Rectal Bleeding

Rectal bleeding is a sign that something is wrong. When bright red blood comes from the anus, or is mixed with the stool, it's often minor, but that is not always the case. The first sign may be pink toilet water or seeing spots on the tissue paper, but the amount of passed blood can vary greatly. Sometimes the rectal bleeding stops on its own, but any case should be mentioned to your gastroenterologist, Dr. Shamsi. Mild cases of rectal bleeding can be evaluated and treated in his office. While we call it rectal bleeding, the source of the bleeding can be anywhere in the gastrointestinal tract.

Where does the blood come from?
What are the more common causes of rectal bleeding?
How can the cause and location of my rectal bleeding be determined?


Where Does the Blood Come From?

The blood seen in cases of rectal bleeding normally comes from either the colon, the rectum, or the anus. The colon is the large intestine, where food passes after having been digested in the small intestine. The colon, mostly, removes water from the undigested food and stores it before it is eliminated from the body. The end of the colon, the last seven inches or so, is called the rectum, and the anus is the opening through which the stool passes when it is eliminated from the body. Together, these three are a several foot long muscular tube that is called the large intestine or lower gastrointestinal tract.

Anal Fissure
The color of the blood seen in rectal bleeding is often a clue about its origin. The closer to the anus, the brighter red the blood will be, in general. Bleeding from the anus, rectum, or end of the colon is often bright red, while dark red or maroon blood often comes from higher up the colon. If the source of the bleeding is at the top of the colon, near where it connects to the small intestine, the blood can be in the system long enough to appear black. The color of the blood, however, is not definitive because massive bleeding from as far up as the stomach can cause blood to speed through the colon and not stay in the system long enough to turn black.

Any notice of rectal or rectum bleeding should be examined by Dr. Shamsi

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What are the More Common Causes of Rectal Bleeding?


Anal Fissure - This common, but painful, condition is a tear in the lining of the anal canal. It can be caused by passing hard stools or by diarrhea. After the lining is torn, the following bowel movements will be painful, but little blood is evident. This condition is frequently mistaken for hemorrhoids, which do not generally cause pain during a bowel movement. Treatment is often as simple as frequent warm baths and the use of bulking agents to keep the stools soft and specially formulated creams specifically ordered by Dr. Shamshi and compounded at pharmacies, but surgery is sometimes needed.

Hemorrhoids - Swollen or dilated blood vessels near the anus can occur inside or outside of the rectum. Problems can occur when the cushion that holds the vessels enlarges, with anal bleeding or anal itching as possible results. Bleeding from hemorrhoids is usually mild, but iron deficiency anemia can result if hemorrhoidal bleeding is left untreated for several months or years.

Diverticulosis - This condition appears most often in those over the age of fifty, and is thought to be caused by years of high pressure spasms in the colon or weaknesses in the colon wall. Diverticula are permanent pockets or sacs that stick out from the colon wall and can occasionally bleed. If the bleeding is serious and consistent, hospitalization and surgery will be necessary to correct the condition.

Colon Cancers and Polyps - The greatest fear whenever rectal bleeding is seen is cancer. Polyps are benign, but if they grow large enough, they can bleed, and certain types of polyps can turn into cancer. Bleeding from either is usually mild, and can range from bright red to black.

Proctitis and Colitis - Colitis is an inflammation of the colon, and proclitis is one in the rectum. If either of these becomes ulcerated, bleeding can result. These conditions have a variety of causes, including bacterial and viral infections as well as some diseases, and each cause has its own treatment. Diarrhea, cramps, and rectal urgency may accompany either of these conditions.

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How Can the Cause and Location of My Rectal Bleeding Be Determined?

To properly treat anal bleeding, its cause and source need to be accurately diagnosed. This begins with a physical examination by your gastroenterologist, Dr. Shamsi, who will also need your comprehensive medical history. He may need blood tests, and may also need to perform an anoscopy, colonoscopy, angiogram, and other examination procedures.

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