Differential Diagnosis for a 30-year-old Woman with Rectal Bleeding
Single Most Likely Diagnosis
- Hemorrhoids: This is the most common cause of rectal bleeding in adults, especially in young women. The act of wiping after a bowel movement can cause bleeding from hemorrhoids, which are swollen veins in the lowest part of the rectum or anus.
Other Likely Diagnoses
- Anal Fissure: A small tear in the lining of the anus can cause pain and bleeding, especially during and after bowel movements. The pain can be severe, and the bleeding is usually bright red.
- Rectal Prolapse: This condition occurs when the rectum loses its normal attachments inside the body, allowing it to protrude out through the anus. This can cause bleeding, especially during wiping.
- Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis and Crohn's disease can cause rectal bleeding, although they are less common in this age group without other symptoms like diarrhea, weight loss, or abdominal pain.
Do Not Miss Diagnoses
- Colorectal Cancer: Although rare in young women, colorectal cancer can present with rectal bleeding. It's crucial to not miss this diagnosis, as early detection significantly improves prognosis.
- Infectious Colitis: Certain infections can cause rectal bleeding, and while less common, they can be serious and require prompt treatment.
- Diverticulitis: Inflammation of the diverticula in the colon can cause bleeding, and while more common in older adults, it should not be overlooked in younger patients.
Rare Diagnoses
- Angiodysplasia: A condition characterized by fragile, blood-filled vessels in the colon that can cause bleeding. It's more common in older adults but can occur in younger individuals.
- Solitary Rectal Ulcer Syndrome: This condition involves the presence of an ulcer in the rectum, which can cause bleeding, usually during bowel movements.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bleeding. It's rare in adults and more commonly associated with intestinal obstruction symptoms.
- Vascular Malformations: Abnormal connections between arteries and veins can cause bleeding and are usually diagnosed incidentally or during investigation for other symptoms.