“Rectal bleeding is very common. It is one of the most common complaints that occur in primary care. [gastroenterology] ” said Sameer Gupta, a gastroenterologist and professor of medicine at the University of California, San Diego Health.
However, it can be a dangerous symptom.
“Blood in the stool is abnormal. It does not automatically mean cancer, but it is clearly not something that should be assumed to be normal and requires no further attention.” ,” said Sophie Barzola, a gastroenterologist and clinical professor at New York University’s Grossman School of Medicine.
“It’s important to remember that benign diseases of the anus and rectum that can cause bloody stools are much more common than other diseases.” colon or rectal cancerYoung people are especially at risk for this disease. But that doesn’t mean we should ignore the issue,” Barzola added.
There are several forms of bleeding. For example, blood on the toilet bowl or toilet paper may be bright red or maroon in color and barely noticeable, or it may run out, the latter of which is a medical emergency.
Additionally, other symptoms that may be associated with bleeding include constipation, the urge to defecate, and abdominal pain.the projected Approximately 150,000 new cases of colorectal cancer are expected to occur in the United States in 2023 alone.
“Although there is some information that may give physicians and individuals a better idea of whether the bleeding is more likely to be due to benign causes or due to tumor growth,” , these clues are not very accurate,” said Gupta. “Trying to diagnose on your own whether rectal bleeding is due to benign causes is not so easy.”
There are many different causes of rectal bleeding, and they vary in severity. “The list is long,” Barzola said.
The most common structural causes of benign bleeding include: hemorrhoids, dilated veins in the anus and rectum, often caused by straining. Although not a complete list, other examples that can cause bleeding include small breaks in the skin of the anus called fissures, and bleeding from openings in the colon wall. Also called diverticula, inflammatory bowel disease, and cancer.
Unfortunately, even doctors are not good at determining the cause of bleeding without undergoing a colonoscopy. “Research shows that, based on rectal examination, “Clinicians are not perfect at distinguishing between hemorrhoids and other sources of blood loss, given the clinical findings,” says Lisa Strate, a gastroenterologist and professor of medicine at the University of Washington.
Further complicating the situation is that multiple causes of rectal bleeding can coexist. “You can have hemorrhoids or anal fissures and colorectal cancer at the same time,” says Barzola.
what to do if you see blood
If you notice blood in your stool, the first thing you should do is ask yourself whether you need immediate testing at the emergency room.
“If a person feels dizzy or weak, that could be a sign that they’re losing a lot of blood,” Strate says.
Other signs that you probably need to go to the emergency room include heavy bleeding, frequent bloody stools, severe abdominal pain, fainting, shortness of breath, fever with bloody stools, or low blood pressure. .
Even if it is not an emergency, you should make an appointment with your primary care physician or gastroenterologist. During your consultation, you can expect to take a detailed medical history and possibly perform blood tests. red Doctors check blood cell counts and inflammation, and do a rectal examination to check for obvious external causes of bleeding. In some cases, your doctor may refer you for a colonoscopy.
“Given the increasing incidence of colorectal cancer in people under the age of 50, the threshold for pursuing endoscopy research is much lower these days,” Barzola said. Mentioned other similar procedures that look inside. colon.
In her view, assuming there are no red flag symptoms, it makes sense to first try to treat the bleeding conservatively, but to plan for follow-up. This means that if a clinician suspects that the cause of the bleeding is likely to be benign, they may first treat it using non-invasive methods. However, if bleeding continues, you may be referred for an endoscopy.
“All benign causes of rectal bleeding should improve with treatment,” he says. If the bleeding doesn’t improve, it may be a sign that something more worrying is going on. People who have rectal bleeding and do not initially undergo a colonoscopy “need to see a follow-up clinic within 60 days to close the clinical loop and ensure symptoms are resolved.” ‘And everyone else has to have a colonoscopy,’ he said.
“It’s easy to ignore symptoms. It’s human nature,” Barzola said. “Your health is paramount and bloody stool is never normal. There is no need to fear whatever it is. Take the next step and consult a medical professional.”
Netana H. Markovitz is a resident at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston.