Rectal bleeding

Rectal bleeding is a common, usually benign condition.  Very few people get through adulthood without ever having seen some blood on the toilet paper following a bowel movement.  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, in the colon) may be darker in color, mixed within the stool and may be accompanied by other symptoms in the abdomen such as pain or bloating.

An accurate diagnosis is the key to the proper management of rectal bleeding.  The possible serious (usually higher) sources must be ruled out, and once they are, the patient may be reassured that they are just dealing with a nuisance disorder.  Diagnostic tools include 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 on 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.

© Pezim Clinic, Vancouver, British Columbia, Canada