Rectal bleeding is an indication something is wrong. Usually it is something minor and easily diagnosed, but not always. It is important the specific cause of rectal bleeding is identified and the appropriate treatment started. Although rectal bleeding isn’t usually serious, it is important you don’t just assume this is the case as rectal bleeding may be a sign of rectal cancer.

What Causes Rectal Bleeding?

Hemorrhoids – Dilated blood vessels or veins in the anal or rectal area are called hemorrhoids. Hemorrhoids can be internal (usually painless) or external (felt as small bumps when wiping). Hemorrhoids are usually treated with stool bulking agents and creams or ointments. If they worsen, they can be treated with banding or surgery.

Fistula – A fistula is an abnormal, burrowing channel usually found from the rectum to the skin around the anus. A fistula will drain a whitish discharge and may bleed. Usually it is a localized problem, but it can be associated with Crohn’s disease (chronic inflammation in other parts of the intestinal tract). Fistulas are treated with antibiotics and hot baths. Surgery is only required if they persist.

Fissure – A tear in the lining tissue of the anus, similar to having cracked lips, is called a fissure. They are primarily caused by passage of a hard stool or severe diarrhea. Pain and bleeding occur with bowel movements due to exposed nerve endings and blood vessels. Treatment consists of warm baths and stool bulking agents. Surgical intervention may be needed in some cases.

Diverticulosis – Diverticula are pockets or pouches that project from the bowel wall due to recurrent, high pressure spasm of the colon. Occasionally they may bleed. Diverticular bleeding usually involves a lot of blood all at one time. It normally does not continue in small amounts during a bowel movement over a period of several days or weeks. Serious, persistent diverticular bleeding usually requires hospitalization and sometimes surgery.

Proctitis and Colitis – Inflammation and ulceration can occur in the rectum, colon, or both. When the inflammation and ulceration is limited to the rectum it is called proctitis. If the colon is involved it is called colitis. There are many disorders which can cause inflammation and bleeding inside the rectum and colon. In addition to bleeding, there may be rectal urgency, cramps, and diarrhea. It is important to identify the underlying cause of the inflammation so appropriate treatment can be given.

Polyps and Cancer – Cancer is the  biggest concern when there is rectal bleeding. Because colon cancer is so common, it is always considered a diagnosis if there is rectal bleeding. Polyps are usually benign growths within the colon, however, there are certain types that can turn into cancer. When polyps reach a larger size, they may sometimes bleed. Colon cancer is mostly found in people over age 50, but can be found in younger individuals. If discovered early, colon cancer is usually curable.

Rectal Prolapse – As people age, they may develop weakened rectal support tissues. When this occurs, part of the rectum can project from the anus and bleed. This condition is called rectal prolapse. It is identified as an abnormal bulging from the rectum and can be felt when wiping. Surgical intervention is the only effective treatment for this condition.

Diagnosing Rectal Bleeding

Medical History – In many cases, the medical history will provide clues, but it doesn’t provide the definitive diagnosis. The following types of questions are considered in rectal bleeding: What is the patient’s age? Polyps and cancer are generally found in older individuals. Is there pain or straining with bowel movements? There may be a tear present. Is there dripping blood into the toilet after a bowel movement? There may be some hemorrhoidal bleeding present. The color and frequency also must be taken into consideration when evaluating rectal bleeding.

Visual and Digital Exam – It is important for the physician to visually inspect the area to determine if there are any tears or hemorrhoids present. A finger exam can assist in determining if there is tenderness or a tumor just inside the rectum. The prostate is also examined in men.

Endoscopy – A bowel preparation and sedation are generally used for these exams. A flexible sigmoidoscopy takes about 10 minutes and only examines the first one-third of the colon. A colonoscopy, on the other hand, takes a little longer but examines the entire colon. Both procedures allow the doctor to view the colon lining and identify any areas where bleeding may be occurring. Because the colonoscopy is more thorough, it may be the best initial exam to identify bleeding.

Barium Enema X-Ray – Liquid barium is inserted by enema into the rectum and x-rays are taken. The x-rays will highlight abnormal shadows, such as tumors, diverticuli and colitis. By itself, a barium enema x-ray does not identify an actual bleeding point.