Rectal Bleeding Causes

• Anorectal disorders: These 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.
  
  
  • External 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 are brought on by hard stools and straining with bowel movements. Treatment 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.

• Rectal 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 stops in between bowel movements.
    
    
  • In both hemorrhoids and rectal 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 outpouchings that project from the bowel wall. Their development is caused by decreased fiber in the diet.
  
  
  • People with this condition are usually older than 40 years, and it generally increases with age.
    
    
  • Stools are dark red or maroon. Pain is usually absent but, when present, typically occurs in the left abdomen.
    
    
  • Persistent bleeding may mean hospitalization is necessary. Surgery is required in up to 25% of these patients.

• 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 is a common cause of rectal bleeding in young adults-typically those younger than 50 years.
  
  
  • 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 crampy, 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. They can be hereditary. Usually harmless, some types can be precancerous.
    
    
  • Tumors: Both benign and malignant forms are frequently found in the colon and rectum. Those people older than 50 years are most affected. However, tumors can be found in younger people.
    
    
  • Less than 20% of people with tumor or polyps will have rectal bleeding. However, 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. Evaluation in an emergency department is essential and usually involves evaluation with lighted probes to uncover the extent of injury.
  
  
• 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 body 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.)

• Rectal bleeding in children: Rectal bleeding in small children should be taken seriously. Most children will require admission to the hospital and evaluation by a surgeon.
  
  
  • Intussusception: This condition occurs when the bowel simply twists upon itself. It is the most common cause of intestinal obstruction and rectal bleeding in children younger than 2 years. The majority of cases occur within the first year of life.
    
    
    • The 3 cardinal symptoms are intermittent abdominal pains, vomiting, and rectal bleeding. However, these are not always present. Admission to the hospital is warranted because observation, further imaging tests, and surgery may be required.
  
  
• Meckel diverticulum: A rare condition, this occurs in less than 2% of the population. In fact, only 76 cases have been treated in the last 4 years. 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 diagnosis requires many tests and surgery.