Rectal bleeding refers to

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethr ...

in the

rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...

, thus a form of

lower gastrointestinal bleeding Lower gastrointestinal bleeding (LGIB) is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital's emergency department. LGIB accounts for 30–40% of all ga ...

. There are many causes of rectal hemorrhage, including inflamed

hemorrhoid Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''h ...

s (which are dilated vessels in the perianal fat pads), rectal

varices A varix (: varices) is an abnormally dilated blood vessel with a tortuous course. Varices usually occur in the venous system, but may also occur in arterial or lymphatic vessels. Examples of varices include: * Varicose veins, large tortuous veins ...

, proctitis (of various causes),

stercoral ulcer Stercoral ulcer is an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation due to a large bowel obstruction, damage to the autonomic nervous system, or stercoral colitis. It is most commonly located in th ...

s, and

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s. Diagnosis is usually made by

proctoscopy Proctoscopy, or rectoscopy, is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum, or sigmoid colon. A proctoscop ...

, which is an

endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

test.

Signs and symptoms

Those with rectal bleeding may notice bright red blood in their stool. Symptoms associated with rectal bleeding include having several bowel movements in a day, feelings of incomplete rectal evacuation, straining, hard or lumpy stools, feelings of urgency, loose or watery stools, and leakage of bowel movement.

Causes

Bleeding from the rectal area could indicate premalignant polyps or

colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the Colon (anatomy), colon or rectum (parts of the large intestine). Signs and symptoms may include Lower gastrointestinal ...

. Compared to

, anal lesions or benign colorectal conditions are far more common causes of rectal bleeding. Other causes of rectal bleeding include

hemorrhoids Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''he ...

, full-thickness

rectal prolapse A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depen ...

, fissures, sentinel tags,

ulcers An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing ...

, rhagades, external thromboses with extravasation of blood clot, prolapsed polyps or tags, anal trauma or anal-receptive intercourse,

abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

opening, dermatologic conditions of the perianal region, hypertrophied papilla, and distal proctitis. An ulcer could be caused by

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...

anal cancer Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. A ...

HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...

, or another STD.

Inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine ...

s may also cause rectal bleeding.

Risk factors

Certain medications, such as

calcium channel blockers Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., a ...

proton pump inhibitors Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of gastric acid, stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase, H+/K+ ATPase proton pump. The body ...

, can exacerbate anorectal symptoms by causing

diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the ...

, or they can exacerbate bleeding (e.g., Coumadin,

nonsteroidal anti-inflammatory drugs A nonsteroidal compound is a drug that is not a steroid nor a steroid derivative. Nonsteroidal anti-inflammatory drugs (NSAIDs) are distinguished from corticosteroids as a class of anti-inflammatory agents. List of nonsteroidal steroid receptor mod ...

). A history of

hemorrhoidectomy Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''he ...

, fissure surgery, fistula surgery,

polypectomy In medicine, a polypectomy is the surgical removal of an abnormal growth of tissue called a polyp. Polypectomy can be performed by excision if the polyp is external (on the skin). See also * Colonic polypectomy * Non-lifting sign Reference ...

, or

colectomy Colectomy (''wikt:colo-#Prefix, col-'' + ''wikt:-ectomy#Suffix, -ectomy'') is the surgical removal of any extent of the Large intestine#Structure, colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curativ ...

may be relevant. Gastrointestinal symptoms can also result from other procedures like

gastric bypass Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch, where the small intestine is rearranged to connect to both. Surgeons have developed several differen ...

cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...

. Any prior assessment, such as a

colonoscopy Colonoscopy () or coloscopy () is a medical procedure involving the Endoscopy, endoscopic examination of the large bowel (colon) and the distal portion of the small bowel. This examination is performed using either a Charge-coupled device, CCD ...

or flexible

sigmoidoscopy Sigmoidoscopy ("sigma", the Greek term for letter " s/ς" + "eidos" + "scopy": namely, to look inside an "s"/"ς"-like object) is the minimally invasive medical examination of the large intestine from the rectum through to the nearest part of th ...

, may also be important, as well as any history of

carried out in connection with one of these operations.

Diagnosis

Any complaint of bleeding should be followed up with a

complete blood count A complete blood count (CBC), also known as a full blood count (FBC) or full haemogram (FHG), is a set of medical laboratory tests that provide cytometry, information about the cells in a person's blood. The CBC indicates the counts of white blo ...

(CBC) in order to determine the extent of the bleeding and guide treatment. The

partial thromboplastin time The partial thromboplastin time (PTT), also known as the activated partial thromboplastin time (aPTT or APTT), is a blood test that characterizes coagulation of the blood. A historical name for this measure is the Kaolin-cephalin clotting time ...

(PTT) and the

international normalized ratio The prothrombin time (PT) – along with its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) – is an assay for evaluating the extrinsic pathway and common pathway of coagulation. This blood test is also c ...

(INR), which can be used to detect bleeding tendencies, are additional crucial lab tests to obtain. Testing for STIs, such as

gonorrhea Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Gonorrhea is spread through sexual c ...

and

chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear, they may occur only several w ...

, should be conducted on patients who engage in anal receptive sex. No matter if there are other clinical symptoms present or not, endoscopies are the gold standard for examining rectal bleeding and should be completed on patients over 40. To check for a distal source of bleeding, such as internal

, proctitis, rectal ulcers,

malignancies Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not ...

, or

, one can use an anoscope or rigid procto-

sigmoidoscope Sigmoidoscopy ("sigma", the Greek term for letter " s/ς" + "eidos" + "scopy": namely, to look inside an "s"/"ς"-like object) is the minimally invasive medical examination of the large intestine from the rectum through to the nearest part of the ...

. When proximal lower GI pathology is suspected, a colonoscopy needs to be performed. If there is a significant amount of bleeding or the patient is too unstable to be put under anesthesia for an endoscopic procedure,

CT angiography Computed tomography angiography (also called CT angiography or CTA) is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, im ...

may be pursued. It could be challenging to pinpoint the precise location of the blood if there is a lot of blood in the stomach. Tagged red blood cell scintigraphies are a precise way to locate the bleeding vessels and pinpoint the area where they are bleeding. It can be applied to chronic and recurrent rectal bleeding with no apparent cause.

References

External links

Cleveland Clinic

Mayo Clinic
{{Medical resources , ICD11 = {{ICD11, ME24.A1 , ICD10 = {{ICD10, K62.5 , ICD10CM = , ICD9 = {{ICD9, 569.3 , ICDO = , OMIM = , MeshID = D006471 , DiseasesDB = 19317 , SNOMED CT = 12063002 , Curlie = , MedlinePlus = 007741 , eMedicineSubj = , eMedicineTopic = , PatientUK = rectal-bleeding-in-adults , NCI = , GeneReviewsNBK = , GeneReviewsName = , NORD = , GARDNum = , GARDName = , RP = , AO = , WO = , OrthoInfo = , Orphanet = , Scholia = Q3422583 , OB = Gastrointestinal tract disorders Rectal diseases