Should I be worried about rectal bleeding?
Bleeding from the rectum (the lower part of the large bowel on the left side of the body) is a common symptom of several conditions ranging from mild (haemorrhoids) to severe (cancer of the rectum) and should always be taken seriously. If you experience any of the following symptoms, make an appointment to see your GP:
- Spots of blood on the toilet paper after defaecation. The blood may appear separate to the stool.
- Bloody stool.
- Rectal bleeding associated with the passage of mucus, change in bowel habit and weight loss. There may be pain on defaecation.
What causes rectal bleeding?
Rectal bleeding may indicate a benign cause such as haemorrhoids or a more sinister underlying condition such as rectal carcinoma.
Haemorrhoids, commonly called piles, are enlarged and engorged veins that are found in the anal canal. Straining at stool usually causes them. Haemorrhoids are classified into first, second and third degree depending on the extent they prolapse (come down) through the anal canal.
First degree piles remain inside the rectal canal and cannot be seen from the outside. Second degree piles prolapse during defaecation but return of their own accord. Third degree piles remain outside the anal margin unless replaced digitally. Other symptoms of haemorrhoids are irritation and itching around the anal region. They are not typically painful unless they are thrombosed (clotted).
If rectal bleeding is accompanied by other symptoms such as changes in bowel habit, weight loss and a sensation of incomplete evacuation, your doctor may suspect carcinoma of the rectum and you will be sent for further testing.
These are small bulges of tissue which protrude outward from the lining of the bowel. Your doctor will need to identify whether they are cancerous or not. Often, Polyps are asymptomatic and are only discovered following a routine colonoscopy to investigate rectal bleeding. They can cause iron deficiency anaemia due to blood loss.
Where bleeding from the rectum is also accompanied by left-sided abdominal pain and constipation, you will be tested for Diverticular disease. A diverticulum is an outpouching of the wall of the colon. It is usually caused by a lack of dietary fibre.
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Inflammatory bowel disease or colitis
Symptoms include rectal bleeding, the passing of mucus and diarrhoea.
This is a longitudinal tear in the skin of the anal canal caused by the passage of a large constipated stool. There is associated pain during defaecation, which may last minutes to hours.
What kind of tests will I need to have?
To determine the exact cause of rectal bleeding, your doctor will take a full medical history, asking about your symptoms and their duration. A sample of stool will be taken to test for the presence of blood. A physical examination will also be required, which will include a rectal examination. This involves the insertion of a finger up into the rectum to feel for any masses.
Other tests include camera tests called a proctoscopy and a sigmoidoscopy, which look at the anal canal and the lower part of the bowel. A proctoscopy is the only reliable way of diagnosing internal haemorrhoids.
A colonoscopy may also be required to examine the whole large bowel. An X-ray of the bowel called a barium enema may also be done to look at the anatomy of the bowel.
In addition, your doctor may also take some blood tests to rule out anaemia.
Will I need an operation?
Treatment options for rectal bleeding depend on the identifying cause. Some will require surgery, while others can be treated with ointments and/or drugs.
If you have been diagnosed with haemorrhoids, there are several treatment options open to you and your doctor will advise you on which one is most suitable. Some of the options are:
- Creams, ointments and suppositories. A wide range is available both on prescription and over-the-counter. Many contain a local anaesthetic and some contain steroids. While these can provide relief from the pain and irritation of haemorrhoids, it is advisable not to overuse them.
- Injection with an irritant solution. The solution is injected directly into the haemorrhoids. This can be done on an outpatient basis.
- Banding. This procedure can also be done to obliterate the haemorrhoidal vessels. (Using a special forceps and a banding instrument a band is placed around the haemorrhoid, squeezing the vessels causing the haemorrhoid to shrink.)
- Haemorrhoidectomy. This is a surgical operation to excise the haemorrhoids.
- Finally, to prevent haemorrhoids from recurring eat a high-fibre diet and try not to strain when passing stool.
If tests reveal that you have Diverticular disease your doctor will recommend a high-fibre diet and may also prescribe bulking agents such as ispaghula or sterculia to aid bowel movement.
Inflammatory bowel disease can be treated with prescribed drugs to dampen down the inflammation.
Some causes of rectal bleeding, such as rectal cancer, can only be treated with surgery. In this instance, an operation is performed to remove the cancer and some of the bowel. Other investigations will be performed to see if the cancer has spread (metastasised). Chemotherapy may also be required.
Where Polyps are concerned, a biopsy is carried out to take a sample of the infected tissue. If the results show that the polyps are malignant they will be surgically removed.
Anal fissures may also require an operation called an anal stretch if, following treatment with anaesthetic ointments, the rectal bleeding persists.
