Anorectal Bleeding (Hematochezia)
Anorectal bleeding refers to the presence of blood in the stool, while it is passing from the rectum. Anorectal bleeding is also referred to as hematochezia. The rectum is a chamber which begins at the end of the large intestine. Normally rectum is empty because stool is stored in the descending colon which is higher than the rectum.
When descending colon becomes full, stool passes to the rectum causing an urge to pass stool. Young children and infants do possess the ability to control and delay the urge to defecate.
Anorectal bleeding is often accompanied by following Signs and symptoms
Signs and symptoms of Anorectal bleeding
• Bright red stool/maroon colored stool
• Abdominal pain/rectal pain/Back pain
• Dizziness, lightheadedness
• Low blood pressure
• Rapid heartbeat/palpitations
Color of the blood present in the stool is dependant of the location of the bleeding, according to the color of the blood following types of rectal bleeding can be noticed.
• Bright red blood –
bright red colored blood is present in the stool when the bleeding site is close like -anus, rectum, or sigmoid colon.
• Maroon blood –
in some patients maroon-colored blood may be seen in the stool, the maroon stool is noticed when the bleeding site is far like the transverse colon, and the right colon.
• When the stool is black in color and, sticky in nature. It is often associated with a foul smell. Such discharge is called MELENA. Melena occurs in the stool when the Blood is infected by the bacteria. In such patients, the bleeding site is in the upper GIT (gastrointestinal tract). It has been seen that ulcers in the stomach and duodenum are responsible for melena in the stool.
• Sometimes when the discharge of blood from the gastrointestinal tract is too slow, it may not be visible to the naked eyes, such blood in stool is called occult bleeding. Occult blood may be associated with anemia and it can be diagnosed with the help of fecal occult blood testing.
To identify the site and reason for Anorectal bleeding, it is important for your treating doctor to follow certain procedures and tests. Following tests are required for proper diagnosis.
• Patient’s history
• physical examination is performed to evaluate any signs and symptoms of abdominal distension, discomfort, or tenderness which may be present because of a possible bleeding ulcer or a cancerous mass
• Your doctor may perform a detailed anal and digital rectal examination
• It is important to keep a track of your vital signs because low B.P, Elevated heart rate indicate significant blood loss. Likewise, elevated body temperature indicates possible bacterial infection and requires proper treatment.
• A blood test is required to evaluate clotting time and identifying the source of infection.
• Nasogastric tube
• A stool test is always required to find out the presence of occult blood in the stool, which is int visible to the naked eyes.
• Anoscopy – anoscope is placed into the anus to examine the entire rectum for the presence of any lacerations or ulcers
• Flexible sigmoidoscopy is used to examine the rectum and lower end of the colon.
• Colonoscopy – a soft tube with light and camera is inserted into the rectum to visualize the entire large colon.
• CT Scan
Probable Causes of Rectal Bleeding are as Follows
• Hemorrhoids are swollen rectal veins, they can be external and internal
• An anal fissure is a tear in the lining of the rectum. Often bright red blood in stool is associated with anal fissures.
• Diverticulosis (outpouching that project from bowel wall), it is especially common after the age of 40 years. The probability of having diverticulosis increases with age. Often dark red maroon stool is associated with diverticulosis.
• Bacterial infections like those from E.coli, salmonella, clostridium difficile causes Anorectal bleeding. It is accompanied by abdominal pain, fever, and diarrhea.
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis) are common in younger people below 50 years.
• Tumors may be present in people older than 50 years. weight loss, a change in the caliber of stool, a sense of rectal fullness or constipation may be experienced, colonoscopy is required
• Bowel trauma because of gunshot and foreign body insertion.
• Ulcers in upper GIT may occur because of the swallowing of a foreign object which is causes injury. ulcers, rupture or tear of the lining of esophagus or stomach because of continuing and forceful vomiting
• Dilated vein
Natural and Home Remedies for Anorectal bleeding are as follows
1. 8 – 10 glass of water
2. Do not strain bowel movements
3. Increase fiber in the diet
4. Avoid sitting on the toilet too long
5. Ice pack to the affected area
6. Sitz bath with warm water
7. Avoid alcohol
Dr Reena Prajapat is a dentist, she post graduated in hospital management from Apollo Institute of hospital Administration, Hyderabad. Her strong belief in natural and home remedies lead her to Pursue bachelor in naturopathy.