Rectal Bleeding: Causes, Symptoms, and When to Seek Help

Hemorrhoidal bleeding

Dear Dr.
Tsai,
I have reviewed the frequently asked questions regarding rectal bleeding, and while my situation is somewhat similar, there are still differences, so I would like to seek your advice.
I have been experiencing rectal bleeding for about a week now, which occurs after bowel movements.
There is no pain or other sensations associated with it.
Recently, I have also felt a frequent urge to defecate, and when I enter the restroom, both gas and stool come out together, with the stool being soft.
The rectal bleeding does not occur every time; it happens approximately every five days.
Additionally, around 3 or 4 PM, I often feel very fatigued and sleepy.
Please advise me on how to proceed with a consultation and what might be causing these symptoms.

Yang, 50~59 year old female. Ask Date: 2006/10/24

Dr. Cai Yaozhou reply Internal Medicine

Hemorrhoids refer to the presence of blood in the stool or a positive fecal occult blood test.
The causes may include gastrointestinal bleeding, tumors, anal fissures, hemorrhoids, or acute infectious enteritis, among others.
The differential diagnosis and treatment involve...
What are the causes of lower gastrointestinal bleeding? In adults, the most common causes of chronic lower gastrointestinal bleeding are hemorrhoids and colorectal tumors, while the most common causes of acute lower gastrointestinal bleeding are diverticular disease and vascular malformations (angiodysplasia).
The majority of lower gastrointestinal bleeding tends to be mild and intermittent.
Internal hemorrhoids are painless, whereas anal fissures can be quite painful, typically occurring during the passage of hard stools or straining.
Generally, the severity is mild, but there are exceptions; for instance, some patients with cirrhosis may develop varices in the anal region, which can lead to significant bleeding.

How should this be managed? A rectoscopy or sigmoidoscopy can provide direct visualization.
Patients are advised to consume a diet high in fiber, drink plenty of water, exercise regularly, and maintain a regular bowel habit.
For discomfort, warm sitz baths or the use of topical agents may help.
If the situation remains troubling, consulting a colorectal surgeon is recommended.

Next, regarding tumor lesions, both benign and malignant tumors can cause rectal bleeding.
Depending on the location, the presentation of the bleeding may vary, and other symptoms must also be considered.
When located in the rectum or anus, blood may be present around the stool, often accompanied by tenesmus and a sensation of incomplete evacuation.
In the sigmoid colon or descending colon, blood may be mixed with the stool or associated with changes in bowel habits, such as thinner stools.
In higher sections of the intestine, symptoms may present solely as anemia or a palpable mass.
Diagnostic procedures may include barium enema or colonoscopy.

Reply Date: 2006/10/24

More Info

Rectal bleeding can be a concerning symptom, and it is essential to understand its potential causes, associated symptoms, and when to seek medical help. Given your description, it seems you have been experiencing rectal bleeding for about a week, occurring after bowel movements, without pain or other significant symptoms. However, you also mentioned feeling fatigued and having frequent urges to defecate, with soft stools.

Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of rectal bleeding, hemorrhoids can cause bright red blood to appear on the toilet paper or in the toilet bowl after a bowel movement. They can be internal or external and are often associated with straining during bowel movements.

2. Anal Fissures: These are small tears in the lining of the anus, often resulting from passing hard stools. They can cause sharp pain during and after bowel movements, along with bleeding.

3. Diverticular Disease: Diverticulosis, which involves small pouches forming in the colon wall, can lead to diverticulitis, where these pouches become inflamed or infected, potentially causing bleeding.

4. Colorectal Polyps or Cancer: While less common, polyps can bleed, and colorectal cancer is a serious condition that can present with rectal bleeding, especially in older adults.

5. Gastrointestinal Conditions: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can also lead to rectal bleeding.

Symptoms to Monitor
While you currently do not have pain associated with the bleeding, it is crucial to monitor for any additional symptoms, such as:
- Changes in bowel habits (diarrhea, constipation)
- Abdominal pain or cramping
- Weight loss
- Changes in appetite
- Fatigue or weakness
The fatigue you mentioned could be related to several factors, including anemia from blood loss, dehydration, or other underlying conditions. It's essential to consider this in conjunction with your rectal bleeding.

When to Seek Help
You should seek medical attention if:
- The bleeding persists for more than a few days.

- You notice a significant amount of blood (more than a small amount on toilet paper).

- You experience any pain, especially if it is severe.

- You have accompanying symptoms such as fever, chills, or significant changes in your bowel habits.

- You feel lightheaded, dizzy, or weak, which could indicate anemia from blood loss.

Next Steps
Given your symptoms, it would be advisable to consult a healthcare provider. They may recommend a physical examination, including a digital rectal exam, and possibly further investigations such as a colonoscopy to determine the cause of the bleeding. Early diagnosis and treatment are crucial, especially if there are underlying conditions that need to be addressed.

In the meantime, maintaining a healthy diet rich in fiber can help prevent straining during bowel movements, which may alleviate some symptoms. Staying hydrated is also essential, as it can help soften stools and reduce the risk of hemorrhoids and fissures.

In conclusion, while rectal bleeding can arise from various causes, it is essential to approach it with caution and seek medical advice, especially given the duration of your symptoms and the accompanying fatigue. Your healthcare provider will be able to guide you through the necessary evaluations and treatment options.

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