Rectal Bleeding

Take the Tummy Trouble Quiz 48k899 Digestive Disease Myths Slideshow Pictures Heartburn? Foods to Eat, Foods to Avoid Slideshow

Medical Author:

Dedra R Tolson, MD

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

View Full Profile

• Rectal Bleeding Overview
• Rectal Bleeding Causes
• Rectal Bleeding Symptoms
• Rectal Bleeding in Children
• Rectal Bleeding During Pregnancy
• When to Seek Medical Care
• Rectal Bleeding Diagnosis
• Rectal Bleeding Treatment
• Rectal Bleeding Self-Care at Home
• Rectal Bleeding Medical Treatment
• Rectal Bleeding Follow-up
• Rectal Bleeding Prognosis
• Synonyms and Keywords
• Authors and Editors
• Read more on Rectal Bleeding from Healthwise

Rectal Bleeding Overview

The rectum is the last portion of the large bowel that ends just before the anus. Bleeding from this area can be mild or serious, even life-threatening. The presence of rectal bleeding must be carefully checked because it indicates something is wrong.

• Rectal bleeding is frequently noticed as maroon stools, bright red blood on or in the stool, blood on the toilet tissue, or blood staining the toilet bowl water red. Bleeding from further up in the gastrointestinal tract results in black, tarry stools.
• Rectal bleeding is commonly associated with other potentially dangerous abdominal disorders. Most cases of rectal bleeding warrant a visit to a physician for evaluation.
• Depending on the source of bleeding (which may be from any part of the gastrointestinal tract), treatment can range from relief of symptoms to antibiotics, blood transfusion, or surgery. It is important to locate the source of rectal bleeding so that appropriate treatment can be started and fix the cause of the problem.

Rectal Bleeding Causes

Anorectal disorders are the most common causes of minor rectal bleeding.

Hemorrhoids: Hemorrhoids are swollen rectal veins in the anal and rectal area. They can cause burning, painful discomfort, and bleeding.

• Internal hemorrhoids are small swellings that are easy to see and quite painful. Anal itching is common.
• Internal hemorrhoids are usually painless. A rectal mass sensation may be noted with bowel movements.
• Symptoms from the swelling (thrombosis) of the hemorrhoids are brought on by hard stools and straining with bowel movements. Treatment of hemorrhoids focuses on relieving these symptoms with the use of stool bulking agents and softeners.
• In cases of thrombosed hemorrhoids, a clot forms within the swollen vein. This causes moderate to severe pain and requires minor surgery to remove them.

Anal fissure: This is a tear in the lining of the rectum caused by the passage of hard stools.

• An occurrence can lead to mild rectal bleeding of bright red blood. Exposed nerves and vessels result in moderate to severe pain. Pain worsens with bowel movements then decreases in between bowel movements.
• In both hemorrhoids and anal fissures, symptoms are generally improved with use of stool softeners and bulking agents, increasing fiber in the diet, pain control, and frequent warm water baths.

Diverticulosis: Diverticula are out-pouchings that project from the bowel wall. Their development is caused by decreased fiber in the diet. When the diverticula becomes inflamed and infected it is called diverticulitis.

• People with this condition are usually older than 40 years of age, and it generally increases with age.
• Stools are dark red or maroon. Pain is usually absent but, when present, typically occurs in the left lower part of the abdomen.
• Persistent bleeding, high fever, uncontrolled pain or other signs of serious infection may mean hospitalization is necessary. Fewer than 6% of patients with diverticulitis require surgery.

Infection: Bacterial dysentery is commonly the source of infectious, bloody diarrhea.

• Responsible organisms include Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and Clostridium difficile.
• Physical complaints include abdominal pain, fever, and bloody diarrhea.
• Antibiotics may be given for treatment.

Inflammation: Inflammatory bowel disease (IBD) is a common cause of rectal bleeding in adults, typically younger than 50 years of age.

• Two common types of IBD include Crohn's disease and ulcerative colitis.
• Bleeding occurs in small to moderate amounts of bright red blood in the rectum, usually mixed in with stool and mucus. Associated symptoms include fever and cramping, stomach pain.
• Admission to the hospital is not required. However, bowel rest and steroid therapy are usually indicated for treatment.

Angiodysplasia: This is a vascular problem that involves enlarged veins and capillaries in the wall of the right colon. These areas become fragile and can bleed.

• Episodes are found mainly in elderly people.
• Rectal bleeding is usually slow, chronic, and not obvious until massive bleeding occurs. People complain of weakness, fatigue, shortness of breath, and painless rectal bleeding.

Tumors and polyps

Polyps: Lumps of tissue or polyps bulge out from the lining of the colon. Bleeding occurs when large polyps develop, which can be hereditary. Usually harmless, some types can be precancerous.

Tumors: Both benign and malignant forms are frequently found in the colon and rectum. People older than 50 years of age are most affected. However, tumors can be found in younger people.

• Less than 20% of people with tumor or polyps will have rectal bleeding. When bleeding does occur, it is usually slow, chronic, and minimal.
• If cancerous lesions are advanced, additional symptoms such as weight loss, a change in the caliber of stools, a sense of rectal fullness, or constipation may be experienced.
• Diagnosis requires evaluation with colonoscopy.

Trauma: Rectal bleeding from a traumatic cause is always a critical concern. Rectal damage from a gunshot wound or foreign body insertion can result in extensive infection or rapid and fatal blood loss. Prompt emergent evaluation is necessary.

Upper gastrointestinal source: A common source of rectal bleeding is bleeding from the upper gut, usually the stomach or duodenum. This can occur after someone has swallowed a foreign object that causes injury to the stomach lining, bleeding stomach ulcers, or Mallory-Weiss tears. (Mallory-Weiss tears are cuts or ruptures of vessels in the lining of the esophagus or stomach. They are usually due to continuing or forceful vomiting.)

• Alcohol consumption can also cause ulcers and gastritis.

Meckel diverticulum: A rare condition, this occurs in less than 2% of the population. In this condition, gastric lining is found in an inappropriate location of the gastrointestinal tract. As a result, the gastric acid secreted from this lining erodes tissue and ultimately causing hemorrhage.

• Rectal bleeding in a Meckel diverticulum is painless and appears bright red. Admission to the hospital is essential because surgery is often definitive treatment.