Doctor's Notes on Rectal Bleeding
Rectal bleeding is blood that is passed with the stool during a bowel movement. Rectal bleeding may be bright red or may be a darker, blackish color. It is also possible to have blood in the stool that is not visible to the naked eye (called occult bleeding). The medical term for rectal bleeding is hematochezia. There are a number of causes of rectal bleeding. Causes can include hemorrhoids, tears in the anus, inflammatory bowel diseases, ulcers, ischemic colitis, and polyps or cancers of the intestine or anus.
The symptom of rectal bleeding can be associated with other symptoms, depending on the cause of the bleeding. Other associated symptoms can include fatigue, diarrhea, constipation, abdominal pain, weight loss, decreased appetite, dark or tarry stools, or rectal pain.
Rectal Bleeding Causes
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.
- Few 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.)
Meckel diverticulum: A rare condition, where 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.
There are a variety of causes of rectal bleeding. Common causes include hemorrhoids, anal fissure, diverticulosis, infection, inflammation (IBD or irritable bowel disease, Crohn's disease, colitis), blood vessel problems (angiodysplasia). Other causes of rectal bleeding include polyps, tumors, trauma, an upper gastrointestinal source like stomach ulcers, and Meckel diverticulum (rare). Some of the details of the major causes of rectal bleeding are provided in this information.
It can be hard to describe your poop, so doctors use a scale to show the different kinds. It's called the Bristol stool chart, and it gives you an idea of how long a stool spent in your bowel before heading out.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.