From the Guidelines
Hematochezia is most commonly caused by diverticulosis, angiodysplasia, hemorrhoids, and colorectal cancer, with the specific cause often determined by the patient's age and underlying medical conditions 1. The passage of fresh blood per rectum, known as hematochezia, is a symptom that requires prompt medical evaluation to determine the underlying cause. The most common causes of hematochezia include:
- Diverticulosis: a condition characterized by the formation of small, bulging pouches in the digestive tract, which can bleed and cause hematochezia 1
- Angiodysplasia: a condition characterized by the formation of abnormal blood vessels in the digestive tract, which can bleed and cause hematochezia 1
- Hemorrhoids: swollen veins in the rectum or anus that can bleed and cause hematochezia 1
- Colorectal cancer: a type of cancer that affects the colon or rectum and can cause hematochezia 1 Other potential causes of hematochezia include:
- Inflammatory bowel disease: a condition characterized by chronic inflammation of the digestive tract, which can cause bleeding and hematochezia 1
- Polyps: growths on the inner lining of the colon or rectum that can bleed and cause hematochezia 1
- Anal fissures: small tears in the lining of the anus that can bleed and cause hematochezia 1 Diagnosis of the underlying cause of hematochezia typically involves a physical examination, including a digital rectal exam, blood tests, and visualization procedures such as colonoscopy 1. Treatment depends on the underlying cause and can range from simple measures such as sitz baths and increased fiber intake for hemorrhoids, to medications for inflammatory conditions, or surgery for more serious issues like cancer 1. It is essential to seek medical attention immediately if you experience hematochezia, especially if it is accompanied by dizziness, weakness, or significant pain, as prompt treatment can help prevent complications and improve outcomes 1.
From the Research
Causes of Hematochezia
The causes of hematochezia, which is the passage of fresh blood per rectum, can be varied and include:
- Anatomic diseases, such as diverticulosis 2
- Vascular diseases, such as angioectasia 3
- Inflammatory diseases, such as colitis 3, 4
- Infectious diseases, such as infectious colitis 3
- Neoplastic diseases, such as colon cancer 3, 4
- Other causes, such as hemorrhoids 4, rectal ulcer 3, and radiation colitis 3
Common Causes of Hematochezia
The most common cause of severe hematochezia in certain populations is diverticular disease, with right-sided diverticular bleeding being a significant proportion of these cases 5, 3. Other common causes include:
- Diverticulosis, which can cause bleeding due to the formation of diverticula in the colon wall 5, 3, 2
- Angioectasia, which are abnormal blood vessels in the colon that can cause bleeding 3
- Colitis, which is inflammation of the colon that can cause bleeding 3, 4
Diagnosis of Hematochezia
Colonoscopy is a commonly used diagnostic tool for identifying the cause of hematochezia, with a high diagnostic yield in many cases 5, 3. However, in some cases, the cause of bleeding may remain unknown even after colonoscopy and additional investigations 5, 6.