The digestive system begins with the mouth, followed by the esophagus and stomach. Food then enters the small intestine and finally the large intestine. The rectum is the last portion of the large bowel that ends just before the anus. At times, bleeding from the rectum may become. Therefore, the presence of bleeding must be carefully analyzed to determined its etiology or cause. Rectal bleeding may produce black, tarry stools, or bright red blood on or in the stool. It can also produce blood on the toilet tissue, or blood staining the toilet bowl water red. Rectal bleeding generally develops rapidly. It is commonly associated with abdominal disorders. Therefore, they all require some type of medical evaluation. It is important to identify the source of the rectal bleeding so that appropriate treatment can be instituted.
Causes of Rectal Bleeding
One way of subdividing the sources of rectal bleeding is by the location of its origin. The most common causes of rectal bleeding are anorectal disorders. These include internal, external and thrombosed hemorrhoids. Also, Rectal fissures and rectal trauma may fall into this group. Diverticulosis is a condition in which there are outpouching of the intestinal wall. This is most common after 40 and may be associated with persistent bleeding. This may eventually require some form of surgical intervention. Infections produce a number of conditions that may be associated with rectal bleeding or bloody diarrhea. Inflammatory bowel disease can produce rectal bleeding. It is often associated with stool and mucus. Abnormalities of the arteries and veins of the right side of the large intestine occur in angiodysplasia. They can lead to chronic rectal bleeding. Tumors or polyps of the large intestine or colon can lead to acute and chronic blood loss through rectal bleeding. Other causes include intussusception, meckel’s diverticulum and bleeding from the upper portions of the gastrointestinal tract.
Signs and Symptoms of Rectal Bleeding
The symptoms of rectal bleeding universally include blood in the rectum. This may be in the form of blood clots, fresh red blood and active bleeding. The stool may be interlaced with blood and there may be blood in the toilet water. External hemorrhoids produce painful, itching lumps around the anus. Internal hemorrhoids are usually painless, but may produce a feeling of a rectal mass. Thrombosed hemorrhoids produce considerable pain and frequently require surgical intervention. Hard stools and straining at stool can aggravate these symptoms. Rectal fissures frequently lead to bright red blood in the stool as the rectal wall is torn. The passage of stool during a bowel movement can lead to severe pain. Diverticulosis usually occurs in people over forty and the frequency increases with advancing age. It can produce left abdominal pain and usually dark red blood. Persistent bleeding from a Diverticulosis outpouching may require surgical intervention. Bloody diarrhea can occur from a number of infectious agents. These include Salmonella, Shigella, E. Coli, Campylobacter jejuni and C. difficile and its toxin. They produce crampy abdominal pain, bloody diarrhea and fever. Inflammatory bowel disease is more common in young adults, less than 50. It includes ulcerative colitis and Crohn’s disease. Recurrent episodes of rectal bleeding or bloody diarrhea may occur in association with fever and crampy abdominal pain. The stool is frequently filled with blood and mucus. Angiodysplasia occurs in older individuals. It is usually painless. Chronic blood loss can lead to light headedness, rapid heart rate, fatigue and shortness of breath. About 1/5 of people with rectal tumors or polyps will develop rectal bleeding. Usually, it is a small amounts and chronic. With advanced disease, there may be changes in stool size and shape, fullness in the abdomen, weight loss and constipation. Disease involving the esophagus, the stomach and small intestine can lead to rectal bleeding. Unless the bleeding is rapid, the blood is usually dark. Intestinal obstruction, such as can be seen with intussusception, can produce abdominal pain, nausea and vomiting. Painless blood in the stool may occur with Meckel’s diverticulum.
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Medical Content Last Updated on 07/12/2008
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