BLEEDING PER RECTUM.

INTRODUCTION

Passing blood through the anus during passage of stools is a very common symptom in humans. It is referred to as bleeding per rectum. It is a serious symptom but because of its high prevalence and association with benign diseases it is frequently ignored with its cause wished away. It could be the first symptom of a sinister diagnosis like a cancer of the large intestine.

Besides normal menstrual bleeding no other bleeding from any part of the human being is normal and it should be adequately investigated to establish the cause and treat.

WHAT VOLUME OF BLOOD DOES ONE PASS?

Passing blood through the anus can be occult and imperceptible; the patient comes to the hospital because of anaemia. Frank passage of blood could be small, moderate or large in quantity. The passage could be a single episode or multiple episodes. It could also be recurrent bleeding episodes. Passage of blood in moderate or large quantities many times in a session causes the person to collapse and be rushed to the hospital.

Bleeding that comes from the upper gut, stomach and small intestine, manifests as passage of dark tarry (Coal Tar) stools. The stools are offensive smelling too.

ARE THERE ASSOCIATED SYMPTOMS TO BLEEDING PER RECTUM?

Bleeding per rectum could be the only symptom or there may be other symptoms that point to the cause of the bleeding; the disease that is causing the bleeding or from which the bleeding is coming.

There are important symptoms of large bowel diseases that the doctor will inquire about to help make a diagnosis, therefore the help and co-operation of the patient in providing accurate answers are extremely important.

WHAT ARE THE SYMPTOMS OF LARGE BOWEL DISEASES THAT PRESENT AS BLEEDING PER RECTUM?

1. Change in bowel habits
2. Excessive loud noisy sound in the tummy (Borborigmy)
3. Bloating, Rumbling, belching, hiccups after eating
4. Constipation
5. Diarrhoea
6. Passage of excessive mucus when passing stools
7. Weight loss
8. Feeling of a lump in the abdomen
9. Abdominal pains
10. Abdominal distention

WHAT ARE THE SYMPTOMS OF UPPER GASTROINTESTINAL DISEASES THAT PRESENT WITH BLEEDING PER RECTUM?

1. Abdominal discomfort after eating
2. Upper abdominal pains; constant continuous or constant but rhythmical
3. Jaundice
4. Feeling of a mass in the upper abdomen

 

WHAT ARE THE DISEASES THAT PRESENT AS BLEEDING PER RECTUM?

Many diseases of the stomach, the small and large intestine cause bleeding per rectum.

A. Upper Gut
1. Oesophageal varices
2. Erosive gastritis
3. Peptic ulcers
4. Gastric cancer
5. Polyps
6. Vascular malformations, eg, Vascular ecstasies
7. Harmobilia, bleeding through the bile ducts
8. Haemosuccus pancreaticus, bleeding through the pancreatic ducts
9. Typhoid iliatis
10. Trauma from ingested foreign bodies
11. Trauma from treatment interventions

B. Lower Gut
1. Haemorrhoids
2. Anal fissure
3. Proctitis
4. Diverticula disease
5. Colon, Rectal, anal cancers
6. Polyps
7. Vascular malformations, eg, angiodyplacia, vascular ectasia
8. Dysentery
9. Schistosomiasis of the intestine.

HOW WILL THE DOCTOR INVESTIGATE THE CUASE OF BLEEDING PER RECTUM?

Bleeding per rectum is a serious symptom that require a complete evaluation to ascertain its cause.

The doctor will request that endoscopies by done to directly see where the bleeding is coming from and the cause. A proctoscopy and colonoscopy will be required. These are very important tests that should not be ignored. In the absence of colonoscopy, which is the gold standard, a barium enema will be done.

Prof Jonathan CB Dakubo