Rectal bleeding does require investigation

Rectal bleeding is a common condition and affects over 50% of the adult population. It can be categorised into either painless or painful rectal bleeding, with pain arising from the perianal region.

Mr Romi Navaratnam, a top colorectal and laparoscopic surgeon based in London, explains some of the causes of rectal bleeding, when you should get it investigated and the types of treatments available.

What causes rectal bleeding?

The most common condition associated with rectal bleeding and mild perianal discomfort are haemorrhoids (piles).

Severe perianal pain, following or during defecation, associated with rectal bleeding and constipation is often secondary to an anal fissure. The pain associated with defecation may be considerable and may last a few hours.

Painless rectal bleeding can be associated with several conditions, apart from haemorrhoids.

Other benign causes of rectal bleeding include diverticular disease, which is a very common condition, affecting a number of patients over the age of 45 and more often associated with lower abdominal, primarily left-sided pain.

Bleeding in conjunction with diarrhoea can be associated with conditions such as inflammatory bowel disease. This includes ulcerative colitis or Crohn’s disease.

Does rectal bleeding need to be investigated by a specialist?

Irrespective of age, rectal bleeding requires investigation. Although the incidence of sinister pathology below the age of 40 is low, symptoms should not be ignored.

How is rectal bleeding investigated?

The investigation of choice is a colonoscopy. Alternatives to colonoscopy are CT pneumocolon, which tends to be reserved for elderly or infirm patients. Either investigation may be preceded by a stool faecal calprotectin test, however, the investigation is required regardless of the result.

A major advantage of colonoscopy is that on successful completion, the patient can get immediate reassurance.

How is rectal bleeding treated?

The treatment for rectal bleeding depends on what is causing it. The following treatments are typically employed:

• Haemorrhoids - Assuming the colonoscopy is normal, the identification and management of common conditions, such as haemorrhoids, involves techniques like haemorrhoidal banding. The outcomes between haemorrhoidectomy, which requires a general anaesthetic and haemorrhoidal banding and can be undertaken efficiently as an outpatient procedure, are comparable at 12 months.
• A common condition such as fissure - Treatment consists of the application of a topical ointment - such as Diltiazem 2 % - applied on a twice-daily basis for eight weeks in conjunction with a daily laxative. The success rate is in the region of 75%.
• Diverticular disease - Management is often dietary and lifestyle changes. Recurrent severe episodes that require hospitalisation may require planned laparoscopic (keyhole) surgery.
• Benign polyps - Identifying small or large benign polyp during a colonoscopy will result in removal through a therapeutic colonoscopy, usually at the same sitting.
• Bowel cancer - The identification of early bowel cancer may require advanced endoscopic techniques, undertaken through further colonoscopy or alternatively, laparoscopic surgery. The outcomes following laparoscopic surgery are excellent with a large majority of people being returned to their normal lifestyle within a four-week time frame.

The presence of rectal bleeding does require investigation, irrespective of age. Undergoing a colonoscopy, which is a very well-tolerated procedure can often provide strong and immediate reassurance.

If you are experiencing rectal bleeding and would like to see a specialist, go to Mr Romi Navaratnam's Top Doctors profile and book an appointment to discuss it with him.