Rectal Bleeding

What is rectal bleeding?

• The large intestine, also called the bowel or colon, ends in a section called the rectum. At the end of the rectum is the anus. The anus is the opening where stool, or bowel movements, leave your body. With rectal bleeding, there may be blood found in your rectum, or you may be bleeding out of your anus.
  
  
• Rectal bleeding may be acute (short-term) or chronic (long-term). With rectal bleeding, you may lose a small or large amount of blood, and the bleeding may be slow or fast. If you are having a hemorrhage (heavy bleeding that does not stop), rectal bleeding can be life-threatening. Treating the cause of your rectal bleeding may help prevent serious health problems. Once caregivers learn the cause of your rectal bleeding, treatments or procedures may be done to make it stop. Signs and symptoms that are caused by rectal bleeding, such as pain or dizziness, may decrease or go away once the bleeding stops.

What causes rectal bleeding?

Hemorrhoids may cause rectal bleeding. Hemorrhoids are swollen blood vessels that slip out of place in your rectum or anus. Anal fissures (tears in the tissue inside your anus) also may cause rectal bleeding. You may have bleeding in your rectum if you have a disease in your colon, such as colitis or diverticulitis. You also may have rectal bleeding from growths, such as tumors and polyps. Cancer treatments, such as radiation or surgery, also may cause rectal bleeding.

What increases my risk of having rectal bleeding?

As you get older, you have a higher risk of rectal bleeding. The following also increase your risk:

• Using certain medicines, such as blood thinners or pain medicines. Pain medicines that increase your risk of rectal bleeding include aspirin and nonsteroidal anti-inflammatory medicines (NSAIDs).
  
  
• Liver disease.
  
  
• Long-term problems in your colon, such as inflammatory bowel disease.
  
  
• Human immunodeficiency virus (HIV) infection.

What are the signs and symptoms of rectal bleeding?

• If you have rectal bleeding, you may see blood on your toilet paper or in the toilet after having a stool. You may see dark or bright-red blood in your stool. You also may have blood leaking from your anus. Symptoms may include cramping or pain in your rectum, anus, or abdomen (stomach).
  
  
• If you lose a large amount of blood from your rectum, you may become hypovolemic. This means that you do not have enough blood in your body. This may cause a fast heartbeat and rapid breathing. You may be confused or dizzy, or you may faint. Your skin may feel sweaty or moist, and your mouth may feel dry. You may urinate very little, or not at all. Your skin and gums may be pale (lighter in color) than usual.

How is rectal bleeding diagnosed?

Your caregiver will examine you and look for the cause of your bleeding. He may check your rectum by gently inserting a gloved finger into your anus. He may collect a stool sample, and test the stool for blood. Ask your caregiver about these and other tests that you may need:

• Blood tests: Your caregiver may collect a sample of blood, and count your blood cells. The blood is taken from a blood vessel in your hand, arm, or the bend in your elbow. Your caregiver also may check your blood type.
  
  
• Angiography: Your caregiver may use angiography to see blood vessels in your body. This test may show growths, tissue damage, or problems with blood flow.
  
  
• Colonoscopy: To do a colonoscopy, caregivers may use a scope (a long tube with a light on one end) to see inside your colon. A colonoscopy may show the location where the bleeding is coming from, and what is causing it.
  
  
• Computed tomography scan: This test is also called a CT scan. An x-ray machine uses a computer to take pictures of the organs and blood vessels in your abdomen. Your caregiver may use a CT scan to check for problems that could cause bleeding. You may be given dye before the pictures are taken. The dye may be given through an intravenous (IV) line, which is a tube placed in your vein. The dye may help your caregivers see the pictures better. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to this dye. Tell caregivers if you are allergic to shellfish or dyes.
  
  
• Radionuclide scintigraphy: Radionuclide scintigraphy may be used to look for bleeding in your intestines. Before taking the pictures, tracer chemicals are put in your IV to show areas where there is bleeding.

How is rectal bleeding treated?

You may need to have an IV placed to give you liquids. The amount of oxygen in your blood may be checked with a pulse oximeter. This is a small device that sticks or clips to your finger, ear, or toe. Depending on the cause of your rectal bleeding, you may need any of the following treatments:

• Blood transfusion: If you lose too much blood, you may need a blood transfusion. During a blood transfusion, you will get whole blood, or parts of blood, through an IV. Some people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.
  
  
• Endoscopy: To do an endoscopy, caregivers use a scope to see the inside of your digestive tract. During the endoscopy, small tumors may be removed. Caregivers may put a shot of medicine in bleeding areas to narrow the blood vessels and stop the bleeding. Heat, laser, or electric currents may be used to fix tissues and make the blood clot. Clamps or clips may also be used to stop the bleeding.
  
  
• Embolization: If you have an angiography, you may also need embolization. With this treatment, plugs are used to stop blood vessels from bleeding.
  
  
• Medicine:
  
  
  • Vasoconstrictor medicine: This medicine decreases the size of your blood vessels, and may help stop them from bleeding.
    
    
  • Iron: You may need to take iron if you lose a lot of blood. Iron helps your body make more red blood cells.
  
  
• Surgery: You may need surgery to remove hemorrhoids. If you have a tumor, polyp, or growth in your colon or rectum that is causing the bleeding, you may need surgery to remove it.

What are the risks of rectal bleeding, testing, and treatment?

• You may be allergic to the dye used in tests and have trouble breathing. Medicine that may be used during an endoscopy can harm your kidneys. You may get a fever, abdomen pain, or damaged blood vessels after embolization. After surgery to fix an anal fissure, you may have trouble having bowel movements. Even with treatment, rectal bleeding may continue, or it may go away for a time and then begin again.
  
  
• Without treatment, you may continue having pain and other symptoms. You may be confused or faint when you lose too much blood. You may get anemia. This is a problem that happens if you do not have enough blood cells to carry oxygen inside your body. If you lose too much blood, you may need a blood transfusion. These problems can be life-threatening. Call your caregiver if you have questions about rectal bleeding, or your medicine or care.

Where can I find more information?

• International Foundation for Functional Gastrointestinal Disorders
  P.O. Box 170864
  Milwaukee , WI 53217
  Phone: 1- 414 - 964-1799
  Phone: 1- 888 - 964-2001
  Web Address: http://www.iffgd.org
  

• National Digestive Diseases Information Clearinghouse (NDDIC)
  2 Information Way
  Bethesda , MD 20892-3570
  Phone: 1- 800 - 8915389
  Web Address: www.digestive.niddk.nih.gov
  

When should I call my caregiver?

Call your caregiver if:

• You begin to have changes in your stool, such as diarrhea. Diarrhea is when you have frequent, loose, watery stool.
  
  
• You have cramping pain in your abdomen or rectum.
  
  
• You urinate less often than usual.
  
  
• You have a fever.
  
  
• You cannot control when you are going to have a stool.
  
  
• Your skin and gums look pale (lighter in color) than usual, and you feel very tired.
  
  
• Your skin feels sweaty or clammy (moist) for no reason.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You are confused, or you feel weak, dizzy, or lightheaded.
  
  
• You have a fast heartbeat.
  
  
• You have bleeding from your anus that does not stop.
  
  
• You have diarrhea with blood in it.
  
  
• You have new trouble breathing or you are breathing faster than usual.
  
  
• You see blood in the toilet after trying to have a bowel movement.
  
  
• You urinate very little, or not at all.
  
  
• Your rectal bleeding had stopped for a time, but has started again.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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