Rectal bleeding is bleeding from the anal canal. The blood may be mixed with stool or separately and can form clots. The blood can vary in colour from bright red to black and tarry depending on where in the bowel it comes from. Sometimes, occult or microscopic bleeding can occur which is not visible to the naked eye but is detected on stool testing. Medically, rectal bleeding is referred to as haematochezia.
A doctor can tell a lot about what might be causing the problem from the colour of the blood. The closer the source of the bleeding is to your bottom (anus, rectum and sigmoid colon), often the brighter and fresher looking the blood appears (bright red bleeding).
it is likely to be coming from the transverse colon or right colon.
it is called melena and it indicates that you are bleeding in your upper gastrointestinal tract. Stomach or duodenal ulcers cause this type of bleeding and so, too, can bleeding from the right colon. Because the blood stays in the gastrointestinal tract for a period of time before it is expelled from the body, bacteria in the colon begin to break it down causing it to turn black.
it has not stayed in the colon for long enough for bacteria to start to break it down and so it is brighter in colour. On rare occasions, however, if you have significant bleeding from your right colon, small intestine or ulcers, it can move so quickly through your gut that there is not time for the bacteria to break it down and so it can appear as a lot of bright red blood.
Occult bleeding is harder to detect as it cannot be seen with the naked eye. Normally it is only detected by laboratory testing (faecal occult blood or faecal immunochemical tests). It can have many of the same causes as other types of rectal bleeding but the bleeding is too slow for there to be any obvious sign of bleeding. It may be associated with anaemia resulting from a reduction in iron in the body due to blood loss.
Among the signs that indicate rectal bleeding are:
- blood in your stool
- streaks of blood when you wipe your bottom
- bloody diarrhoea
- blood dripping into the toilet after opening your bowels
- dark, tarry stool.
If rectal bleeding goes away by itself after a day or two, it could be nothing to worry about. However, you should see your GP or seek a specialist opinion if:
- it persists for several days
- you have pain or a lump in your bottom or tummy
- you are tired for no reason
- you are losing weight for no reason
- the consistency or frequency of your stool has changed
- there are other risk factors, for example, aged over 50, family history of bowel cancer.
Seek medical help if your stool is black or dark red or you have bloody diarrhoea.
There can be a number of different causes of rectal bleeding, some of which are potentially serious.
Causes might include:
- Haemorrhoids (see below)
- Anal fissure
- Crohn’s disease
- Ulcerative colitis
- Ischemic colitis
- Rectal ulcer or trauma
- Bowel cancer
- Rectal prolapse
Haemorrhoids (piles) are enlarged blood vessels in the anal canal (the end of your large intestine). They form cushions of tissue that can become congested, prolapsed or bleed when opening your bowels. You might experience symptoms such as:
- Severe pain or a burning sensation
- Mucus discharge
- Feeling like your bowel doesn’t empty properly
- Feeling lumps or bulges by your bottom. If they feel tender you may have a thrombosed haemorrhoid
- Feeling something protruding from your bottom after opening your bowels (prolapse).
These are not always obvious unless they become enlarged as they are normally painless. They may prolapse or protrude outside your bottom but this normally resolves itself. If not, they can be gently pushed back into place.
These occur lower than internal haemorrhoids and are located in the skin around the anus. They may cause itching, pain or bleeding. If they prolapse a blood clot can develop causing a painful condition called a thrombosis. Thrombosed haemorrhoids turn purple or blue and can be very painful but are not normally serious. They will normally resolve by themselves but may need medical attention.
Haemorrhoids are categorised in four stages depending how severe they are:
- First degree haemorrhoids bleed but do not protrude outside your bottom
- Second degree haemorrhoids prolapse when you open your bowels but retract on their own
- Third degree haemorrhoids prolapse and have to be pushed back inside with a finger
- Fourth degree haemorrhoids prolapse and cannot be pushed back inside and are permanently out. This can also lead to a painful thrombosis.
Prolapsed internal haemorrhoids can feel itchy and may make you feel like you need to open your bowels constantly.
Haemorrhoids are most common between 45 and 65 years of age but can occur in younger or older patients. Haemorrhoid swelling can be caused by a number of things, including:
- Constipation causing you to strain on the toilet and creating hard stools which can cause tearing
- Eating a low fibre diet
- Chronic cough
- Standing or sitting for long periods
- Heavy lifting
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