Rectal bleeding, known as hematochezia, refers to the passage of red blood from the anus, often mixed with stool and blood clots. It is called rectal bleeding because the rectum lies immediately above the anus, but red blood in the stool may be coming from the rectum. The severity of rectal bleeding varies widely. Most episodes of rectal bleeding are mild and stop on their own. Many patients report only observing a few drops of fresh blood that turns the toilet water pink or observing spots of blood on the tissue paper after they wipe. Others may report brief passage of a spoonful or two of blood. Generally, mild rectal bleeding can be evaluated and treated in the doctor's office without hospitalization or the need for urgent diagnosis and treatment.
Causes of Blood in Stool
Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test. At other times it may be visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.
Possible causes of blood in stool include:
- Diverticular disease. Diverticula are small pouches that project from the colon wall. Usually diverticula don't cause problems, but sometimes they can bleed or become infected.
- Anal fissure. A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut.
- Colitis. Inflammation of the colon. Among the more common causes are infections or inflammatory bowel disease.
- Angiodysplasia. A condition in which fragile, abnormal blood vessels lead to bleeding.
What are the symptoms?
Hematochezia is usually a bright red color. Remember, hematochezia is caused by bleeding in the colon, which is fairly close to the anus. The blood only travels a short distance, so it’s still fresh by the time it leaves your anus. You might notice it mixed in with your stool, though it can also come out separately.
In addition, hematochezia tends to cause more minor bleeding. Other symptoms that might accompany hematochezia include:
Blood in stool diagnosis and treatment
There are numerous tests that the doctor can run in order to properly determine the cause of blood in stool and choose the appropriate treatment option. Diagnostic tests for rectal bleeding include:
- Nasogastric lavage, the process to help ythe doctor determine if blood is coming from the upper digestive tract.
- Esophagogastroduodenoscopy (EGD) – an endoscope is inserted down a person’s mouth to check their esophagus.
- Colonoscopy and Barium X-ray.
- Laparotomy – the doctor opens the abdomen, if all other tests fail to determine the bleeding site.
- Checking blood work for H. pylori, anemia, and clotting problems.
How to treat rectal bleeding
Hematochezia treatment depends on the underlying cause of the rectal bleeding. Treatment for hematochezia can vary greatly from prescribed medications to even surgery. Possibly hematochezia treatments include treating low blood volume and anemia if blood loss is significant, stopping any active bleeding from continuing and preventing rebleeding, increasing fiber in your diet, taking anti-inflammatory medications, antibiotics, and any other specific form of treatment to directly aid in the specific cause for the rectal bleeding.
Depending on the cause, treatment may involve simple things you can do on your own. These include eating a high-fiber diet to relieve constipation that can cause and aggravate hemorrhoids and anal fissures, and sitting in warm or hot baths to relieve fissures. Your doctor will prescribe or recommend treatment based on your diagnosis.