From the Guidelines
The most common cause of rectal bleeding is hemorrhoids, which are swollen blood vessels in the rectum or anus. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus) and often cause bright red blood on toilet paper, in the toilet bowl, or on stool surfaces. Other common causes include anal fissures (small tears in the lining of the anus), diverticular disease, inflammatory bowel disease, polyps, and colorectal cancer. For mild hemorrhoidal bleeding, treatment typically includes increasing fiber intake to 25-30 grams daily, drinking plenty of water (6-8 glasses daily), using over-the-counter remedies like hydrocortisone creams or witch hazel pads, and taking warm sitz baths for 10-15 minutes several times daily. While hemorrhoids are most common, it's essential to note that any rectal bleeding should be evaluated by a healthcare provider, especially if it's persistent, accompanied by changes in bowel habits, or occurs in individuals over 40, as these could indicate more serious conditions requiring prompt medical attention 1.
Some key points to consider in the evaluation of rectal bleeding include:
- The importance of a thorough medical history and physical examination, including a digital rectal examination, to rule out other causes of lower gastrointestinal bleeding 1.
- The use of endoscopy, such as anoscopy or flexible sigmoidoscopy, as a first-line diagnostic tool for evaluating rectal bleeding 1.
- The consideration of other potential causes of rectal bleeding, such as anorectal varices, and the use of imaging investigations like EUS or CT scan to aid in diagnosis 1.
- The need for prompt evaluation and treatment of severe rectal bleeding, including the potential for blood transfusions and surgical intervention 1.
Overall, while hemorrhoids are a common cause of rectal bleeding, it's crucial to approach each case with a thorough evaluation to rule out other potential causes and provide appropriate treatment to prevent complications and improve patient outcomes.
From the Research
Causes of Rectal Bleeding
- The most common cause of rectal bleeding is hemorrhoids, as stated in 2 and 3
- Other causes of rectal bleeding include anal fissures, proctitis, and rectal cancer, as mentioned in 4
- Neoplastic polyps and colonic carcinoma are also common causes of rectal bleeding, as found in 5
Diagnosis and Treatment
- A systematic approach to diagnosis, including patient history, examination, and investigation, is essential for identifying the cause of rectal bleeding, as discussed in 2 and 4
- Colonoscopy is a valuable tool for assessing rectal bleeding, particularly in patients over 40 years old, as recommended in 2 and 6
- Treatment options for rectal bleeding depend on the underlying cause, and may include medication, non-operative measures, and surgery, as outlined in 3