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Expert Speak

Rectal Bleeding

Dr. Vikram Ananthakrishnan M.S., D.N.B., F.R.C.S.

Rectal Bleeding is a common complaint that causes a lot of anxiety to the patient. This indicates that there is some problem in the system. But it need not be a major problem. It is important to get medical help to diagnose and treat the condition.

Dr Vikram Ananthakrishnan, noted general surgeon, explains the possible causes and treatment options for rectal bleeding.

What Causes Rectal Bleeding?

There are many reasons why this happens. Some conditions that cause rectal bleeding are fairly minor and can be cured. For instance, straining at stools could tear the lining tissue of the anus and this could cause bleeding. Some fairly serious problems like cancer could also cause rectal bleeds. If you have rectal bleeding, do not ignore it, but seek medical advice.

Is there a pattern to rectal bleeding?

The doctor needs to know when bleeding occurs in relation to the stools. Is it at the beginning, while straining, or does it occur later? Haemorrhoids bleed at the beginning and there will be drops of blood. Fissure will streak the stool.
The presence or absence of pain is also an indicator: Fissures and infections are associated with pain.
The nature of the stools also gives clues. Is it watery or is there any constipation associated? Diarrhoea may be associated with rectal bleed. Constipation may be the cause of a chronic fissure.
Does the patient have any history of loss of weight or appetite? These symptoms may be due to an under lying cancer.
History of Diabetes, Hypertension and treatment with anticoagulants has to be sought as Aspirin may cause a Gastrointestinal bleed.

What are the investigations a patient with rectal bleeding may need to undergo?

The doctor begins with a general physical examination. He checks:

  • The rate and volume of pulse.
  • Blood pressure.
  • Looks for pallor, dehydration.
  • The abdomen, for masses,
  • The rectum, for haemorrhoids.

Any of the following investigations that may be necessary:

  • Digital exam
  • Proctoscopy.
  • Sigmoidoscopy.
  • If there is no blood gushing out then Colonoscopy can be done.

  • Upper G.I. Endoscopy since very often there is an upper gastrointestinal cause for bleed.

  • Hemoglobin, Packed Cell Volume.
  • Blood Urea , serum Creatinine
  • Blood Sugar
  • Angiogram if the bleed is still not identifiable.

  • A barium enema double contrast is done only in an elective setting.

Who is at risk of the conditions that result in rectal bleeding?

One broad observation can be made: In the younger age group haemorrhoids and fissures are the causes of bleed.
Peptic ulcer can cause (Malena) black stools.
In the older age group Malignancy , angiodysplasia and diverticula form the vast majority of cases.

What is the treatment that a patient is advised to take?

This obviously depends on the cause of the bleed and the haemodynamic stability (the condition of the patient in relation to the extent of blood loss and anaemia) of the patient.

Medical management

Haemorrhoids, fissure may require supplemental treatment with Metronidazole and doxycycline.
Pantopazole or omeprazole may need to be added as acid suppressants if peptic ulcer is the cause.
Triple therapy for eradication of Helicobacter pylori can prevent recurrent bleed.

Referral to a surgeon/ Higher Centre:

  • If there is continuing haemodynamic instability (blood loss),

  • Cause of bleed is not known .

  • If the cause of bleed is determined and requires surgery such as malignancy, diverticulae, haemorrhoids.

Dr. Vikram Ananthakrishnan M.S., D.N.B., F.R.C.S.

Dr.Vikram Ananthakrishnan completed his M.S. in General Surgery from the Grant Medical College, Bombay and then his Diplomate of The National Board, India (D.N.B). He completed his F.R.C.S. from Royal College of Surgeons, Glasgow, U.K.

Dr.Vikram is currently an Assistant Professor in the Department of General Surgery at Sri Ramachandra Medical College, Chennai. He is also a visiting consultant at The Apollo Hospitals, Chennai. His special area of interest is laparoscopic surgery, colon & rectal surgery.

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