Home Doctor: Practical Medicine for Every Household
Rectal Bleeding Blood discharge through the anus generally alarms the patient greatly. It is caused by many pathological conditions, both benign and malignant, so it is important to know how to recognize the bleeding and associate it with the rest of the symptoms presented at the time of evaluation. First of all, I will clarify some concepts; it is not necessary to learn the names but the differences between them, since the presumptive diagnosis will depend on this: • • • •
Hematochezia: Red bleeding, fluid, no clots, mixed with stool Melena: Black stools with a very bad smell and no visible blood. It is indicative of bleeding from the upper digestive tract because the blood has passed the digestion process. Rectorrhagia: Bright red blood, with or without clots Fecal occult blood: Refers to a type of bleeding that is not visible but causes symptoms of anemia. It can only be diagnosed by a stool test.
TYPE OF BLEEDING
CHARACTERISTICS
PROBABLE CAUSES
Hematochezia
• •
Stools mixed with blood It may be abundant or just traces, but it is always mixed with feces.
• • • • •
Chron’s Disease Ulcerative Colitis Gastroenteritis Amoebiasis Diverticulosis
Melena
•
Black stools with a very bad smell
• •
Bleeding Peptic Ulcer Gastric Cancer
•
Bright red blood that may contain clots. It can be very abundant or only leave traces when wiped off.
• • • •
Hemorrhoids Anal Fissure Anal Cancer Colon Cancer
There is no blood evidence, only symptoms of weakness, and the blood test shows decreased hemoglobin.
•
Colon Cancer (85% of cases)
Rectorrhagia
•
Fecal Occult Blood
•
As you can see from the table, each of these types of bleeding offers a range of diagnoses that we should keep in mind when evaluating a patient with rectal bleeding. We will discuss below the most common cause of rectal bleeding. 153
