Discovering blood after a bowel movement can be a frightening experience. If you notice a bright red to black-colored blood in your stool, in the toilet bowl, or on the toilet paper, you may be experiencing rectal bleeding. Having blood in your stool does not always signal a serious medical problem. However, it is better to consult a doctor whether you are experiencing small or large amounts of rectal bleeding to have a proper diagnosis.
What is hematochezia?
Hematochezia is the medical term for rectal bleeding. It refers to the passage of fresh blood mixed with stool through the rectum. Bleeding anywhere in the lower gastrointestinal tract such as the colon or anus can cause rectal bleeding.
The normal color of feces is usually light to dark brown. Decomposed foods and bilirubin are present in the feces. The color of feces also depends on the amount of fat excreted and the types of food eaten. However, blood in the stool via the anus indicates bleeding in the gastrointestinal tract. Sometimes, blood in stool is invisible to the naked eye and can only be determined by fecal occult blood tests. However, the number of people admitted to the hospital for upper GI bleeding is more than the number of people admitted for lower GI bleeding. Nearly 85 percent of lower GI bleeding involves the colon.
Hematochezia vs. Melena
Hematochezia can also be confused with melena due to overlapping symptoms. In melena, blood comes out from the anus, which may or may not be accompanied with stool. The color of the blood is dark brown to maroon and sometimes black. In this case, the bleeding is due to an upper GI bleeding. Hematochezia indicates that there is a problem in the lower gastrointestinal tract. It may also indicate other underlying medical conditions such as diverticulitis, large polyps, hemorrhoids, recent trauma, and colon cancer.
Symptoms of Hematochezia
- Abdominal cramps
- Constipation or diarrhea
- Abdominal distension
- Body weakness
In some cases, the condition can become more serious and life-threatening. Seek medical help right away if you experience the following symptoms:
- Difficulty breathing
- Severe abdominal pain
- Vomiting blood
- Sudden changes in the level of consciousness
There are also other signs and symptoms to watch out for since hematochezia can also indicate colon cancer. They include:
- Abdominal distension
- Changes in the frequency of bowel movements
- Abdominal pain
- Narrow and ribbon-like stools
- Rectal pain
- Sensation of incomplete bowel evacuation
- Unexplained and sudden weight loss
Causes of Hematochezia
A number of conditions can cause hematochezia. They include:
- Colorectal cancer
- Anal fissures
- Inflammatory bowel disease (IBD)
- Angiodysplasia or vascular abnormalities in the small intestine
There are people who cannot break down the pigment called betanin found in beetroots. Betanin is the pigment responsible for a red colored urine or stool, and the condition is called beeturia, which can be commonly mistaken for hematochezia.
Common causes of hematochezia:
- Ulcerative colitis
- Gastric cancer
- Peptic ulcer
- Necrotizing enterocolitis
- Different types of inflammatory bowel disease (IBD)
- E. coli food poisoning
- Solitary rectal ulcer syndrome
- Ruptured or irritated anal hemorrhoids
- Gastrointestinal bleeding
Hematochezia should be treated according to the underlying medical condition. However, the condition should be clearly identified through taking the patient's medical history and physical examination before starting any treatment.
A blood sample of the patient may be taken. For further evaluation, a stool sample is collected for a fecal occult blood test. A fecal occult test should be done every 1-2 years to detect the incidence of colorectal cancer. A digital rectal exam can also be done. To check for abnormalities in the rectal area, the doctor inserts a gloved finger in the rectum. Any palpable and large tumor can be detected through rectal examination.
To check further abnormalities such as polyps in the sigmoid area and colon, a sigmoidoscopy or colonoscopy can be done. These polyps may indicate cancer. A CT scan is also recommended for initial diagnosis. Depending on the clinical circumstances, endoscopic procedures can also be performed, which include wireless capsule endoscopy, esophagogastroduodenoscopy (EGD), and double balloon enteroscopy (DBE) or push-pull enteroscopy. Radionuclide scans and angiography are two nonsurgical modalities that can be used to diagnose hematochezia.
The order of use of various diagnostic modalities will depend on the following factors:
- The hemodynamic status of the patient
- Rate of bleeding
- Failure to pinpoint bleeding with initial tests
Some patients without any diagnosis may experience multiple episodes of lower gastrointestinal bleeding. Such patients have to undergo upper GI series with upper and lower endoscopy, electrolysis, and selective mesenteric angiography. Any unusual lesions can be diagnosed by an elective evaluation test of the entire GI tract. Moreover, arteriovenous malformation can be diagnosed by evaluating the whole GI tract. Blood tests may also be done such as:
- Serum electrolyte levels test
- Complete blood count (CBC)
- Coagulation profile test (Activated partial thromboplastin time and prothrombin time tests)
- Manual platelet count test
- Hematochezia Caused by Hemorrhoids - If hemorrhoids have caused hematochezia, then home remedies should be done, which include some dietary changes and hot sitz bath. People suffering from hemorrhoids should eat a high-fiber diet along with an increased fluid intake to avoid constipation and straining during bowel movements. Moreover, sitting for too long on the toilet should be avoided since it can increase the pressure on the site. Discomfort caused by hemorrhoids can be relieved by using over-the-counter creams, suppositories, and ointments.
- Hematochezia Caused by Diverticulitis - To alleviate abdominal spasms, some medications are available for patients with diverticulitis. These medications include dicyclomine, hyoscyamine, and antibiotics such as metronidazole, ciprofloxacin, and cephalexin. If medications do not work, then surgery may be required. To stop the bleeding, the bleeding diverticula can be removed by surgery.
- Hematochezia Caused by Colorectal Cancer - Treatment of colorectal cancer depends on which stage of cancer the person is in. Prognosis can be good if there is no metastasis and detection is good. However, palliative care will be required if the condition becomes severe or worse. To reduce the likelihood of metastasis of cancer cells, chemotherapy will be required. To remove the polyps from the rectal area or colon, sometimes, treatment is done by abdominoperineal excision or colonoscopy. Certain modifications and major changes are also required in the lifestyle of cancer patients.
Rectal surgeons, proctologists, or gastroenterologists usually treat any form of rectal bleeding. Treatment for rectal bleeding usually depends on the symptoms experienced and the overall health condition of the patient. First, a diagnosis needs to be confirmed before starting any kind of treatment.
- Anemia and Low Blood Volume Treatment - Anemia is caused by moderate to profuse bleeding along with dizziness, shock, or low blood pressure. There may be a need to hospitalize the patient and treated through blood transfusions and intravenous fluids. Treatment of low blood volume and anemia is the first step to undertake diagnostic tests.
- Detection of the Cause and Location of the Bleeding - It is important to diagnose the source of the problem. Localizing can be done by using various diagnostic procedures such as colonoscopy, angiography, and radionuclide scans. To fix the problem, certain blood tests are also undertaken.
- Prevent Rebleeding and Guard Against Frank Bleeding - Colonoscopy can be used to cauterize bleeding postpolypectomy ulcers or angiodysplasias.
However, sometimes, colonoscopy may not be able to identify the source of bleeding. In many cases, it is not able to stop a recurrent bleeding. Visceral angiograms are helpful in such cases. With the help of an angiogram, medications are pushed through the angiographic catheter to stop the bleeding and seal the blood vessels. Sometimes, to plug the bleeding blood vessel through the catheter, microscopic coils are infused. However, the doctor may ask to perform surgery if both processes fail.
Local measures can be used to treat mild bleeding caused by hemorrhoids or anal fissures. These local measures include the use of hemorrhoid creams, stool softeners, and sitz baths. To treat mild and moderate bleeding, several other nonsurgical and surgical treatments are also available.
- The Detection of Non-Bleeding Lesions - In the future, non-bleeding lesions can bleed, so it is important to detect them through blood and stool tests. Usually, the problem can be detected and cured by surgical and nonsurgical procedures.
The common physical problems that cause hematochezia can be prevented, but this may not always be the case.
- Hemorrhoids - One major cause of hematochezia is hemorrhoids, which can be avoided by hydration and proper diet. Bleeding in patients with hemorrhoids may occur due to constipation and straining. The risk of hemorrhoid formation may increase due to pregnancy and diarrheal illness.
- Diverticulosis - Physical hazards such as diverticulosis and outpouching in the colon can be lessened by restricting constipation.
- Alcoholism - The risk of rectal bleeding may increase due to alcoholism, which causes irritation in the GI tract and lessens the capability of blood to clot. To prevent recurrent rectal bleeding, alcohol consumption must be avoided.
There are multiple causes of blood in the stool or hematochezia, so it is necessary to have an accurate diagnosis to detect the real reason behind the problem. There are surgical and nonsurgical treatments available to prevent recurrent lower GI bleeding. After hematochezia is detected and treated, recurrent bleeding can also be prevented or at least reduced by changing one's lifestyle and eating habits.