After Weeks of No Blood in Stool Why Start Bleeding Again

• Facts
  • Facts you should know near rectal bleeding
  • What does rectal haemorrhage (blood in stool) mean?
• Causes
  • What are causes of blood in the stool (rectal bleeding)?
  • What diseases and conditions can cause blood in the stool (rectal bleeding)?
  • Anal fissures
  • Hemorrhoids
  • Colon cancer and polyps
  • Diverticulitis
  • Meckel'southward diverticulum
  • Angiodysplasias
  • Colitis and proctitis
  • Polypectomy
  • Rare causes of rectal bleeding
• Specialists
  • What kind of doctor treats rectal bleeding?
• Symptoms & Signs
  • When should I call a doctor for claret in the stool (rectal bleeding)?
• Diagnosis & Tests
  • How is the crusade of blood in the stool (rectal bleeding) diagnosed?
  • History and physical examination
  • Anoscopy
  • Flexible sigmoidoscopy
  • Colonoscopy
  • Video sheathing and small intestine endoscopy
  • Radionuclide scans
  • Visceral angiogram
  • MRI and CT tomographic angiography
  • Nasogastric tube aspiration
  • Esophagogastroduodenoscopy
  • Blood tests
• Treatment
  • What is the treatment for rectal bleeding (blood in the stool)?
• Prevention
  • Is it possible to prevent rectal bleeding (blood in the stool)?
• Prognosis
  • What is the prognosis of rectal bleeding (blood in the stool)?
• Center
  • Blood in the Stool (Rectal Haemorrhage, Hematochezia) Middle
• Comments
  • Patient Comments: Blood in the Stool - Feel
  • Patient Comments: Blood in the Stool - Causes
  • Patient Comments: Blood in the Stool - Diagnosis
  • Patient Comments: Blood in the Stool - Treatment
  • Patient Comments: Blood in the Stool - Hemorrhoids
  • Patient Comments: Blood in the Stool - Anal Fissures
  • Patient Comments: Blood in the Stool - Diseases Causes
  • Patient Comments: Blood in the Stool - Associated Symptoms
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Facts you should know about rectal bleeding

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Flick of colon beefcake and sources of rectal bleeding

• Rectal bleeding is the passage of blood through the anus. The bleeding may upshot in bright red blood in the stool as well every bit maroon-colored or black stool. The bleeding also may exist occult (not visible with the man middle).
• The common causes of rectal haemorrhage from the colon include anal fissure, hemorrhoids, diverticulosis, colon cancer and polyps, colonic polyp removal, angiodysplasias, colitis, proctitis, and Meckel's diverticula.
• Rectal haemorrhage also may be seen with bleeding that is coming from higher in the intestinal tract, from the stomach, duodenum, small intestine, or Meckel's diverticulum.
• Rectal bleeding may not be painful; however, other symptoms that may accompany rectal bleeding are diarrhea, and abdominal cramps due to the irritation caused by the blood in the stool.
• Rectal haemorrhage is normally evaluated and treated by gastroenterologists and colorectal or general surgeons.
• The origin of rectal bleeding is determined by history and concrete test, anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, visceral angiograms, upper gastrointestinal endoscopy, or capsule endoscopy of the pocket-size intestine, and blood tests.
• Rectal bleeding is managed start by correcting any low blood volume and anemia if present with claret transfusions and then, determining the site and cause of the haemorrhage, stopping the bleeding, and preventing futurity rebleeding.
• Rectal bleeding can be prevented if the cause of the haemorrhage can be found and definitively treated, for example, by removing the haemorrhage polyp or tumor. In add-on, it may be appropriate to search for additional abnormalities, for example, polyps or angiodysplasias that have non yet bled only may practice then in the future. This may crave either gastrointestinal endoscopy or surgery.

Rectal Haemorrhage (Claret in Stool) Symptoms

Blood in the stool or rectal bleeding is a symptom of a disease or condition.

The color of claret in the stool can be:

• brilliant carmine,
• maroon,
• yellowish,
• white,
• greenish,
• blackness and tarry, or
• not visible to the naked eye (occult).

Causes of claret in stool range from harmless, annoying weather of the gastrointestinal tract such equally hemorrhoids or anal fissures, to serious weather such as cancer.

What does rectal bleeding (blood in stool) mean?

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Rectal bleeding (known medically as hematochezia) refers to the passage of red claret from the anus, often mixed with stool and/or blood clots. Information technology is called rectal bleeding because the rectum lies immediately above the anus, but cerise blood in the stool may exist coming from the rectum, every bit discussed later, but it also may exist coming from other parts of the alimentary canal.) The severity of rectal bleeding (i.e., the quantity of claret that is passed) varies widely. Most episodes of rectal bleeding are mild and stop on their own. Many patients report only observing a few drops of fresh blood that turns the toilet water pink or observing spots of blood on the tissue paper after they wipe. Others may report brief passage of a spoonful or 2 of blood. Generally, mild rectal haemorrhage tin exist evaluated and treated in the doctor's office without hospitalization or the need for urgent diagnosis and treatment.

Bleeding too may exist moderate or severe. Patients with moderate bleeding will repeatedly pass larger quantities of brilliant or dark red (maroon-colored) claret ofttimes mixed with stool and/or blood clots. Patients with severe haemorrhage may pass several bowel movements or a single bowel movement containing a large amount of blood. Moderate or severe rectal bleeding can chop-chop deplete a patient's body of blood, leading to symptoms of weakness, dizziness, about-fainting or fainting, signs of low blood pressure or orthostatic hypotension (a drib in blood pressure when going from the sitting or lying position to the standing position). Rarely, the haemorrhage may be so severe as to cause shock from the loss of claret. Moderate or severe rectal bleeding ordinarily is evaluated and treated in the infirmary. Patients with signs and symptoms of a reduced volume of blood frequently require emergency hospitalization, and transfusion of blood.

SLIDESHOW

Diverticulitis (Diverticulosis) Symptoms, Diet, Treatment Encounter Slideshow

What are causes of claret in the stool (rectal bleeding)?

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Colour of blood in the stool

Claret in the stool primarily comes from the upper gastrointestinal tract (stomach and duodenum although occasionally the esophagus) or the lower alimentary canal (colon, rectum, and anus). Although the minor intestine besides may exist the source of blood in the stool, compared to the upper and lower parts of the gastrointestinal tract, the small intestine is infrequently the source. Most people think of blood in the stool as pregnant that the stool contains red blood, simply this is non ever truthful. As discussed previously, the bloody stool may be maroon colored or black.

The colon is the part of the gastrointestinal tract through which undigested food passes after the digestible part of the food has been digested and absorbed in the small intestine. The colon is primarily responsible for removing h2o from the undigested food, and storing the undigested nutrient until information technology is eliminated from the body equally stool. The rectum is the last 15 cm (six inches) of the colon. The anal canal, approximately an inch in length, connects the rectum with the anus opening through which stool passes when it is eliminated from the torso. Together, the colon, rectum, anal canal, and anus form a long (several anxiety in length), muscular tube that also is known as the large intestine, large bowel, or the lower alimentary canal.

The colon can be divided further into 3 regions; the correct colon, the transverse colon, and the left colon. The right colon, too known as the ascending colon, is the office of the colon into which undigested food from the small intestine is first deposited. It is furthest from the rectum, anal culvert, and anus. The transverse colon forms a span between the right and the left colon. The left colon is made upwardly of the descending colon and the sigmoid colon. The sigmoid colon connects the descending colon to the rectum.

The color of blood in the stool often depends primarily on the location of the bleeding in the alimentary canal. Generally, the closer the bleeding site is to the anus, the brighter red the blood will be. Thus, haemorrhage from the anus, rectum, and the sigmoid colon tends to be bright carmine, whereas bleeding from the transverse colon and the right colon tends to be dark red or maroon-colored. With bleeding from the upper GI tract and depending on how long the blood remains in the stomach and pocket-sized intestine, the colour in the stool will change from vivid cherry-red, to maroon, to black. Blood in the stool that is red or maroon is most usually is referred to equally rectal bleeding.

Bleeding that occurs from the stomach and duodenum ofttimes is black, "tarry" (pasty), and foul smelling. The black, evil-smelling and tarry stool is chosen melena. Melena by and large occurs when the bleeding is in the stomach where the blood is exposed to acid or is in the pocket-sized intestine for a prolonged amount of time; however, melena too may occur with bleeding from the colon if the transit of the blood through the colon is slow, and there is plenty time for the intestinal bacteria to break the blood down into chemicals (hematin) that are black.

Claret from the sigmoid colon, rectum and anus ordinarily does non stay in the colon long enough for the bacteria to plough it black. Rarely, massive haemorrhage from the right colon, from the pocket-sized intestine, or from ulcers of the tummy or duodenum tin can cause rapid transit of the blood through the alimentary canal and result in vivid ruby rectal bleeding. In these situations, the blood is moving through the colon so speedily that there is not enough time for the leaner to turn the blood darker or black.

Occult gastrointestinal bleeding

Some other "type" of blood in the stool is occult blood. Occult gastrointestinal bleeding refers to a slow loss of claret into the upper or lower gastrointestinal tract that does not change the colour of the stool or outcome in the presence of visible brilliant carmine claret. Claret in the stool is detected but by testing the stool for claret (fecal occult blood testing) in the laboratory. Occult blood in the stool has many of the same causes as rectal haemorrhage, and may be associated with the same symptoms as more active bleeding. For case, boring bleeding from ulcers, colon polyps, or cancers can cause minor amounts of blood to mix and exist lost inside the stool. Chronic occult bleeding often is associated with anemia due to the loss of iron along with the blood (atomic number 26 deficiency anemia).

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What diseases and weather tin can cause blood in the stool (rectal bleeding)?

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Many diseases and conditions can crusade rectal bleeding. Common causes include:

• Anal fissures
• Hemorrhoids
• Cancers and polyps of the rectum and colon
• Diverticulosis
• Aberrant claret vessels in the lining of the intestines (angiodysplasia)
• Ulcerative colitis
• Ulcerative proctitis
• Crohn's colitis
• Infectious colitis
• Ischemic colitis
• Meckel's diverticula

As discussed previously, it likewise is possible for "rectal bleeding" to exist coming from the stomach and duodenum, primarily from ulcers, cancers, and angiodysplasias.

QUESTION

Bowel regularity means a bowel move every 24-hour interval. See Answer

Anal fissures

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An anal fissure is a adequately common, painful status in which the lining of the anal canal is torn. An anal crevice normally is caused by physical trauma due to constipation or a forceful bowel motility through a tight anal muscle or physical trauma also may be contributing factors. Once the skin is torn, each subsequent bowel movement can be painful, and the pain oftentimes is severe. The amount of bleeding that occurs with an anal crevice is modest and usually is noticed in the toilet basin or on the toilet newspaper every bit vivid reddish in colour. The symptoms of an anal fissure are commonly mistaken for hemorrhoids, but hemorrhoids generally practice non crusade pain with bowel movements.

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Hemorrhoids

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Hemorrhoids are masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels. Although most people call back hemorrhoids are aberrant, they are present in everyone. It is only when the hemorrhoidal cushions overstate that hemorrhoids get susceptible to trauma from passing stool and cause problems (such equally bleeding or anal discomfort) and are considered aberrant or a disease. Like anal fissures, bleeding from hemorrhoids usually is mild and does not cause anemia or low blood pressure. Rarely, a person may develop fe deficiency anemia as a result of repeated hemorrhoidal bleeding over several months to years, peculiarly if the dietary intake of iron is low.

Picture of the formation of hemorrhoids

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Colon cancer and polyps

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Tumors of the colon and rectum are growths (masses) arising from the wall of the large intestine. Benign tumors of the large intestine usually are chosen polyps because of their shape. Malignant tumors of the large intestine are cancers, and most are believed to have developed from polyps. Bleeding from colon polyps and cancers tends to be balmy (the amount of blood loss is pocket-sized), intermittent, and commonly does non crusade low claret pressure or shock.

Cancers and polyps of the colon and rectum tin can cause bright red rectal haemorrhage, maroon colored stools, and sometimes melena. The colon cancers and polyps located nearly the rectum and the sigmoid colon are more likely to cause balmy intermittent bright red rectal haemorrhage, while colon cancers located in the correct colon are more likely to cause occult bleeding that over fourth dimension tin can atomic number 82 to moderate or astringent atomic number 26 deficiency anemia.

Motion picture of the colon with colon cancer and colon polyps

Diverticulitis

Diverticulosis is a condition in which the colon contains outpouchings (picayune sacks). Diverticula are present in a majority of people who reach the age of 50-threescore years. The cause of colonic diverticula is non entirely known, but may be contributed by years of loftier pressure within the colon or a weakness in the wall of the colon. Diverticula are permanent, and no nutrition will cause them to disappear. The only way to rid a person of diverticula is to surgically remove the part of the colon that contains the diverticula. A person with diverticulosis typically has many diverticula scattered throughout the colon, simply diverticula are almost common in the sigmoid and descending colon.

Most people with diverticulosis accept few or no symptoms. Diverticulosis is not a problem unless a diverticulum ruptures and an infection (abscess) results, a condition called diverticulitis. Diverticulitis causes abdominal pain, fever and tenderness usually in the left lower abdomen. Rarely, bleeding tin can occur from a diverticulum when a blood vessel within the diverticulum is weakened by the infection and ruptures.

Bleeding from diverticulosis (diverticular bleeding) without the presence of diverticulitis is painless. Bleeding from diverticulosis is more often than not more than severe and brisker than haemorrhage from anal fissures, hemorrhoids, and colon tumors. Diverticular bleeding is the well-nigh common cause of moderate to severe rectal bleeding that requires hospitalization and claret transfusions among the elderly population in the Western earth.

When haemorrhage occurs in a diverticulum located in the sigmoid colon, the bleeding tends to be vivid reddish. When haemorrhage occurs in a diverticulum located in the right or ascending colon, the bleeding may also be bright red if the bleeding is brisk and the transit through the colon is rapid; however, the color is more than likely to be night cerise, maroon, or, sometimes, even black (melena).

Bleeding from diverticulosis is usually brief (it stops on its own). Withal, diverticular bleeding tends to recur. For example, a patient may experience several episodes of rectal bleeding from diverticula during the same hospitalization. Even after discharge from the hospital, some patients who exercise non take the diverticula-containing part of their colon surgically removed volition feel another episode of diverticular bleeding within 4-v years.

Picture of diverticular disease (diverticulitis)

Meckel's diverticulum

A Meckel's diverticulum is an out-pouching (sack) that protrudes from the pocket-sized intestine near the junction of the modest intestine and the colon. It is present from birth and occurs in a small percentage of the population. Some Meckel'southward diverticula can secrete acid, similar the stomach, and the acrid can cause ulcerations in the inner lining of the diverticulum or the tissues of the small intestine adjacent to the diverticulum. These ulcers can bleed. Haemorrhage from a Meckel'south diverticulum is the most mutual crusade of gastrointestinal bleeding in children and young adults. Bleeding from a Meckel's diverticulum is painless only can be brisk and tin cause bright red, dark red, or maroon stools.

Angiodysplasias

Aberrant collections of enlarged claret vessels oft occur but under the inner lining of the colon, small intestine or breadbasket. These abnormal vessels are chosen angiodysplasias. Angiodysplasias usually tin be seen easily during endoscopy as brilliant red, spider-like lesions just beneath the colon'southward lining. Although angiodysplasias may occur anywhere in the colon, they are about common in the right or ascending colon. The cause of angiodysplasias is unknown, merely they occur with increasing frequency as people grow older. Bleeding from angiodysplasias is painless and can event in vivid red, dark red, maroon, or black stools. Angiodysplasias too can cause occult bleeding and atomic number 26 deficiency anemia.

Colitis and proctitis

Colitis means inflammation of the colon. Proctitis means inflammation of the rectum. Several dissimilar diseases tin crusade colitis and proctitis. These include bacterial or viral infection, ulcerative colitis or proctitis, Crohn's colitis, ischemic colitis, and radiations colitis or proctitis.

Ulcerative colitis, ulcerative proctitis, and Crohn's colitis are chronic inflammatory diseases of the colon due to overactivity of the body's immune system. These diseases can cause intestinal pain, diarrhea, and bloody diarrhea (diarrhea mixed with claret). Occasionally, moderate or astringent rectal bleeding may occur. The bleeding originates from ulcerations in the colon.

Like ulcerative colitis and Crohn's colitis, infections - bacterial and, less unremarkably, viral -- tin inflame the colon, leading to intestinal hurting, diarrhea, and fifty-fifty encarmine diarrhea. Rarely, infections may crusade moderate or astringent rectal bleeding. Examples of infections causing rectal bleeding include Salmonella, Shigella, Campylobacter, C. difficile, Due east. Coli O157:H7, and cytomegalovirus (the final in individuals with HIV infection).

Ischemic colitis is inflammation of the colon that is caused when the supply of blood to the colon is reduced all of a sudden. This is virtually oftentimes due to a blood clot that obstructs a small-scale artery supplying claret to a portion of the colon. The sudden reduction in the flow of blood can lead to ulceration of the colon and cause sudden onset of severe lower abdominal, cramping pain followed by rectal haemorrhage. The nigh common part of the colon afflicted by ischemic colitis is the splenic flexure (the part of the colon where the transverse colon joins the left colon). The amount of blood lost during an episode of ischemic colitis usually is pocket-size. Rectal haemorrhage and the abdominal pain of ischemic colitis usually subside on their ain after several days. The colonic ulcers unremarkably heal after a few weeks.

Radiation treatment for cancers of the belly can cause radiations colitis acutely, but permanent changes to the inner lining of the colon and the colonic blood vessels may occur, which can consequence in bleeding many years subsequently treatment. A common instance is radiations proctitis that results from pelvic radiation for the treatment of prostate cancer. Rectal bleeding from radiation proctitis usually is mild, but occasionally can be chronic enough to cause anemia.

Polypectomy

Colon polyps plant during colonoscopy usually are removed, a process called polypectomy. Bleeding can occur at the site of the polypectomy days to weeks after the polyp is removed. Such bleeding is chosen delayed post-polypectomy bleeding. Smaller polyps (2-3 mm in size) can exist removed with biopsy forceps. The amount of claret loss from the apply of a forceps usually is minute, and there volition be no delayed bleeding. Even so, larger polyps (larger than five-10 mm) usually are removed with an electro-surgical snare. These snares are connected to a motorcar that generates an electrical current. The polyp is looped within a snare, and electric electric current is passed through the snare. The electrical current cuts off the polyp and cauterizes ("rut seals") the tissue at the base of the polyps. Cauterization prevents bleeding during polypectomy; however, the site of cauterization heals with the formation of an ulcer. Rarely, these ulcers tin drain several days to up to two-3 weeks later polypectomy. Mail service-polypectomy bleeding can at times be brisk and astringent, and can exist bright red, night crimson, maroon colored, or black.

Rare causes of rectal bleeding

Rarely, rapid and severe bleeding from the upper gastrointestinal tract (for example, ulcers of the breadbasket or duodenum) tin cause bright red rectal bleeding. Other rare causes include leaking of larger amounts of blood into the gastrointestinal tract when a blood vessel ruptures. This may occur when an ulcer of the gastrointestinal tract erodes into a nearby avenue or when an arterial graft, for example, an aortic graft used to repair an aortic aneurysm, erodes into the gastrointestinal tract. Fifty-fifty more than rare is bleeding from a rectal ulcer, or tumors of the pocket-sized intestine.

What kind of doctor treats rectal haemorrhage?

Rectal bleeding usually is managed by a gastroenterologist, a colon and rectal surgeon, or a proctologist.

When should I phone call a md for blood in the stool (rectal bleeding)?

Any claret in the stool is not normal and should be reported to a health-care professional. Nonetheless, there are sure circumstances that might be considered an emergency and medical intendance should be accessed immediately. These situations include:

• Black, tarry stools that may be due to bleeding from the esophagus, stomach or duodenum (upper gastrointestinal [GI] tract). This is especially a potentially serious concern in patients with liver disease and/or portal hypertension who have esophageal varices. This is a potential life-threatening situation.
• Maroon colored stool may be caused by an upper GI bleed or a bleeding source in the small intestine.
• Lightheadedness, weakness, fainting (syncope), breast pain or shortness of breath may be symptoms of significant blood loss.
• Bleeding that is associated with fever and abdominal hurting.

How is the cause of blood in the stool (rectal bleeding) diagnosed?

An accurate diagnosis of the location and the cause of rectal bleeding is important for proper treatment, and prevention of farther haemorrhage. Diagnosis relies on the history and concrete examination, anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, angiograms, and blood tests.

History and physical examination

The age of the patient may offer an important inkling to the cause of rectal bleeding. For example, moderate to severe rectal bleeding in teenagers and young adults is more likely to come from a Meckel's diverticulum. Moderate or severe rectal bleeding in older individuals is more likely to be due to diverticulosis or angiodysplasias. Mild rectal haemorrhage in an adult with prior intestinal radiation treatment may be due to radiations proctitis.

The presence or absence of other symptoms also may provide important clues. Bleeding from diverticulosis, angiodysplasias, and Meckel's diverticula commonly is not associated with abdominal or rectal pain. Rectal bleeding from ischemic colitis is often preceded by the sudden onset of lower abdominal, crampy hurting. Fever, abdominal pain, and diarrhea often occur with colitis due to infection, ulcerative colitis, or Crohn's colitis. Balmy bleeding accompanied with pain in the anal expanse during defecation (passing of stool) suggests bleeding from an anal fissure. A recent modify in bowel habit such as increasing constipation or diarrhea suggests the possibility of cancer of the colon.

Inspection of the anus may disclose bleeding from a hemorrhoid or anal crevice. Unfortunately, almost hemorrhoids and fissures are non actively bleeding at the time a patient arrives at the doctor'due south office. Thus, even if a doctor finds a hemorrhoid or anal fissure, he/she cannot be certain that they are the crusade of the bleeding. Therefore, flexible sigmoidoscopy or colonoscopy will take to exist washed to exclude other potentially more than serious causes of haemorrhage.

Anoscopy

An anoscope is a three-inch long, tapering, metal or clear plastic, hollow tube approximately one inch in diameter at its wider finish. The anoscope is lubricated, and the tapered cease is inserted into the anus, through the anal culvert, and into the rectum. Every bit the anoscope is withdrawn, the area where internal hemorrhoids and anal fissures are establish is well seen. Straining by the patient, as if they are having a bowel movement, may make hemorrhoids more than prominent.

Whether or not hemorrhoids and anal fissures are plant, if there has been rectal bleeding, the colon to a higher place the rectum needs to be examined to exclude other important causes of haemorrhage. Test above the rectum can be achieved by either flexible sigmoidoscopy or colonoscopy, procedures that let the doctor to examine approximately one-3rd or the entire colon, respectively.

Flexible sigmoidoscopy

Flexible sigmoidoscopy utilizes a flexible sigmoidoscope, a fiberoptic viewing tube with a light at its tip. It is a shorter version of a colonoscope. It is inserted through the anus and is used past the doctor to examine the rectum, sigmoid colon and part or all of the descending colon. It is useful for detecting diverticula, colon polyps, and cancers located in the rectum, sigmoid colon, and descending colon. Flexible sigmoidoscopy also can be used to diagnose ulcerative colitis, ulcerative proctitis, and sometimes Crohn's colitis and ischemic colitis.

Despite its value, flexible sigmoidoscopy cannot observe cancers, polyps, or angiodysplasias in the transverse and right colon. Flexible sigmoidoscopy besides cannot diagnose colitis that is across the reach of the flexible sigmoidoscope. Considering of these limitations, colonoscopy may be necessary. The advantage of flexible sigmoidoscopy over colonoscopy is that it tin exist accomplished with no grooming of the colon or after only one or two enemas.

Colonoscopy

Colonoscopy is a process that enables an examiner (usually a gastroenterologist) to evaluate the inside of the unabridged colon. This is accomplished by inserting a flexible viewing tube (the colonoscope) into the anus and then advancing information technology slowly under directly vision through the rectum and the entire colon. The colonoscope often tin reach the part of the minor intestine that is adjacent to the right colon.

Colonoscopy is the most widely used procedure for evaluating rectal bleeding too every bit occult bleeding. It can exist used to observe polyps, cancers, diverticulosis, ulcerative colitis, ulcerative proctitis, Crohn's colitis, ischemic colitis, and angiodysplasias throughout the entire colon and rectum.

If there is any possibility that the bleeding is coming from a location in a higher place the colon, and esophagogasatroduodenal endoscopic examination (EGD) too should be done to identify or exclude an upper gastrointestinal source of bleeding.

Video sheathing and pocket-size intestine endoscopy

If neither an upper or lower gastrointestinal source of blood in the stool is establish, the minor intestine becomes suspect as the source of the bleeding. There are two means of examining the small intestine. The beginning is the video capsule, a large pill containing a miniature photographic camera, battery and transmitter that is swallowed and relays photos of the small intestine wirelessly to a recorder carried over the abdomen. The second way to examine the small intestine is with a specialized endoscope similar to the endoscopes used for upper gastrointestinal endoscopy and colonoscopy. The advantage of these endoscopes over the video capsule is that bleeding lesions tin can be biopsied and treated, something that tin can't be done with the capsule. Unfortunately, small abdominal enteroscopy is time consuming and not by and large available. Patients often must be sent to centers where small intestinal enteroscopy is bachelor.

Radionuclide scans

There are two types of radionuclide scans that are used for determining the site of gastrointestinal haemorrhage; a Meckel's scan, and a tagged ruby-red claret cell (RBC) scan.

The Meckel's scan is a scan for detecting a Meckel's diverticulum. A radioactive chemical is injected into the patient's vein, and a nuclear camera (similar a Geiger counter) is used to scan the patient'due south abdomen. The radioactive chemical will be picked up and concentrated by the acid-secreting tissue in the Meckel's diverticulum and will announced every bit a "hot" surface area in the right lower abdomen on the scan.

Tagged RBC scans are used to make up one's mind the location of the gastrointestinal bleeding. Later drawing claret from the bleeding patient, a radioactive chemical is attached to the patient's cerise blood cells and the "tagged" blood-red blood cells are injected dorsum into the patient's vein. If at that place is active gastrointestinal bleeding, the radioactive red blood cells leak into the intestine where the bleeding is occurring and will appear every bit a hot expanse with a nuclear photographic camera. One drawback of the tagged RBC scan is that bleeding will not show as a hot area if there is no active bleeding at the time of the browse. Thus, information technology can neglect to diagnose the site of haemorrhage if bleeding is intermittent and the scan is done betwixt bleeding episodes. Another drawback of the browse is that it requires a reasonable amount of haemorrhage to class a hot area. Thus, it tin can fail to diagnose the site of the bleeding if haemorrhage is likewise ho-hum. The tagged RBC scan is safe, and can be done quickly and without discomfort to the patient.

Unfortunately, the tagged RBC scans are not very accurate in defining the exact location of the bleeding; at that place is oft a poor correlation betwixt where the tagged RBC scan shows the bleeding to be and the bodily site of bleeding constitute at the time of surgery. Therefore, tagged RBC scans cannot be relied upon to help surgeons make up one's mind what area of the gastrointestinal tract to remove in the event the haemorrhage is severe or persistent and requires surgery. However, if the scan shows a hot surface area, it usually means there is active bleeding, and the patient may exist a candidate for a visceral angiogram to more accurately locate the site of bleeding.

Visceral angiogram

A visceral angiogram is an Ten-ray study of the claret vessels of the alimentary canal. The dr. (usually a specially trained radiologist) will insert a thin, long catheter into a blood vessel in the groin and, under X-ray guidance, will accelerate the tip of the catheter into 1 of the mesenteric arteries (arteries that supply claret to the gastrointestinal tract). A radio-opaque dye is injected through the catheter and into the mesenteric artery. If at that place is active bleeding, the dye tin be seen leaking into the gastrointestinal tract on the X-ray motion picture. Visceral angiograms are accurate in locating rapid haemorrhage in the gastrointestinal tract, but information technology is not useful if the bleeding is slow or has stopped at the time of the angiogram.

The visceral angiogram is not widely used because of its potential complications such every bit kidney damage from the dye, allergic reactions to the dye, and the formation of blood clots in the mesenteric arteries. It is reserved for patients who have severe and continuous bleeding and in whom colonoscopy cannot locate the site of the haemorrhage.

MRI and CT tomographic angiography

Magnetic resonance imaging (MRI) and CT browse can both be used in a way similar to X-rays in visceral angiography, a diagnostic process that has been discussed previously. The apply of MRI and CT angiography for diagnosis in gastrointestinal bleeding is a relatively recent development, and their value has non been clearly defined. They could exist considered experimental.

Nasogastric tube aspiration

If in that location is business organisation about bleeding coming from the stomach or duodenum, nasogastric tube aspiration tin be washed. A thin, flexible rubber or plastic tube is passed through the nose and into the tummy. The liquid contents of the breadbasket then are aspirated and examined for visible blood. (The contents also can be tested for occult blood.) If the bleeding is coming from the stomach, there may be visible blood in the aspirate. In that location also may be visible blood if the bleeding is coming from the duodenum if some of the blood leaks retrograde back into the breadbasket. The primary difficulty in interpreting results of aspiration is that in that location may exist no claret if the bleeding has stopped even temporarily. Therefore, the absenteeism of blood in the aspirate cannot completely exclude the stomach as the source of the haemorrhage. Only esophagogastroduodenoscopy can exclude causes of upper gastrointestinal bleeding.

Esophagogastroduodenoscopy

If in that location is major concern about bleeding coming from the esophagus, stomach or duodenum, an esophagogastricduodenoscopy (EGD) can be washed using an endoscope similar to the endoscope used for colonoscopy.

Blood tests

Blood tests such as a complete claret count (CBC) and iron levels in the blood play no role in locating the site of gastrointestinal bleeding; still, the CBC and blood iron levels may aid to make up one's mind whether bleeding is acute or chronic, since an anemia (low red claret cell count) associated with fe deficiency suggests chronic bleeding over many weeks or months. Colonic weather unremarkably causing iron deficiency anemia include colon polyps, colon cancers, colon angiodysplasias, and chronic colitis.

When a patient loses a large amount of blood suddenly, as with moderate or severe acute rectal bleeding, the lost blood is replaced by fluid from the torso'due south tissues. This influx of fluid dilutes the blood and leads to anemia (a reduced concentration of cherry-red blood cells). Information technology takes time, still, for the tissue fluid to replace the lost blood within the claret vessels. Therefore, presently after a sudden episode of major bleeding, there may be no anemia. Information technology takes many hours and even a mean solar day or more for the anemia to develop while tissue fluid slowly dilutes the blood. For this reason, a ruddy blood cell count early after bleeding is not reliable for estimating the severity of the bleeding.

What is the treatment for rectal bleeding (blood in the stool)?

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Treatment and management of rectal bleeding include

1. correcting the low claret volume and anemia;
2. diagnosing the crusade and the location of the haemorrhage;
3. stopping active bleeding and preventing rebleeding; and
4. Looking for other nonbleeding lesions that may bleed in the futurity.

Correcting low blood book and anemia

Moderate to severe rectal bleeding can cause the loss of enough blood to issue in weakness, low blood pressure level, dizziness, or fainting, and even stupor. Patients with these symptoms usually are hospitalized. They need to be rapidly treated with intravenous fluids and/or blood transfusions to supervene upon the claret that has been lost then that diagnostic tests such as colonoscopies and angiograms can be performed safely to make up one's mind the cause and location of the bleeding.

Patients with severe iron deficiency anemia may need hospitalization for blood transfusions followed past prolonged treatment with oral iron supplements (tablets). Patients with iron deficiency anemia as a result of chronic gastrointestinal blood loss should undergo tests (such as colonoscopy) to determine the cause of the chronic blood loss.

Unless anemia is severe, patients with balmy rectal bleeding from colon polyps, colon cancers, anal fissures, and hemorrhoids usually do not need hospitalization. Mild anemia can be treated with oral atomic number 26 supplements while tests are performed to diagnose the cause of bleeding.

Determining the cause and location of bleeding

Colonoscopy is the virtually widely used procedure for the diagnosis and handling of rectal bleeding. Virtually colonoscopies are performed after assistants of oral laxatives to cleanse the bowel of stool, blood, and claret clots. Nonetheless, in emergency situations such as when the bleeding is severe and continuous, a doctor may cull to perform an emergency colonoscopy without showtime cleansing the large bowel. In trained and experienced hands, the risk of either constituent (delayed) or urgent colonoscopy is pocket-size. (Colon perforation, the virtually common complexity, is rare). The benefits usually far outweigh the potential risks.

Colonoscopy is useful for both diagnosing the cause and determining the location of the bleeding. Locating the site of bleeding is specially of import in diverticular bleeding. Even though most diverticular bleeding stops spontaneously without the need for surgery, patients with severe, recurrent, or continuous diverticular haemorrhage may need surgery to remove the bleeding diverticulum. Since a patient typically has numerous diverticula scattered throughout the colon, colonoscopy may be able to determine which diverticulum is haemorrhage prior to surgery. Without an accurate knowledge of the location of the bleeding diverticulum, the surgeon may take to perform an extensive colon resection (which is not as desirable equally removing a modest section of the colon) in order to make sure that the bleeding diverticulum is removed.

Nevertheless, colonoscopy has limitations. During colonoscopy doctors may not find agile haemorrhage from a specific diverticulum. He/she may just find a colon filled with blood forth with scattered diverticula. In such situations, the diagnosis of diverticular bleeding is assumed if no other cause for the bleeding such every bit colitis or colon cancer is institute. In these situations, there is e'er some uncertainty about the location of the bleeding. Pocket-sized, haemorrhage angiodysplasias as well may exist hard to see and may be missed in a colon filled with claret. This is when radionuclide scans and visceral angiograms may be helpful. If the patient starts haemorrhage once again, an urgent, tagged RBC browse followed by a visceral angiogram may demonstrate the location of the bleeding.

Colonoscopy besides cannot positively diagnose haemorrhage from a Meckel'south diverticulum because the colonoscope usually cannot reach the role of the small intestine in which the Meckel'southward diverticulum is located. Just colonoscopy notwithstanding tin exist helpful in establishing the diagnosis of a bleeding Meckel's diverticulum. Thus, in a young patient with rectal bleeding, a colonoscopy showing a blood filled colon without another source of bleeding, particularly if accompanied by an abnormal Meckel'south scan, makes the diagnosis of Meckel's diverticulum bleeding highly likely. Surgical resection of the Meckel'south diverticulum should upshot in permanent cure with no recurrence of bleeding.

Stopping haemorrhage and preventing rebleeding

Colonoscopy is more than than just a diagnostic tool; information technology can also be used to cease bleeding by removing (snaring) bleeding polyps, by cauterizing (sealing with electrical current) bleeding angiodysplasias or postpolypectomy ulcers and, occasionally, past cauterizing actively haemorrhage blood vessels inside diverticula. Cauterization during colonoscopy is usually achieved by inserting a long cauterizing probe through the colonoscope. Colonoscopy with cauterization has been used to terminate haemorrhage in many patients with bleeding from diverticula or angiodysplasias, thereby decreasing their demand for blood transfusions, shortening their infirmary stays, and avoiding surgery.

When colonoscopy cannot identify the site of bleeding or is unable to stop recurrent or continuous haemorrhage, visceral angiograms may exist helpful. When a bleeding site is identified by an angiogram, medications can be infused through the angiographic catheter to constrict the bleeding blood vessel and stop the bleeding, Microscopic coils also tin can be infused through the catheter to plug (embolize) the haemorrhage blood vessel, thereby stopping the bleeding.

If colonoscopy and visceral angiogram cannot stop continuous haemorrhage or prevent rebleeding, then surgery becomes necessary. Ideally, the site of bleeding has been identified by colonoscopy, nuclear scans, or visceral angiogram, so that the surgeon tin can target the site of haemorrhage for exploration and excision. For example, a surgeon can commonly resect a colon cancer, a bleeding polyp, or a Meckel's diverticulum with precision. Sometimes, the exact site of haemorrhage cannot be established, and the surgeon will have to perform an all-encompassing colon resection under the presumption that a diverticulum or angiodysplasia is the cause of the bleeding.

Balmy rectal haemorrhage from anal fissures and hemorrhoids ordinarily can be treated with local measures such as sitz baths, hemorrhoidal creams, and stool softeners. If these measures fail, several nonsurgical and surgical treatments are bachelor.

Is it possible to prevent rectal bleeding (blood in the stool)?

Most diseases that cause rectal bleeding are likely preventable, but it ofttimes is not possible.

• Hemorrhoids tin can be avoided with proper diet and by prevention of constipation and straining to pass stool, but normal pregnancy increases the risk of hemorrhoid formation every bit does the astute diarrheal illness.
• Avoiding constipation is believed to decrease the risk of diverticulosis, outpouchings in the lining of the colon, and the risk of a diverticular bleed.
• Booze abuse increases the run a risk of rectal bleeding in a variety of ways, from direct irritating the lining of the gastrointestinal (GI) tract, to decreasing clotting capabilities of blood.

What is the prognosis of rectal bleeding (blood in the stool)?

The prognosis depends upon the underlying cause of the bleeding. Fortunately, the cause of rectal bleeding often is beneficial, and due to hemorrhoids or an anal crack.

It is of import to never ignore blood in the stool or rectal bleeding. It may be a clue to a serious illness and the before a diagnosis can exist made, the ameliorate the take chances for a cure.

Medically Reviewed on 3/eight/2022

References

Cagir, B. "Lower Gastrointestinal Bleeding." Medscape. July 26, 2019. <http://emedicine.medscape.com/article/188478-overview>.

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Source: https://www.medicinenet.com/blood_in_the_stool_rectal_bleeding/article.htm

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