Rectal Bleeding
Rectal bleeding is a common symptom. The majority of patients with rectal bleeding have a simple condition such as haemorrhoids, but the symptoms should always be taken seriously and investigated. Rectal bleeding with a change in bowel habit and colicky abdominal pain should be regarded as due to colorectal cancer until proved otherwise.
Causes
History
Anus
Haemorrhoids
Piles occur at any age. Bleeding from piles is noted either on the toilet paper or as splashes in the toilet after defecation. Uncomplicated piles are not painful.
Fissure-in-ano
Fissure-in-ano is most common under the age of 40 years. It is quite common in children. The patient experiences pain on defecation, which may persist for minutes or hours afterwards. Constipation is usually a precipitating cause, the constipation being made worse by the fissure as the patient avoids defecation because of pain. Blood is noticed on the toilet paper or streaked on the stool.
Carcinoma of the anal canal
Carcinoma of the anal canal usually occurs in the elderly. It presents with pain on defecation and streaking of blood on the stools and blood on the toilet paper. Initially, in the early stages, it may be mistaken for a fissure-in-ano.
Trauma
There may be a history of a penetrating injury to the anal canal. Sexual abuse or homosexual practices may be relevant.
Colorectal
Carcinoma
With colonic carcinoma, the blood may be mixed with the stool. There is usually a history of accompanying change in bowel habit and colicky abdominal pain. With rectal cancer, the blood is usually streaked on the stool and there may be a history of tenesmus, i.e. a sense of incomplete evacuation of the rectum.
Polyps
The history may be similar to that of carcinoma.
Diverticular disease
Bleeding associated with diverticular disease is typically acute, massive and fresh. There may be a past history of diverticular disease.
Inflammatory bowel disease
With ulcerative colitis and Crohn’s disease, there is often sudden onset of diarrhoea with watery, brown motions containing mucus and fresh blood. There is usually colicky abdominal pain. With ulcerative proctitis, the patient may complain of tenesmus.
