Anal, Rectal Bleeding, Blood in Stool, Bloody Diarrhea

The passage of blood during bowel movements should not be presumed to be due to hemorrhoids. While rectal bleeding can be a sign of a benign disorder such as hemorrhoids it can also be caused by more serious conditions. Patient’s with rectal bleeding should be promptly evaluated in consultation with a Gastroenterologist in NYC for the best possible outcomes. Careful history taking and physical examination by a GI doctor or Gastroenterologist will help determine the cause and best treatment.

Rectal bleeding or anal bleeding can be a sign of a number of disorders such as:

  1. Hemorrhoids

  2. Anal fissure

  3. Proctitis

  4. Diverticulosis

  5. Colon polyps

  6. Colorectal cancer

  7. Anal cancer

  8. Infectious colitis/diarrhea

  9. Ischemic colitis

  10. Ulcerative colitis or Crohn’s disease

Hemorrhoids

Hemorrhoids are a common cause of rectal bleeding. Hemorrhoids are dilated/enlarged veins within the rectum or around the anus and can be classified as internal or external. External hemorrhoids develop around the anus. The can be very painful when enlarged and thrombosed (clotted). The do not typically bleed unless the overlying mucosa is damaged or weakened. The pain of acute thrombosis may be so severe as to require urgent opening and drainage of the clot. Internal hemorrhoids are within the rectum are graded based on their size and whether or not they prolapse (protrude from the rectum out through the anus).  These typically bleed and are painless but can be painful the larger and more swollen they are. 

Risk factors for hemorrhoids include:

  1. constipation

  2. straining

  3. pregnancy

  4. prolonged sitting

  5. low fiber diet

Anal Fissure

Anal Fissures are a common and often benign disorder of the anus. These painful tears form primarily as a result of local trauma due to straining, hard stools, constipation, diarrhea, or anal intercourse. Bleeding and pain are the most common symptoms. Anal fissures can become chronic if not appropriately treated. The internal anal sphincter lays just below the surface and when injured can cause spasms and reduce blood flow. This can lead to a cycle of muscle spasm and further tearing.

Proctitis

Proctitis is inflammation in the lining of the rectum. This can be painful or painless. Some patients note painless rectal bleeding with passage of normal stools while others note urgency and passage of mucous and blood. Causes include infections such as gonorrhea, chlamydia, or herpes. Patients can also develop a proctitis as a result of a chronic inflammatory bowel disease called ulcerative proctitis, which is a form of ulcerative colitis affecting only the rectum.

Colitis

Colitis is a condition in which the lining of the colon is inflamed. This can be due to infectious causes, ischemic (low blood flow), or inflammatory such as Crohn’s disease or Ulcerative colitis. Symptoms may include diarrhea, abdominal pain, change in bowel habit, blood and mucous in stools. Diagnosis may require a combination of blood testing, imaging by CT or MRI, and endoscopy/colonoscopy.

Diverticulosis

Diverticulosis is a condition in which weakening occurs in the colon creating areas of out-pouching or sacs along the walls of the colon. This condition has no symptom itself and is seen typically in patients older than age 60. However, bleeding from diverticulosis can occur. Symptoms include abrupt onset of lower abdominal pain and grossly bloody bowel movements. Prompt and emergent medical attention is advised.

Colon polyps

Colon polyps form in the colon as we age. Polyps are growths of tissue. Some polyps can become precancerous and as they grow and enlarge may bleed. Large polyps found in the sigmoid colon or rectum will produce bright red blood. If they bleed from the right side of the colon the blood may look darker, maroon, or near black in color.

Colorectal cancer

Cancers of the large intestine can present with bleeding. Most colon cancers occur over the age of 50 but there is a rising incidence of colorectal cancers in patients less than age 50. Patients with family history of colorectal cancer or colon polyps are at a higher risk. Colonoscopy is performed in asymptomatic patients starting around age 45-50 with the goal of detecting colon cancer early or finding and removing colon polyps, which are precursors to colon cancer. In patients with symptoms a colonoscopy may be performed for diagnosis of the cause of bleeding.

Anal cancer

Anal cancer is a cancer that arises around the anus or in the anal canal. Symptoms can include rectal bleeding, frequent bowel movements or urge to have bowel movements along with bleeding. The risk factors for anal cancer include female sex, number of sexual partners, anal intercourse, exposure to HPV, smoking, and presence of HIV. A colonoscopy or flexible sigmoidoscopy with biopsies is used for diagnosis.

Infectious colitis

Bloody diarrhea presenting abruptly along with fever, abdominal pain, nausea, sweats may be a sign of an infectious colitis. Bacterial pathogens like salmonella and campylobacter jejuni can cause acute diarrhea with bleeding. The bacteria may be picked up by ingestion of undercooked meat or poultry. Diagnosis may require stool testing such as rapid Stool DNA PCR or stool culture. Imaging may be required or a colonoscopy if symptoms do not resolve after 2-4 weeks.

Ischemic colitis

Ischemia means lack of blood supply. The upper left portion of the colon near the spleen is susceptible to drops in blood pressure or blood volume as it has limited supplies of blood via blood vessels in the area. Ischemic colitis can be seen in elderly, due to medications, excessive or extreme exercise blood clots, or atherosclerotic disease. Lack of blood supply causes tissue damage resulting in bleeding.

Diagnosis and Treatment

The condition may require Dr. Motola to perform a digital rectal exam (finger), swabs for STDs, in-office Anoscopy (small plastic device), stool testing, blood work, imaging, or a colonoscopy. Treatment depends on the diagnosis.


Disclaimer: This information is intended to educate but not provide treatment or diagnostic information. Self-diagnosis should not be made base on this or any other online information. Please consult with a doctor about your specific condition. Dr. Motola is available for office consultations. A thorough history and physical exam is needed to make accurate diagnosis before treatment provided.