Rectal Bleeding

Rectal Bleeding is a common, usually benign condition. Very few people get to adulthood without ever having seen some blood on the toilet paper following a bowel moevment. Fortunately, it is most often benign, particularly if it is bright red (fresh), separate from or on the surface of the stool, and associated with some anal pain suggestive of a fissure or some other local anal irritation. More serious rectal bleeding (coming from higher up) may be darker in color, mixed within the stool and may be accompanied by other symptoms in the abdomen.

An accurate diagnosis is the key to the proper management of rectal bleeding. The possible serious (usually higher) sources must be ruled out, and if they are, then one is just dealing with a nuisance disorder. The diagnostic tools included careful history-taking, physical examination, digital examination of the anus and simple (rigid) sigmoidoscopy. Additional studies including flexible sigmoidoscopy or colonoscopy may be required.

The management of rectal bleeding will depend upon its source. Anal canal bleeding (the vast majority of rectal bleeding cases) may be managed by diet changes, infrared photocoagulation, elastic band ligation of hemorrhoids, etc. Higher bleeding may require removal of polyps, medical treatment of inflammation, or even surgery in some cases.

Michael E Pezim, MD FRCSC FACS
Pezim Clinic, Vancouver, British Columbia, Canada