Rectal bleeding – what does it mean?

Rectal bleeding can be alarming, yet it is something many people experience in their lifetimes. Should we be worried? Is it worth getting checked out? We asked expert colorectal surgeon Mr Giovanni Tebala for these important answers.

Is rectal bleeding normal?

No, it is not. The presence of blood in the stool, either mixed in or around it, or just pouring out alone, either on the toilet paper or directly in the bowl, is always a sign of something abnormal going on.

What can cause rectal bleeding?

Rectal bleeding can be caused by totally benign conditions as well as by malignant disease of the large bowel. Much more rarely, it can come from the small bowel, while bleeding from the foregut usually comes up as fresh blood with vomit or as black stools. Bright, fresh bleeding is usually from the tail end, whereas blood mixed with faeces usually comes from further up in the colon.

The most frequent cause for bright red bleeding is the so-called haemorrhoidal disease, frequently accompanied by prolapse of the anus or the rectum (when the anus protrudes out at every motion or permanently). If it is associated with anal pain, it can be due to an anal fissure (a small ulcer). Unfortunately, rectal bleeding can also be due to a malignant condition or to a significant inflammation (colitis) of the bowel. More rarely, it can be associated with bleeding diverticula (small pouches in the wall of the large bowel that can get inflamed and bleed occasionally) or due to a rare benign condition called angiodysplasia, where a clump of abnormal small blood vessels can spontaneously bleed.

When should you worry about rectal bleeding?

Any rectal bleeding, in particular if it is recurrent, represents a red flag and should prompt a consultation with the GP. If it is associated with any of the following, it can potentially be due to a serious condition and needs investigating quickly:

• A change of bowel habits
• Weight loss
• Abdominal pain
• Tiredness
• Dizziness
• A personal or family history of cancer

Is rectal bleeding a problem even if there is no pain?

Rectal bleeding is always a problem and the presence or absence of pain should not reassure us in any way. If bleeding is associated with anal pain, it is most likely due to a benign anal condition, such as haemorrhoids, prolapse or fissure. Bleeding with abdominal pain can be due to a benign condition such as colitis or diverticulitis, but also to a malignant condition. On the other hand, bleeding with no pain can be due to both malignant and benign diseases.

In any case, if you see blood coming out from your anus, you should see your GP as soon as possible. After asking you some questions and visiting you, they will decide if you need further investigation or treatment and may refer you to a specialist.

How do you treat rectal bleeding?

Rectal bleeding is treated by resolving the root cause. Therefore, before starting the treatment is likely that you will need to undergo some investigation such as a camera test. Haemorrhoids can be treated with local remedies, such as creams and ointments, but sometimes they require some form of operative management that can range from a simple rubber band ligation to a more invasive surgical operation.

Fissures are usually due to a spasm of the anal sphincter (the muscular ring that regulates the opening and closure of your anus), which can be treated either with local creams, injections of Botox or with a surgical operation to release the sphincter. Inflammation of the colon (colitis) is usually treated with medication, but in the most refractory cases it may be necessary to remove the bowel to avoid much more severe complications. A malignant condition of the colon requires a much more complex multidisciplinary approach, which often entails a surgical operation.

If you are experiencing rectal bleeding, get yourself checked out! Visit Mr Tebala’s Top Doctors profile to book an appointment.