of severe pain syndrome, at first the doctor may limit himself to a simple examination of the anal area. Sometimes a defect can be identified immediately.

If the rectal examination was not performed immediately, it is rescheduled for the next visit. The fact is that anal fissures are often the result of other proctological diseases, which may not be diagnosed without a full examination.This means that the pathology of the rectum will progress steadily.

For a comprehensive assessment of the patient’s condition, the following tests are carried out:

• General analysis of blood and urine. Allows you to identify concomitant diseases, primarily anemia, inflammation.
• Coprogram – microscopic analysis of feces, which is especially important if dysfunction of other parts of the gastrointestinal tract is suspected.
• Biochemical blood test. Detects metabolic changes in the body.
• Ultrasound of the abdominal organs. Reveals anomalies in the development of internal organs.

If a concomitant pathology is detected, its treatment is carried out in parallel, which avoids the recurrence of the anal fissure.

Anal fissure treatment

Anal fissure in children is a disease that, in the early stages of its development, lends itself well to conservative treatment. The operation can only be indicated if drug therapy is ineffective or if the process is chronic for a long time, when a roller of dense scar tissue forms around the crack, which interferes with healing.

Conservative treatment

The key aspect of effective treatment of anal fissure in children at an early stage of the development of the disease is the correction of diet and water balance. This allows you to soften the stool and prevent re-trauma to the mucous membrane.

It is recommended to temporarily exclude fatty and fried foods from the diet, reduce the amount of meat consumed. It is worth increasing the amount of fruits and vegetables that are rich in fiber. Coarse fiber attracts fluid, increases the volume of stool and thus contributes to the normalization of the stool.

In addition to correcting the diet, the proctologist prescribes the following groups of medicines:

• Mild laxatives (if constipated).
• Healing ointments and creams, suppositories.
• Anti-inflammatory suppositories.

To cleanse the intestines and eliminate the local inflammatory process, the child is recommended to take baths with chamomile decoction for 2-5 days. The water temperature is about 37 ° C. If the child has anemia against the background of minor bleeding, the doctor prescribes iron supplements, vitamin B 12, folic acid.

Surgical treatment

Surgical excision of an anal fissure in children is carried out with the ineffectiveness of conservative treatment methods. It is indicated in the chronic form of the disease and is practiced mainly in adolescence, when the process from acute to chronic.

The essence of the operation consists in excision of pathological scar tissue and the crack itself with further suturing of the defect. After that, the patient receives standard conservative therapy aimed at stool stabilization and postoperative wound healing.

Prophylaxis of anal fissure

Prevention includes 2 directions:

• Balanced nutrition of the child with a sufficient amount of fluid to drink.
• Regular (ideally daily) bowel movements.

Rehabilitation

In the postoperative period, it is important to monitor the stool. With a tendency to constipation, the use of mild laxatives is indicated.

To accelerate healing, after each act of defecation, it is necessary to carry out a gentle toilet of the perineum, which is well supplemented with sit-down trays with chamomile.

Questions

• Which doctor treats anal fissure in children?
  A pediatric proctologist or surgeon deals with the identification and treatment of anal fissures.
• Can anal fissure be cured with folk remedies?
  Conservative therapy for anal fissure in children is aimed at stabilizing the stool and rapid healing of damaged tissues. In some cases, this effect was achieved with the help of traditional medicine – chamomile baths, sea buckthorn candles and other local remedies in combination with a diet.However, in any case, you must first consult with a specialist. Anal fissures are often the result of other proctological diseases that can progress without adequate treatment.
• Does my child need anal fissure surgery?
  In 90% of cases, with timely treatment of the patient for help, surgical intervention is not required. Timely initiated conservative therapy promotes complete healing of the mucosal defect without subsequent relapses.The exception is neglected cases, when dense scar tissue forms along the edges of the crack, which interferes with healing. As part of the surgical intervention, it is excised and the defect is sutured, after which standard medications are prescribed to accelerate healing.
• How to independently identify an anal fissure in a child?
  Pain during bowel movements and red blood in the stool are sure signs of a problem. You can also independently examine the anal area of ​​the child.In 50-60% of cases, the defect of the mucous membrane is visible without the use of additional instruments. However, such a self-diagnosis complex does not replace consultation with a specialist. Only a comprehensive examination and personalized treatment can radically solve the problem of anal fissure in childhood.

Sources

• Vorobiev G.I. Fundamentals of Coloproctology. Rostov-on-Don, 2001, 413 p.
• Braun J., Raguse T. Pathophysiologic role of the internal anal sphincter in chronic anal fissure.Z Gastroenterol. 1985; 10 (23): 565-572.
• Klosterhalfen B., Vogel P., Rixen H., Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. 1989; 1 (32): 43-52.

Doctors:

Children’s Clinic Metro Maryina Roscha

Children’s clinic m.Novye Cheryomushki

Syvorotkina (Sologova) Ekaterina Alexandrovna

Pediatric proctologist, pediatric phlebologist

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