BLEEDING FROM THE ANUS

In case of rectal bleeding, it is important to consult a doctor immediately in order to determine the underlying cause and start the treatment process.

The Gastroenterology Doctor can make an accurate diagnosis and determine appropriate treatment methods based on the patient’s symptoms, health history, and physical examination. Instead of trying to self-diagnose and self-medicating, it is always the safest and right approach to consult a doctor in case of any health complaints.

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    1

    What are the Causes of Rectal Bleeding?

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    The reasons for bleeding from the anus can be varied. Some of these may be insignificant, while others may be a symptom of more serious health problems. The reasons for rectal bleeding can be listed as follows;

    Hemorrhoids

    It occurs due to swelling and inflammation in the veins in or around the anus. Hemorrhoids are a common condition that can cause bleeding in the anus. In general, there may be no pain with bleeding.

    Anal Fissures

    These are wounds that occur as a result of cracking of the mucosa on the inner surface of the anus. Constipation can occur due to diarrhea or forced defecation and can lead to bleeding. During defecation, it causes a thin sharp pain as if it is cut with a razor.

    Constipation

    As a result of hard and difficult passage of stool, it can cause injuries and bleeding in the anus.

    Ulcerative Colitis and Crohn’s Disease

    Ulcerative colitis and Crohn’s disease, which are inflammatory bowel diseases, can cause inflammation of the intestines and lead to bleeding from the anus. In these diseases, the incoming blood is usually intertwined with the outside. For other reasons, it looks like blood is plastered on the stool.

    Rectal Polyps

    They are small tumors that form on the lining of the rectum and in some cases can cause bleeding. They can lead to overt or hidden bleeding, especially as the polyp grows

    Colon and Rectal Cancer

    In some cases, bleeding from the anus can be a sign of cancer in the colon or rectum. Bleeding occurs when hard stool rubs against the surface of the tumor. In tumors on the left side of the large intestine near the exit, the risk of seeing open blood in this way is higher. In right-sided colon cancers, weakness and anemia may come to the fore due to hidden bleeding. Since the stool on the right side of the colon is still liquid, it usually gives late findings.

    Anal Condylomas (Genital Warts)

    Virus-induced warts in the anal area can also cause bleeding. However, these are usually visible lesions around the anus.

    Diverticulitis

    It occurs as a result of inflammation of the diverticula (small pockets formed outward from the intestinal wall) in the intestinal wall and can cause bleeding. In general, these diverticula occur in people who are stressed due to excessive intestinal spasms over the years. The greater the number of diverticulum, the greater the risk of inflammation or bleeding.

    Anal Fistula

    It occurs as a result of the formation of an abnormal channel between the anus and the surrounding skin and can lead to bleeding. However, these are complaints of fecal leakage contaminating the underwear rather than bleeding.

    In the event of rectal bleeding, it is important to consult a gastroenterologist for diagnosis and treatment of the underlying cause. Because some conditions may be a symptom of serious health problems and timely intervention may be required.

    2

    Bleeding Symptoms and Diagnosis Process

    When a bleeding condition such as rectal bleeding is encountered, the symptoms and diagnosis process may be as follows:

    Symptoms

    • Breech Blood: Bright red bleeding, which usually appears in the stool or toilet paper during the toilet, is the most obvious symptom of rectal bleeding.
    • Bloody Defecation: The appearance of blood in the stool can stain the stool or toilet water red.
    • Rectal Pain or Swelling: In some cases, in addition to bleeding from the anus, there may be pain, swelling or itching in the anus area.
    • Constipation or Diarrhea: Some conditions that cause rectal bleeding can lead to changes in bowel movements, such as constipation or diarrhea.

    Diagnosis Process:

    When a doctor is consulted with the complaint of rectal bleeding, the doctor usually follows the following steps:

    Patient History and Examination

    The doctor takes the patient’s history and examines the patient to assess his symptoms, how long he has been experiencing these symptoms, his bowel habits, and other health status.

    Colonoscopy

    In case of rectal bleeding, the most commonly used diagnostic method
    is colonoscopy
    .

    Blood and Stool Tests

    Some disease conditions that cause bleeding can cause blood in the stool or provide convenience.

    The causes of prolongation of bleeding and coagulation time should be investigated.

    In diseases such as ulcerative colitis and Crohn’s, serological tests such as calprotectin in the stool, ASCA Ig G, ASCA Ig A and p-ANCA in the blood can help in the diagnosis.

    Amoeba antigen test in feces and amoeba serological tests in blood should be used to distinguish amoebic dysentery, which is common in our country.

    Capsule Endoscopy


    The capsule endoscopy
    procedure is used for small bowel imaging. The diagnostic procedure is generally used for the follow-up of patients with unexplained blood loss, abdominal pain, weight loss and IBD.

    Double Balloon Enteroscopy (DBE)


    Double balloon enteroscopy
    procedure is used in the diagnosis and treatment of small intestine disorders. It is recommended to perform capsule endoscopy before performing double balloon enteroscopy.

    This process may differ depending on the patient’s condition. Diagnosis is crucial to determine the underlying cause and create the appropriate treatment plan. Therefore, it is important to consult a gastroenterologist when faced with a situation such as bleeding from the anus.

    3

    Is Breech Bleeding a Serious Problem?

    Bleeding from the anus can sometimes be a serious problem, depending on the underlying cause, while in some cases it may be milder or temporary. For this reason, the severity of bleeding from each anus may differ. When assessing this situation, it is important to consider the following factors:

    1. Quantity and Frequency: The amount and frequency of bleeding is important. If the amount of blood coming from the anus is too high and recurs frequently, it should be considered that it may be a more serious condition.
    2. Blood red: Bright red blood is usually the color of blood from the anus. This fresh blood can indicate problems that usually originate in the last parts of the intestines. However, dark, black, or tar-like blood can be a sign of bleeding problems in the upper gastrointestinal tract.
    3. Concomitant symptoms: Other symptoms accompanying rectal bleeding should also be evaluated. Symptoms such as severe abdominal pain, weight loss, changes in stool, anemia can be a sign of a serious underlying cause.
    4. Age and Risk Factors: Age can affect a person’s risk of developing serious illnesses. Rectal bleeding, especially in people older than 50, can increase the risk of colon or rectal cancer.

    Bleeding from the anus may indicate serious intestinal diseases. Therefore, bleeding from the anus should not be ignored. As with any disease, early diagnosis and treatment are important for a successful outcome

    Remember, the information available on the internet should guide you on how to approach. The information you obtain should not cause you unnecessary uneasiness or give you a false sense of security.

    4

    When to Consult a Doctor?

    It is important to consult a doctor in case of bleeding from the anus. You need to consult a doctor immediately if:

    1. Severe Bleeding: If you are experiencing severe rectal bleeding or if the amount of bleeding is constantly increasing, you should contact a healthcare professional immediately.
    2. Sudden and Obvious Change: If you see sudden and pronounced bleeding during defecation, you should immediately consult a doctor.
    3. Continuous Bleeding: If bleeding from the anus is repeated constantly or does not go away within a few days, you should consult a doctor.
    4. Bleeding with symptoms: If, in addition to bleeding from the anus, you are experiencing concomitant symptoms such as abdominal pain, weight loss, vomiting, dizziness, etc., you should consult a doctor immediately.
    5. Having Risk Factors: People older than 50, with a family history of colon or rectal cancer, or with diseases such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease) should be more careful and consult a doctor if bleeding from the anus occurs.

    5

    Risk Factors Related to Bleeding

    Risk factors related to bleeding can vary depending on the different types of bleeding and the underlying causes. Risk factors for different types of bleeding, including rectal bleeding, can be:

    Risk Factors for Breech Bleeding:

    1. Age: In people older than 50, rectal bleeding can increase the risk of colon or rectal cancer.
    2. Constipation or Diarrhea: Experiencing frequent constipation can lead to strain and injury. Diarrhea can also irritate the delicate tissue of the anus and lead to bleeding.  Recent changes in bowel habits are also a risk factor.
    3. Family History: People with a family history of colon or rectal cancer may have an increased risk of rectal bleeding.
    4. Smoking: Smoking can increase the risk of colon cancer.
    5. Eating Habits: Low-fiber diets, unhealthy eating habits, and inadequate fluid intake can increase the risk of constipation.  In addition to low-fiber diets, consuming diets with high fat content, diets with low calcium content, and low consumption of fruits and vegetables with high anti-oxidant properties also increase the risk of colon cancer.
    6. Physical Activity: Lack of regular physical activity can increase the risk of constipation.

    Risk Factors for Upper Gastrointestinal (GI) Bleeding:

    1. Peptic Ulcer: Ulcers in the stomach or duodenum can cause upper gastrointestinal bleeding.
    2. H. pylori Infection: Helicobacter pylori bacteria is a common cause of peptic ulcers and stomach inflammation.
    3. Excessive Alcohol Consumption: Excessive alcohol consumption can cause injury to the mucous membrane of the stomach and duodenum, causing upper gastrointestinal bleeding.

    Risk Factors for Lower Gastrointestinal (GI) Bleeding:

    1. Diverticulosis: It can cause lower gastrointestinal bleeding as a result of inflammation of the diverticula formed in the intestine.
    2. Inflammatory Bowel Diseases (IBD): Inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease can lead to lower gastrointestinal bleeding.
    3. Rectal Polyps and Cancer: Rectal polyps and cancer are potential causes of lower gastrointestinal bleeding.

    If any type of bleeding is encountered or bleeding from the anus, it is important to consult a healthcare professional for a definitive diagnosis and treatment. Sharing your health history and risk factors with your doctor will help for an accurate assessment and treatment plan.

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