Rectal Bleeding: Causes, Symptoms and When to Seek Medical Attention

Haematochezia, or rectal bleeding, is a common issue in the outpatient context. It refers to bleeding from the anus. Haemorrhoids, fissures, proctitis and anorectal cancer are among the conditions that can cause the condition. But it can also be a sign of a pathology in the proximal lower gastrointestinal tract. Regretfully, fewer than half of people who experience rectal bleeding will ever seek medical attention for their symptoms. The first sign of rectal bleeding is frank red blood coming out of the anus. Depending on the cause of the bleeding, the appearance could be minor or severe. Severe cases may manifest as a big volume, brisk flow, whereas mild cases may show up as red blood marking the patient’s stool or toilet paper after wiping. Since haemorrhoids are the most frequent cause of rectal bleeding in middle-aged and older adults, they will be the main focus of the review that follows.  

What is rectal bleeding?

It can be frightening to look down into a toilet and find blood in the excrement. Warning signs that anything is amiss may cause your thoughts to wander. Many illnesses, some more dangerous than others, can cause rectal bleeding. Determining the reason for rectal bleeding is crucial. Haemorrhoids are one example of a reason that might not require treatment. Others, such as colorectal cancer, require immediate medical attention. Other potential causes include inflammatory bowel disease, ulcers and anal fissures. Haematochezia, the medical word for rectal bleeding or blood in the faeces, can be diagnosed with the assistance of a healthcare professional.  

How does rectal bleeding appear?

Rectal bleeding can manifest itself in a number of ways, such as:

• Observing blood in the toilet bowl following a bathroom visit. It may appear as though the water in the bowl has been painted crimson
• Observing tarry black, dark crimson or brilliant red faeces in the toilet  
• Although we refer to bleeding from the butthole as rectal bleeding, the source of the bleeding could actually be anywhere in the gastrointestinal tract. All gastrointestinal bleeding exits along the same route, connecting the stomach, small intestine, colon, rectum and anus.  
• The bright red blood in the stool may be more concerning, as it indicates active bleeding. Darker blood typically indicates past bleeding that has stopped. Darker blood in the stool, however, can be misleading. The fact that the bleeding is coming from a higher location does not necessarily indicate that it has ceased. It takes longer for blood from the upper gastrointestinal system to get through the body and exit the anus. It progressively becomes darker as it passes through the digestive chemicals inside. The blood is bright red and emanates from below. It can be the result of a flesh wound or something else entirely innocuous. It is less likely that upper GI bleeding will be innocuous.  

How does blood appear in stool?

There are several ways that blood in the stool can appear. You may notice blood clots, blood and mucus mixed together or bright red blood streaks on the droppings. Additionally, the faeces may appear sticky, black and dark. The hue of the blood you observe could provide insight into its origin.  

• Bleeding during motion occurs in the form of bright red blood in the stool, which usually means the bleeding is in a lower region in the colon, rectum or anus.
• Dark red or maroon blood can mean that you have bleeding higher up in the colon or the small intestine.
• Melena often points to bleeding in the stomach, such as a bleeding stomach ulcer.  
• Rectal bleeding can occasionally only be detected under a microscope and is invisible to the unaided eye. It is referred to as occult bleeding. If a faecal occult blood test is performed on a stool sample, the reasons for the rectal bleeding can be found.  

Rectal bleeding causes

• Haematochezia or rectal bleeding can occur for a variety of reasons. Rectal bleeding causes range from moderate and common diseases to unusual and serious conditions that require urgent medical care. Other symptoms of bleeding during motion may occasionally provide hints about the potential reason.  
• Haemorrhoids: Swollen veins inside the rectum or anus are known as haemorrhoids, also referred to as piles. They are the most frequent rectal bleeding causes, which are extremely prevalent. These veins protrude near the skin’s surface, and occasionally the skin ruptures, causing them to anal bleeding.  
• Anal fissure: A tear in the anal canal lining is known as anal fissure. It frequently occurs after straining to pass a firm stool, resulting in anal bleeding. It also causes anal pain and is related to constipation.  
• Inflammatory bowel disease (IBD): Inflammatory bowel disease is a chronic inflammation in the GI tract. The symptoms are sometimes mild or severe, comprising blood in stool, abdominal pain, chronic diarrhoea, weight loss and fatigue. It is primarily of two kinds:  
• Crohn’s disease: It mainly develops in the small intestine and the upper part of the large intestine.  
• Ulcerative colitis: It causes sores, ulcers and swelling in the large intestine, which can later spread to the rectum and all parts of the colon.
• Infectious colitis: Some bacterial infections like E. coli can result in haemorrhagic colitis, that is, bleeding during motion. It usually occurs due to bloody diarrhoea.  
• Stomach ulcers: These open sores in the stomach lining, are common and easily treatable. However, without timely treatment, they might lead to complications. They usually result in stomach pain. These ulcers are a kind of peptic ulcer. They lead to anal bleeding.  

Diagnosis of rectal bleeding

There are many diagnostic procedures to examine the rectal bleeding, which may include:

• Digital rectal exam
• Anoscope
• Proctoscopy
• Flexible sigmoidoscopy
• Rectal culture swab.  
• Stool test
• Colonoscopy
• Upper endoscopy  

Treatments for rectal bleeding

Treating rectal bleeding typically entails treating the underlying illness. The underlying reason, which could be anything, determines the course of treatment. You may be able to use topical ointments to help treat the rectal bleeding at home if it is coming from an anal fissure or a haemorrhoid that you can reach.  

Conclusion

To conclude, often, a small amount of blood in the stool is not a reason for concern. But in certain situations, it might be a serious issue. Rectal bleeding symptoms can have a wide range of reasons. To rule out any serious condition, it is advisable to consult a doctor if blood is found in the toilet or during wiping after a bowel movement.