From the Guidelines
The risk of bleeding after a rectal Examination Under Anesthesia (EUA) is generally low, with no significant difference in rates of postoperative rectal bleeding found in patients on anticoagulation therapy, such as warfarin or aspirin, compared to those not on these therapies 1. When considering the risk of bleeding after a rectal EUA, several factors come into play, including the patient's use of anticoagulant or antiplatelet medications, the presence of rectal pathologies, and the performance of biopsies during the procedure.
- The use of aspirin, for example, does not significantly increase the risk of moderate to severe hematuria, hemospermia, or rectal bleeding after transrectal ultrasound-guided biopsy of the prostate (TRUSBx), as evidenced by a large prospective, controlled study 1.
- Similarly, uninterrupted use of warfarin does not lead to a significant difference in postoperative rectal bleeding rates compared to controls 1.
- It's also important to note that the overall incidence of significant bleeding requiring intervention is rare, and most bleeding, when it occurs, is minor and self-limiting.
- To minimize the risk of bleeding, patients should adhere to post-procedure instructions, avoid straining during bowel movements, stay hydrated, and consider using stool softeners if constipated.
- The diagnostic benefits of EUA, including the thorough assessment of rectal pathology that may not be possible during a conscious examination due to pain or muscle guarding, justify the low risk of bleeding associated with the procedure.
From the Research
Risk of Bleeding after Rectal EUA
The risk of bleeding after a rectal Examination Under Anesthesia (EUA) is not directly addressed in the provided studies. However, the studies provide information on the causes and management of rectal bleeding in various contexts.
Causes of Rectal Bleeding
- The source of bleeding from the rectum can be difficult to specify, with lesions potentially located anywhere along the gastrointestinal tract 2.
- Common causes of rectal bleeding include diverticulosis, vascular dysplasia, inflammatory bowel disease, and ischemic colitis 2.
- Acute hemorrhagic rectal ulcer is an important cause of lower gastrointestinal bleeding in critically ill patients 3.
- Rectal bleeding can also occur after radiation therapy for endometrial cancer, with external beam radiotherapy increasing the risk of bleeding compared to vaginal brachytherapy alone 4.
Diagnosis and Management of Rectal Bleeding
- A structured patient history and basic proctological diagnostic assessment can help diagnose and treat common causes of rectal bleeding 5.
- Interdisciplinary diagnostics and treatment may be necessary for more complex cases, including proctitis and rectal cancer 5.
- Aggressive diagnostic evaluation using sigmoidoscopy, angiography, and colonoscopy can help increase the number of directed operations and decrease mortality and operative morbidity in patients with lower gastrointestinal bleeding 6.
Risk Factors for Bleeding
- Age ≤70 years is a predictor of rectal bleeding after external beam radiotherapy and vaginal brachytherapy 4.
- Anticoagulant use is a risk factor for rebleeding after treatment for acute hemorrhagic rectal ulcer 3.
- Thrombocytopenia and multiple comorbidities are independent predictors of mortality in patients with acute lower gastrointestinal bleeding 3.