From the Guidelines
If you notice blood in your stool, you should seek medical attention promptly, especially if this is a new symptom. While waiting for medical care, stay hydrated by drinking plenty of water. Don't take aspirin or NSAIDs like ibuprofen as they can increase bleeding. For mild rectal bleeding from hemorrhoids, over-the-counter treatments like Preparation H cream or witch hazel pads may provide temporary relief, but these won't address the underlying cause. Blood in stool can indicate various conditions ranging from minor issues like hemorrhoids or anal fissures to more serious concerns such as inflammatory bowel disease, diverticulosis, polyps, or colorectal cancer. The color and amount matter - bright red blood typically suggests lower GI tract bleeding, while darker or black stool (melena) may indicate upper GI bleeding.
Key Considerations
- The most common causes of lower gastrointestinal bleeding are diverticulosis, angiodysplasia, haemorrhoids, and ischaemic colitis, as seen in studies such as 1.
- Only a healthcare provider can properly diagnose the cause through examination and possibly additional tests like colonoscopy, sigmoidoscopy, or stool tests, as outlined in 1.
- Surgical intervention is required when haemodynamic instability persists despite aggressive resuscitation, the blood transfusion requirement is greater than 6 U, or severe bleeding recurs, as stated in 1.
Diagnostic Approach
- An algorithm for the management of lower gastrointestinal bleeding is provided in 1, which includes the use of colonoscopy, angiography, and other diagnostic tools.
- The approach to diagnosis and treatment should be based on the severity of bleeding and the patient's overall condition, with a focus on stabilizing the patient and identifying the underlying cause of bleeding.
Treatment
- Treatment should be individualized based on the underlying cause of bleeding, and may include endoscopic, angiographic, or surgical interventions, as discussed in 1.
- In some cases, supportive care and monitoring may be sufficient, while in other cases, more aggressive treatment may be necessary to prevent complications and improve outcomes.
From the Research
Treatment for Hematochezia
The treatment for hematochezia, or the passage of blood in stool, depends on the underlying cause of the condition.
- For patients with chronic, bright red, rectal bleeding who are at low risk for colorectal neoplasia and have an identifiable anal cause for their bleeding, flexible sigmoidoscopy may not be necessary 2.
- Medical therapy is often the first line of treatment for hemorrhoids and anal fissures in patients with inflammatory bowel disease (IBD), as surgery can be risky and may lead to complications 3, 4.
- For patients with a positive fecal immunochemical test (FIT) and rectal bleeding as a sole symptom, flexible sigmoidoscopy can be an effective initial diagnostic tool to detect significant bowel pathologies, such as cancer, IBD, and large polyps 5.
- In some cases, surgical options such as hemorrhoidectomy or sphincterotomy may be considered, but the risk of complications needs to be carefully evaluated 3, 4.
- The choice of treatment ultimately depends on the individual patient's condition, medical history, and the results of diagnostic tests.