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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.

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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.

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