Ano-Rectal Bleeding

A fistula is an abnormal, burrowing channel that usually runs from the rectum to the skin around the anus. It often will drain a whitish discharge, but it can also bleed. While it is usually just a local problem, a fistula can be associated with chronic inflammation in other parts of the intestinal tract. This disorder is called Crohn's disease. Fistulas are treated with antibiotics and hot baths. If they persist, surgery is usually required.

The passage of a hard stool or severe diarrhea may tear the lining tissue of the anus. This problem is similar to having cracked lips in cold weather. Nerve endings and blood vessels are exposed so that pain and bleeding occur with bowel movements. Frequent warm baths and bulking agents, used to keep stools soft, usually correct this problem. Sometimes surgery is needed.

Diverticula are pockets or sacs that project from the bowel wall. They balloon out over the years due to recurrent, high pressure spasm of the colon. Occasionally they can bleed. They usually produce a lot of blood, and it comes all at one time. It normally does not persist in small amounts with bowel movements over days or weeks. Serious, persistent diverticular bleeding usually requires hospitalization and, at times, surgery.

Either the rectum, colon, or both, can become inflamed and ulcerated. There are a number of disorders which cause the inside surface of the bowel to become ulcerated and bleed. There may be rectal urgency, cramps or diarrhea associated with the bleeding. When the inflammation is restricted to the rectum, the condition is called proctitis. When the colon is involved, it is called colitis. It is important to identify the specific cause of the inflammation so that appropriate treatment can be started.

Of course, the greatest concern about rectal bleeding is cancer. Polyps are benign growths in the colon. When polyps reach a large size, they can bleed. And certain types of polyps turn into cancer. Colon cancer is usually curable when discovered early. It most often occurs in people over the age of 50, but it is not unheard of in younger individuals, even in their 30's or younger. Because colon cancer is such a common cancer, it is always considered as a possible diagnosis.

Some older individuals will have weakened rectal support tissues. Part of the rectum then can project from the anus and bleed. This condition is called rectal prolapse. It can be felt as an abnormal bulging from the rectum when wiping. Surgery is the only effective treatment.

The physician will inspect the anal area looking for tears and hemorrhoids. A finger exam can provide information when there is tenderness or a tumor inside. In men, the prostate is also examined.

There are several types of endoscopes used to view the colon. In the office, the physician may use a rigid or, more commonly, a flexible viewing sigmoidoscope. This exam is called flexible sigmoidoscopy and is performed in 5 to 10 minutes. A more thorough exam is accomplished with a colonoscope, allowing the physician to view the entire 5- to 6-foot long colon. Sedation is usually given for this exam. Frequently a bleeding lesion will be present beyond the reach of the sigmoidoscope. So colonoscopy may be the best initial exam. Both exams are usually done on an outpatient basis.

This is a complementary exam that uses liquid barium inserted by enema into the rectum. X-rays highlight abnormal shadows, such as tumors, diverticuli and colitis. By itself, however, it does not identify an actual bleeding point.