Rectal Bleeding

The rectal bleed can present in different ways (e.g. melaena, mixed in with stool, or fresh red blood), which gives a good indication of where the source of the bleed is.

Presentation:

• Upper gut bleed - The blood will have a long transit time before reaching the anus, therefore coming out very black in colour and mixed in with the stool = Melaena

• Colon - Blood will be mixed in with stool. Causes of this include UC, Diverticulitis, Colorectal cancer, Polyps, Infection (Dysentery)

• Anus - Bright red blood that coats the stool, and is seen on the tissue after wiping or dripping into the toilet. Causes of this are Haemorrhoids or an Anal fissure.

  • Haemorrhoids cause some pain for a bit after defecation

  • Anal fissures are extremely painful and last 1-2 hourrs after defecation

Haemorrhoids

• Grade 1 - No prolapse (i.e. internal) - Conservative management, including potential use of topical steroids to alleviate pruritus

• Grade 2 - Prolapse on straining, which spontaneously reduces - Rubber band ligation (preferred), sclerotherapy, or infrared photocoagulation

• Grade 3 - Prolapse on straining and requires manual reduction - Rubber band ligation is the treatment of choice

• Grade 4 - Prolapse on straining, and can’t be manually reduced, External haemorrhoids, or Low-grade haemorrhoids failing to respond to therapy - Surgical haemorrhoidectomy

N.B. All patients are given lifestyle and dietary advice, such as adequate fluids and a high-fibre diet to avoid constipation.

A complication that can occur here is Thrombosed haemorrhoids. This presents with painful, purple protrusions. Conservative measures such as ice packs, laxatives, and lidocaine gels are 1st-line treatments. If these measures fail, surgical haemorrhoidectomy may be required.