Rectal Bleeding

Rectal bleeding is the presence of blood with a bowel movement, either on the toilet tissue or in the toilet bowl. This is a common problem that may be minor or life threatening, and you should discuss it with your doctor.

Causes

• Hemorrhoids – These are dilated blood vessels or veins in the anal or rectal area.  They can occur either internally or externally.  Internal hemorrhoids are usually painless. They develop quite commonly with chronic constipation and especially with pregnancy.
• Fissure – The passage of a hard stool or severe diarrhea may tear the lining tissue of the anus.  Nerve endings and blood vessels are exposed so that pain and bleeding occur with bowel movements.
• Diverticulosis – Diverticula are pockets or sacs that project from the bowel wall.  Occasionally they can bleed. They usually produce a lot of blood, and it comes all at one time. It normally does not persist in small amounts with bowel movements over days or weeks. Serious, persistent diverticular bleeding usually requires hospitalization.
• Proctitis and Colitis – Either the rectum, colon, or both, can become inflamed and ulcerated.  There may be rectal urgency, cramping or diarrhea associated with the bleeding. When the inflammation is restricted to the rectum, the condition is called proctitis.  When the colon is involved, it is called colitis. It is important to identify the specific cause of the inflammation so that appropriate treatment can be started.
• Polyps and Cancer – Of course, the greatest concern about rectal bleeding is cancer. Polyps are benign growths in the colon. When polyps reach a large size, they can bleed. Certain types of polyps can turn into cancer. Colon cancer can be curable if discovered early. It most often occurs in people over the age of 50, but it is becoming more common among younger individuals. 

Diagnosis

• The Visual and Digital Exam – The physician will inspect the anal area looking for tears and hemorrhoids. A finger exam can provide information when there is tenderness or a tumor inside.
• Colonoscopy or Sigmoidoscopy – There are types of scopes used to view the colon.  Flexible sigmoidoscopy examines the lower third of the colon.  A colonoscopy examines the entire colon. 
• Barium Enema X-ray – This is an exam that uses liquid barium inserted by enema into the rectum. X-rays highlight abnormal shadows, such as tumors, diverticuli and colitis. By itself, however, it does not identify an actual bleeding point.