RECTAL BLEEDING |
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What causes rectal
bleeding?
Rectal bleeding may
indicate a benign cause such as haemorrhoids or a more sinister
underlying condition such as rectal carcinoma.
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Haemorrhoids
Haemorrhoids, commonly called piles, are enlarged and engorged
veins that are found in the anal canal. Straining at stool
usually causes them. Haemorrhoids are classified into first,
second and third degree depending on the extent they prolapse
(come down) through the anal canal. First degree piles remain
inside the rectal canal and cannot be seen from the outside.
Second degree piles prolapse during defaecation but return of
their own accord. Third degree piles remain outside the anal
margin unless replaced digitally. Other symptoms of haemorrhoids
are irritation and itching around the anal region. They are not
typically painful unless they are thrombosed (clotted). |
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Rectal Cancer
If rectal bleeding is accompanied by other symptoms such as
changes in bowel habit, weight loss and a sensation of
incomplete evacuation, your doctor may suspect carcinoma of the
rectum and you will be sent for further testing. |
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Colonic Polyps
These are small bulges of tissue which protrude outward from the
lining of the bowel. Your doctor will need to identify whether
they are cancerous or not. Often, Polyps are asymptomatic and
are only discovered following a routine colonoscopy to
investigate rectal bleeding. They can cause iron deficiency
anaemia due to blood loss. |
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Diverticular Disease
Where bleeding from the rectum is also accompanied by left-sided
abdominal pain and constipation, you will be tested for
Diverticular disease. A diverticulum is an outpouching of the
wall of the colon. It is usually caused by a lack of dietary
fibre. |
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Inflammatory bowel disease or
colitis
Symptoms include rectal bleeding, the passing of mucus and
diarrhoea. |
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Anal fissure
This is a longitudinal tear in the skin of the anal canal caused
by the passage of a large constipated stool. There is associated
pain during defaecation, which may last minutes to hours. |
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Should I be
worried about rectal bleeding?
Bleeding from the rectum (the lower part
of the large bowel on the left side of the body) is a common symptom
of several conditions ranging from mild (haemorrhoids) to severe (cancer
of the rectum) and should always be taken seriously. If you
experience any of the following symptoms, make an appointment to see
your GP:
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Spots of blood on
the toilet paper after defaecation. The blood may appear
separate to the stool. |
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Bloody stool. |
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Rectal bleeding
associated with the passage of mucus, change in bowel habit and
weight loss. There may be pain on defaecation. |
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What kind of tests
will I need to have?
To determine the exact
cause of rectal bleeding, your doctor will take a full medical
history, asking about your symptoms and their duration. A sample of
stool will be taken to test for the presence of blood. A physical
examination will also be required, which will include a rectal
examination. This involves the insertion of a finger up into the
rectum to feel for any masses.
Other tests include camera tests called a proctoscopy and a
sigmoidoscopy, which look at the anal canal and the lower part of
the bowel. A proctoscopy is the only reliable way of diagnosing
internal haemorrhoids.
A colonoscopy may also be required to examine the whole large bowel.
An X-ray of the bowel called a barium enema may also be done to look
at the anatomy of the bowel.
In addition, your doctor may also take some blood tests to rule out
anaemia. |
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Will I need an operation?
Treatment options for
rectal bleeding depend on the identifying cause. Some will require
surgery, while others can be treated with ointments and/or drugs.
If you have been diagnosed with haemorrhoids, there are several
treatment options open to you and your doctor will advise you on
which one is most suitable. Some of the options are:
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Creams,
ointments and suppositories. A wide range is available both on
prescription and over-the-counter. Many contain a local
anaesthetic and some contain steroids. While these can provide
relief from the pain and irritation of haemorrhoids, it is
advisable not to overuse them. |
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Injection with an irritant solution. The solution is injected
directly into the haemorrhoids. This can be done on an
outpatient basis. |
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Banding.
This procedure can also be done to obliterate the haemorrhoidal
vessels. (Using a special forceps and a banding instrument a
band is placed around the haemorrhoid, squeezing the vessels
causing the haemorrhoid to shrink.) |
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Haemorrhoidectomy. This is a surgical operation to excise the
haemorrhoids. |
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Finally,
to prevent haemorrhoids from recurring eat a high-fibre diet and
try not to strain when passing stool. |
If tests reveal that you
have Diverticular disease your doctor will recommend a high-fibre
diet and may also prescribe bulking agents such as ispaghula or
sterculia to aid bowel movement.
Inflammatory bowel
disease can be treated with prescribed drugs to dampen down the
inflammation.
Some causes of rectal
bleeding, such as rectal cancer, can only be treated with surgery.
In this instance, an operation is performed to remove the cancer and
some of the bowel. Other investigations will be performed to see if
the cancer has spread (metastasised). Chemotherapy may also be
required.
Where Polyps are
concerned, a biopsy is carried out to take a sample of the infected
tissue. If the results show that the polyps are malignant they will
be surgically removed.
Anal fissures may also
require an operation called an anal stretch if, following treatment
with anaesthetic ointments, the rectal bleeding persists. |
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| RECTAL BLEEDING RELATED ITEMS |
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