Understanding rectal bleeding: causes, treatments, and when to seek help

Rectal bleeding can be a worrying symptom for many individuals, and while it may be caused by minor issues, it can also indicate more serious conditions.

In this article, a leading colorectal surgeon will answer common questions surrounding rectal bleeding, its causes, available treatments, and when to seek medical attention.

What are the common causes of rectal bleeding?

Rectal bleeding can result from a wide range of conditions, some of which are minor, while others may require medical intervention. Common causes include:

• Haemorrhoids: swollen blood vessels in the rectum or anus are a frequent cause of rectal bleeding. Haemorrhoids can lead to bright red blood, often noticeable after bowel movements.
• Anal fissures: small tears in the lining of the anus caused by passing hard stools can result in pain and rectal bleeding.
• Diverticular disease: small pouches (diverticula) that form in the wall of the colon can sometimes bleed.
• Colorectal polyps: these are benign growths in the lining of the colon or rectum that may cause bleeding. Though not cancerous, they can become malignant over time if left untreated.
• Inflammatory bowel disease (IBD): conditions such as Crohn’s disease and ulcerative colitis can cause inflammation of the bowel lining, leading to bleeding.
• Colorectal cancer: in some cases, rectal bleeding may be a symptom of colorectal cancer. While less common, it is important to rule out this possibility, especially in individuals over 50 or those with a family history of colorectal cancer.

What symptoms accompany rectal bleeding?

The nature of rectal bleeding can vary, and it’s important to pay attention to associated symptoms. These can help your doctor determine the underlying cause. Some symptoms include:

• Bright red blood: this usually indicates a source of bleeding close to the anus, such as haemorrhoids or anal fissures.
• Dark, tarry stools: this may suggest bleeding from higher up in the digestive tract, such as in the stomach or small intestine.
• Mucus in the stool: this can be a sign of inflammatory bowel disease or an infection.
• Abdominal pain or discomfort: if bleeding is accompanied by pain, it may indicate more serious conditions like diverticulitis or cancer.
• Changes in bowel habits: persistent constipation, diarrhoea, or changes in stool consistency or colour should be investigated.

When should I seek medical help?

While minor rectal bleeding can often resolve on its own, certain situations warrant medical evaluation:

• Heavy or persistent bleeding: if you are passing large amounts of blood or bleeding continues for more than a few days, consult a doctor.
• Accompanying symptoms: seek medical attention if bleeding is associated with severe pain, significant weight loss, fatigue, or changes in bowel habits.
• Age over 50: for individuals over the age of 50, it is important to report rectal bleeding, as the risk of colorectal cancer increases with age.
• Family history of colorectal cancer: if you have a family history of colorectal cancer, it’s critical to inform your doctor about any rectal bleeding, even if it seems minor.

How is rectal bleeding diagnosed?

To diagnose the cause of rectal bleeding, your doctor may recommend the following tests:

• Physical examination: a digital rectal exam may be performed to check for haemorrhoids, fissures, or other abnormalities.
• Colonoscopy: this procedure involves using a small camera to examine the inside of your colon and rectum, helping to identify polyps, cancers, or other sources of bleeding.
• Sigmoidoscopy: similar to a colonoscopy, this procedure focuses on the lower part of the colon and rectum.
• Blood tests: these may be ordered to assess your overall health and determine if the bleeding has led to anaemia.

What are the treatment options?

Treatment for rectal bleeding depends on the underlying cause:

• Haemorrhoids: conservative treatments like increasing fibre intake, using over-the-counter creams, and warm baths can help. In some cases, procedures like banding or surgery may be necessary.
• Anal fissures: these often heal with conservative treatments, such as stool softeners and topical creams. In more severe cases, surgery may be needed.
• Colorectal polyps: polyps are typically removed during a colonoscopy to prevent them from becoming cancerous.
• Inflammatory bowel disease: treatment may involve medications to reduce inflammation and manage symptoms.
• Colorectal cancer: if cancer is the cause, treatment options may include surgery, chemotherapy, or radiation therapy, depending on the stage of the cancer.

Conclusion

Rectal bleeding can be caused by a variety of conditions, ranging from minor issues like haemorrhoids to more serious illnesses like colorectal cancer. It is essential to seek medical evaluation if bleeding persists or is accompanied by other symptoms. Early diagnosis and treatment can significantly improve outcomes, particularly in more serious cases.

Are you thinking about getting a diagnosis for haematuria? Arrange a consultation with Mr Pasha Nisar via his Top Doctors profile.