What Does Rectal Bleeding Indicate?

Understandably, noticing a bloody smear on your toilet paper or red-tinged water in the bowl after a bowel movement can trigger alarm bells. More often than not, however, the bleeding is due to conditions that resolve with relatively simple treatment measures. This might include a change in diet or medication to help resolve constipation or other common causes of rectal bleeding.

Sometimes, though, rectal bleeding can signal a serious issue such as an ulcer, a perianal abscess, or colorectal cancer. Regardless of the cause of your rectal bleeding, prompt treatment is often the most effective solution for relieving your symptoms and resolving the underlying condition.

Dr. Bharat Pothuri is a well-respected physician in Cypress, Texas, who specializes in diseases of the digestive system, which includes conditions responsible for rectal bleeding. This dedicated expert is board-certified in both gastroenterology and hepatology and is pleased to share some of his medical insight regarding the causes and concerns of rectal bleeding.

What causes rectal bleeding?

The causes of rectal bleeding are as varied as the patients who experience it. It’s important to remember that rectal bleeding is actually a symptom of an underlying issue. And that underlying issue is the focus of our evaluation. The color of the blood you’re experiencing often helps us narrow down potential sources of rectal bleeding.

For instance, bright red blood often indicates a problem in your colon or rectum. Conditions that cause this type of bleeding can include hemorrhoids, a tear or fissure in the tissue lining the anus, or colon polyps which may or may not develop into cancer.

Dark red rectal blood typically comes from a source higher in your colon or small bowel. Melena is a term used to describe dark, tar-like feces that contain partially-digested blood. The cause of this kind of rectal bleeding is generally found in the stomach and may be a sign of ulcers.

Other conditions that can cause rectal bleeding include:

• Diverticulosis, which causes tiny pouches to form in the bowel wall that may bleed when they become infected
• Crohn’s disease, ulcerative colitis, and other forms of inflammatory bowel disease (IBD)
• Colorectal cancer

What is the most common cause of rectal bleeding?

Hemorrhoids are the most common cause of rectal bleeding. These swollen veins are like the varicose veins found in your legs. They can occur within your rectum as internal hemorrhoids or involve the anus as external hemorrhoids.

They typically develop because of chronic constipation or straining during bowel movements and may be related to pregnancy, heavy lifting, or obesity. Bouts of diarrhea, long periods of sitting or standing, and a family history may also increase your risk of developing hemorrhoids.

How do you treat hemorrhoids?

The most effective treatment depends on the nature and size of your hemorrhoids. We start with addressing the underlying causes of your hemorrhoids, such as constipation. I might also recommend warm baths and use of a cream or suppository that contains hydrocortisone to help reduce inflammation.

For persistently symptomatic hemorrhoids, rubber band ligation is a common outpatient procedure that involves placing specially-designed rubber bands around the base of an internal hemorrhoid to cut off its blood supply. This causes the hemorrhoid to shrink and fall off within a few days.

Severe hemorrhoids that are resistant to other treatment methods may require injection of a chemical solution into the vein to destroy it (sclerotherapy) or surgical removal (hemorrhoidectomy).

What is the exam like for rectal bleeding?

Every exam includes a detailed review of your symptoms to help determine when the problem started and the frequency and severity of your rectal bleeding.

Depending on the type of symptoms you’re having, you may require an examination that includes a visual assessment of your anal region to look for fissures, external hemorrhoids, or other obvious causes for the bleeding. I may also perform a digital rectal examination to check for abnormalities in the lower rectum and anal canal.

When indicated, I also recommend my patients undergo a colonoscopy. During this procedure, a small, flexible tube that contains a camera is inserted into your anus and used to carefully examine your entire colon. You’ll be awake but sedated during the colonoscopy, which helps you relax and decreases the minimal discomfort the procedure may cause.

A colonoscopy allows us to check for polyps and other concerning abnormalities that might indicate precancerous or cancerous changes in your colon. Colorectal cancer has a very high cure rate and is relatively easy to treat when it’s found early.