Page 1 of 2 A functional disorder refers to a disorder or disease where the primary abnormality is an alteration in the way the body works. These disorders generally cannot be diagnosed in a traditional way; that is, as an inflammatory, infectious, or structural abnormality that can be seen by commonly used examination, x-ray, or blood test.
The lack of an obvious cause, and the absence of a physical abnormality in the gut (stomach, esophagus, and intestines) are features common to all the functional gastrointestinal (GI) disorders. While these disorders are more common than structural diseases, they are not life threatening. However, they often impair quality of life.
Nevertheless, the presence of a functional disorder does not exclude the possibility of a co-existing disease, and your doctor will be on the lookout for worrying symptoms and signs. The following discussion describes so-called “alarm symptoms” that are not explained by any functional disorder, and therefore demand further inquiry.
- Alarm Symptoms
- What is Rectal Bleeding?
- What Causes Rectal Bleeding?
- When Should you see a Doctor about Rectal Bleeding?
- Why Is My Diarrhea Red?
- NYC Rectal Bleeding Treatment | Blood In Stool Specialist
- Symptoms Associated with Rectal Bleeding
- What Causes Blood in Stool?
- Diagnosing Anal Bleeding in Our New York Clinic
- Blood in Stool Treatment in NYC
- When Should You Worry About Rectal Bleeding?
- Colon Cancer Symptoms
- Abdominal Pain and Bloating
- Nausea and Vomiting
- Unexplained Weight Loss, Loss of Appetite and Feeling Weak
- Pelvic Pain
- Rectal Bleeding: Possible Causes
- Gastrointestinal Bleeding
- Rectal Bleeding
- Anal Fissures
- Risk factors
- Living with anal fissures
- When to call the healthcare provider
Bleeding from the gut implies that there is a break in the integrity of the intestinal lining (mucosa). Bleeding can occur throughout the length of the gut and possible causes include: benign and malignant tumors; inflammation such as infectious colitis or inflammatory bowel disease (IBD); ulcers such as peptic ulcers; esophagitis; or a traumatic tear such as may occur in the anus (fissure) or the lower end of the esophagus. Often the source of the bleeding is not obvious, although its nature may offer clues as to its origins. Intestinal bleeding is potentially serious and demands investigation – often as an emergency.
Bright red blood covering the surface of the stool means the bleeding is at or just above the anus. It is a common symptom and usually turns out to be a tear of the anus itself (anal fissure), especially if the stools are very hard and painful to pass. Less commonly such bleeding can be due to a proctitis (inflammation of the lower rectum usually due to IBD) or a rectal tumor. Inspection of the anus and sigmoidoscopy can identify these.
In those who have a family history of colon cancer, or who are older than 50 years of age, the doctor may order a colon examination to exclude it – usually a colonoscopy.
Bright red blood mixed with the stools indicates the bleeding is acute and likely in the colon. Causes include infections, IBD, diverticula, or tumor. If a great deal of blood is lost, an emergency colonoscopy will be necessary. Sometimes bleeding from the stomach can be so perfuse that it appears as bright red blood from the rectum. In this case, the individual may be faint and show signs of blood-loss shock – an emergency situation.
Slower bleeding from the upper GI tract (esophagus, stomach, or duodenum) will show as darker blood or even as black, tar-like stools. Bleeding ulcers (often due to NSAIDS), or ruptured esophageal veins seen in liver disease are common causes.
Sometimes the bleeding is very slow, and of insufficient volume to discolor the stool. Here the bleeding is said to be “occult,” and may be detected if the doctor notices a person is pale or if blood tests reveal an anemia (low blood hemoglobin).
Vomiting can be a functional or structural disorder, and itself will require investigation. However, vomiting blood is definitely due to a structural cause such as a stomach or duodenal ulcer, stomach cancer, esophageal vein bleeding, or esophagitis. Violent vomiting from any cause, including a functional one, can tear the lower esophagus and initiate bleeding.
No matter whether the bleeding is bright red, dark red, black and tarry, or occult, there must be a structural cause. Diagnosis of the bleeding source and control of the bleeding are priorities. Coincident functional disturbances are innocent bystanders that can be dealt with later.
Fever is the body’s reaction to inflammation, which may be infectious as in acute bacterial gastroenteritis, or non-infectious as in IBD. Since there is no overt inflammation in the functional gut disorders, fever is always due to something else. Most fevers turn out to be due to an acute, brief illness, but a fever must be investigated if it persists. Normally, oral temperature does not exceed 98.6 degrees Fahrenheit (37 degrees Celsius).
People lose weight for reasons other than illness. These may include increased activity, eating less, or deliberate dieting. Normally functional gut disorders do not cause weight loss unless there is accompanying depression or anxiety disorder. As a rule of thumb, a loss of 10 pounds (4.5 kilograms) over 3 months is significant and in the absence of an explanation may require some investigations.
Also known as dysphagia, difficulty swallowing food is an important symptom. Distinct from globus (where a person feels “a lump” in the throat unassociated with meals and can swallow when asked), dysphagia suggests there is something partially obstructing the esophagus.
Occasionally, swallowing may also be painful (odynophagia), and accompanied by hoarseness or throat pain. Prompt endoscopy is required to find the source of the obstruction which can be a benign narrowing (stricture), a fibrous band at the lower end of the esophagus (Schatzki ring), failure of esophageal motility (eg, achalasia), or a benign or malignant tumor. Only rarely, when all causes of esophageal obstruction have been excluded by tests, can dysphagia be deemed “functional.”
Sometimes food becomes stuck in the esophagus, which can be hazardous. Prompt attention to dysphagia is important.
Learn more about dysphagia
If one has repeated chest pain, it is of primary importance to exclude angina pectoris due to heart disease. Characteristic features of angina include a feeling of a heavy weight on the chest, extension of the pain to the left arm or neck, provocation by physical activity, and relief with rest. Normally a cardiologist will do the appropriate tests, and if they are negative refer the patient to a gastroenterologist to look for an esophageal cause.
A careful history usually, but not always, differentiates the chest pain from heartburn. In many cases, the pain is due to gastroesophageal reflux and responds to adequate doses of a gastric acid suppressing drug such as a proton pump inhibitor (PPI). Some tests of esophageal motility may be helpful, but they seldom make a precise diagnosis. Functional chest pain is uncommon and diagnosed only when all structural causes are excluded.
A sudden change in bowel habit or other gut symptom in someone over 50 years of age should attract diagnostic attention. Sometimes that means a cancer in the colon, esophagus, or stomach, requiring endoscopy to exclude it.
The gut goes to sleep when we do, and is normally undisturbed by functional gut symptoms, although there are exceptions. Therefore, night-time pain, when it occurs, may be a symptom of structural disease and requires further examination.
Many structural gut diseases run in families, so it is important to know and report family health history. Colon cancer, IBD, and celiac disease are more common in the first-degree relatives of affected persons. A family history of colon cancer should prompt a colonoscopy to screen for precancerous polyps whose removal can prevent cancer.
Many experts are now recommending colonoscopy in persons over 50 years of age whether symptoms are present or not. Here the indication for colonoscopy is not the functional gut symptoms, but rather the unrelated increased risk of cancer.
What is Rectal Bleeding?
While rectal bleeding rarely a medical condition, Symptoms associated with rectal bleeding, including diarrhea, constipation, hemorrhoids, anal fissures, and ulcers, can be worrisome.
Rectal bleeding is a scary but surprisingly common phenomenon. A person with rectal bleeding has bleeding from the rectum or anus. Rectal bleeding is usually assumed to refer to bleeding from your lower colon or rectum, which makes up the last few inches of your large intestine. Bleeding from higher in the intestinal tract, from the stomach, duodenum, or small intestine, may also pass through the large intestine and appear to come from the rectum.
Blood from rectal bleeding ranges in color from bright red to maroon to black or tar colored, and the color will often indicate the source of the bleeding. Blood can be on or in the stool; combined with mucus in the stool; or appear on your clothes and underwear, on toilet paper, or in the toilet water.
While rectal bleeding can be completely asymptomatic, symptoms that may occur with common rectal bleeding include anal pain, diarrhea, constipation, black stool, and mucus in the stool.
Symptoms that occur with serious rectal bleeding include abdominal pain, abdominal swelling, or unintentional weight loss. Blood loss from rectal bleeding may cause symptoms of anemia, which include pale skin, weakness, faintness, dizziness when changing from sitting to standing, fatigue, rapid pulse, and fainting.
If you are experiencing rectal bleeding, the first thing to do is try to identify the cause. The cause will determine any treatment you may seek. Treatment for rectal bleeding may include treatment for constipation, dietary changes, weight loss, or over-the-counter topical medication or supplements.
More advanced treatment may include blood transfusions, prescription vitamin or iron supplements, and medication. Surgery may also be required to treat the underlying cause of rectal bleeding.
What Causes Rectal Bleeding?
The most common causes of rectal bleeding are hemorrhoids, ulcers, and anal fissures.
Often called piles, hemorrhoids are swollen veins that appear at the bottom of the large intestine and outside the anus. Hemorrhoids are common, affecting about 75 percent of the U.S. population over the course of a lifetime. They are caused by excessive straining such as while making a bowel movement, sitting on the toilet too long, or, in women, pregnancy and giving birth. People who have persistent hemorrhoids are often constipated, overweight or obese, or eating a very low-fiber diet.
Hemorrhoids can be itchy, painful, and annoying, but they are rarely serious and often go away on their own. Losing weight, consuming more fiber-rich foods, and taking over-the-counter treatments are usually effective at managing the symptoms of hemorrhoids. People with serious or treatment-resistant hemorrhoids may be candidates for infrared coagulation (IRC), an outpatient laser treatment.
A person who has black stools with abdominal pain, fatigue, and a burning sensation in the stomach and bowels may have an ulcer, which is a sore or abrasion in the stomach lining. The two most common causes of ulcers are the bacterial infection Helicobacter pylori (H. pylori) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil or Motrin).
Anal fissures, another cause of rectal bleeding, are tiny tears in the anus and anal canal commonly caused by straining with hard stools. They can usually be managed with treatment for constipation and the use of moistened wipes, which soothe the area around the anus. Anal fissures rarely require medical treatment or surgery.
Less common causes of rectal bleeding include intestinal polyps, diverticulosis, proctitis, colon cancer, and inflammatory diseases of the bowel.
Intestinal polyps are masses of tissue that protrude from the bowel wall, sometimes causing minor bleeding. Proctitis is an inflammation of the lining of the rectum. If you have proctitis you may feel rectal pain and the continuous sensation of having to make a bowel movement.
Colon cancer is the most serious cause of rectal bleeding. Colon, or colorectal, cancer is the third leading cause of cancer-related death in women and the second leading cause of cancer-related death in men, according to the American Cancer Society, although death rates are dropping, thanks to earlier detection. Anal cancer, which is less common than colorectal cancer, can also cause rectal bleeding.
People at high risk for colorectal cancer should undergo regular screenings, primarily colonoscopy. Colorectal cancer should be diagnosed and treated by gastroenterologists and colorectal or general surgeons.
People with an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis may also experience rectal bleeding and related symptoms, such as abdominal pain, diarrhea, constipation, ulcers, and a higher risk for colorectal cancers.
When Should you see a Doctor about Rectal Bleeding?
Light rectal bleeding or spotting due to constipation or hemorrhoids in people under 40 rarely needs medical attention. However, if your rectal bleeding is continuous or heavy, or accompanied by a feeling of faintness or nausea, see a doctor or go to the emergency room right away.
Why Is My Diarrhea Red?
Diarrhea is often caused by a pathogen, such as a virus or bacterium. The most common cause of diarrhea in adults is norovirus. The use of antibiotics can also cause diarrhea. That’s because antibiotics disrupt the bacteria in the lining of the stomach.
There are quite a few reasons why your diarrhea may be red, and some are more serious than others.
One of the most common symptoms of rotavirus is red diarrhea. It’s sometimes called the stomach bug or stomach flu. Rotavirus is the most common cause of diarrhea in infants and children under the age of 5. Symptoms of rotavirus are similar to the standard symptoms of diarrhea, and may include:
- abdominal pain
- watery diarrhea for three to seven days
In some cases, bleeding in the digestive system may show up in your stool.Bleeding in the digestive system can be caused by many conditions, including:
- inflammatory bowel disease
- intestinal infection
- stomach ulcers
Blood from the digestive system may appear darker in color, or almost black. Blood from the anus will typically be a bright red color.
E. coli infection
This bacterium causes many symptoms of diarrhea, including red stools. You can get E. coli from eating undercooked beef, drinking raw milk, or eating food infected with animal feces. It typically takes a couple of days after being infected for symptoms to appear.
Inflammation can cause tears in the skin around the anus. Tears may lead to a small amount of blood in the stool. Typically, this leads to much less redness in toilet water when compared to other sources of red diarrhea. Sources of tears include excess stool and sexual contact with the anus.
In some cases, excess bowel movements may irritate colon growths called polyps. Polyps may be a sign of colorectal cancer. Oftentimes, the bleeding is internal and not visible to the naked eye. Diarrhea may irritate polyps and lead to blood in the stool.
Side effect of medication
Certain medications may cause gastrointestinal bleeding or disrupt bacteria in the stomach. This can lead to bleeding or infection that may cause red diarrhea.
Consuming red food or drinks
Drinking fluids or eating foods that are either naturally red or dyed may cause red stools. These include:
- fruit juices
- red candy
NYC Rectal Bleeding Treatment | Blood In Stool Specialist
Hematochezia can be a symptom of colorectal or anal cancer, a type of cancer that can be cured if detected early. Rectal bleeding can also be caused by bleeding hemorrhoids, anal fissures, colitis or many other causes. Disorder higher up in the digestive tract can also lead to bleeding from anus.
For these reasons, an examination with an experienced NYC gastroenterologist like our blood in stool doctors is the first step to identifying the underlying rectal bleeding causes and determining the best hematochezia treatment options. The cause needs to be properly diagnosed in order to have the correct treatment. Common causes of rectal bleeding include internal hemorrhoids bleeding and anal fissures. These conditions can be better treated if diagnosed and treated early.
According to the study “Factors identifying higher risk rectal bleeding in general practice” published on PubMed: “Rectal bleeding is common in the community and may be an early symptom of bowel cancer. The most useful factors in identifying higher risk groups were rectal bleeding in combination with a change in bowel habit to looser stools and/or an increased frequency of defaecation, bleeding without perianal symptoms and age over 60 years.”
Symptoms Associated with Rectal Bleeding
- straining and constipation
- abdominal pain
- swelling around the anus
- skin problems
- bloody diarrhea
What Causes Blood in Stool?
Causes of blood in stool can range from harmless conditions of the gastrointestinal tract such as bleeding hemorrhoids and anal fissures to more serious conditions such as cancer.
Rectal bleeding causes include:
- Anal Fissures
- Anal Cancer
- Colon Cancer
- Colon Polyps
- Ulcerative Colitis/Crohn’s Disease
- Solitary Rectal Ulcer (ulcer in the rectum)
- Diverticulosis (a bulging pouch that forms on the wall of the large intestine)
- Proctitis (inflammation of the rectum)
- Ischemic colitis (a colon inflammation caused by reduced blood flow)
- Infectious Colitis (inflammation of the colon caused by infection)
More serious causes of rectal bleeding include colorectal and anal cancer. The second leading cause of cancer deaths in the United States, colon cancer begins in your large intestine. Since it is a slow-growing disease, it can be effectively treated with early detection. Most cases of colon cancer come from polyps in your colon. Finding polyps through a colonoscopy and removing them reduces your cancer risk. Anal cancer is less common but also curable when diagnosed early.
Hemorrhoids are veins just below the surface of the skin that have become inflamed or swollen. They can occur on the skin around your anus (external hemorrhoids) or inside your rectum (internal hemorrhoids). Already sensitive, they can easily cause bleeding from rectum if irritated. Common causes of hemorrhoids are:
- Sitting on the toilet too long
- Straining during bowel movements
- Chronic diarrhea or constipation
- A low-fiber diet
The condition usually is signaled by itching, discomfort, and bleeding from rectum. If blood pools in an external hemorrhoid, it may form a clot, called a thrombus.
Tears in the lining of your anus are called anal fissures. Most often, they appear after bouts of constipation, passing hard stools, diarrhea or inflammation. Anal fissures can cause pain during and immediately after a bowel movement as well as bleeding from anus. You may also experience spasms in the ring of muscle at the end of your anus.
Anal bleeding or blood from rectum can be caused by abnormal, benign cell growth. Colon or rectal polyps are benign growths within the lining of your colon or rectum. Some can cause minor gastrointestinal bleeding from anus. Polyps usually are the result of abnormal cell growth. Although a vast majority of polyps do not lead to cancer, some do if left untreated, so it’s important to remove them. That’s why most doctors recommend a regular colonoscopy for people over 50 or younger depending on symptoms and family history.
Proctitis is a medical condition that occurs when the lining of your rectum and rectal lining becomes inflamed. This can be a painful condition. The symptom of proctitis can include anus bleeding.
Causes of proctitis include:
- An infection
- Certain medications
- Prior radiation therapy for cancer treatment
- Some forms of inflammatory bowel disease (IBD)
Diagnosing Anal Bleeding in Our New York Clinic
Pooping blood or finding bright red blood in the stool is never normal. During your examination, our rectal bleeding doctors have several options to find the source of your anal bleeding. They may:
- Examine your anus visually
- Feel for abnormalities within your rectum with a gloved, lubricated finger
- Perform a colonoscopy
- Use an anoscope, a short tube with a camera on its tip
Blood in Stool Treatment in NYC
Treating blood in stool depends first on finding its cause. It is crucial that rectal bleeding should always be evaluated with a thorough consultation and examination by an experienced NYC gastroenterologist for an accurate diagnosis and anal bleeding treatment plan as it may be a symptom or sign of a serious illness or condition.
Hematochezia can be a symptom of colorectal or anal cancer, a type of cancer that can be cured if detected early. The first step to identifying the underlying cause of your rectal bleeding and determining the best treatment options. You may need a colonoscopy for further evaluation. If the cause of rectal bleeding is ultimately found to be bleeding hemorrhoids, our doctors may recommend infrared coagulation (IRC) as the definitive response to stubborn hemorrhoids or hemorrhoid banding or other state of the art treatments. If the blood in stool causes is found to be anal fissures, this can be diagnosed and easily treated in most cases. Your NYC rectal bleeding treatment plan will be tailored to your needs but accurate examination, diagnosis, and treatment are very important.
When Should You Worry About Rectal Bleeding?
You should make an appointment with your hematochezia doctor if your rectal bleeding lasts more than two days, or earlier if the bleeding is severe. Minor bleeding is rarely associated with colon cancer or other serious conditions. However, the only way to determine the causes of anal bleeding is through examination. Therefore, anyone who notices blood in stool for more than two days is advised to contact their gastroenterologist to see if examination is needed.
You should seek immediate emergency help if you have significant bleeding from rectum and any of the following symptoms:
- Rapid and shallow breathing
- Blurred vision
- Dizziness after standing up
- Cold and pale skin
- Low urine output
- Heavy bleeding
- Accompanied by severe abdominal cramping or pain
Important Reminder: This information is only intended to provide guidance, not definitive medical advice. Please consult a doctor about your specific condition. Only trained, experienced physicians like our doctors can determine an accurate diagnosis and proper rectal bleeding treatment.
As best in class NYC gastroenterologists, our doctors provide highly personalized and comprehensive care. Their philosophies regarding the doctor/patient relationship is based on trust and have earned them some of the most respected reputations in NYC.
For more information about the options of Rectal Bleeding treatment in NYC or to schedule an appointment with one of our GI doctors, please contact our Upper East Side or Midtown NYC offices.
Colon Cancer Symptoms
Abdominal Pain and Bloating
Stomach bloating, distention, cramps or pain in the abdominal or bowel region can be symptoms of colon or rectal cancer. These are common issues that can also be caused by a number of conditions, including diet-related gastrointestinal distress, Crohn’s disease or ulcerative colitis. See your doctor if you experience frequent abdominal pain and bloating that does not have an obvious cause.
Nausea and Vomiting
Nausea and vomiting can occur if a colon or rectal tumor is obstructing the bowel and inhibiting the passage of liquid or solid waste or gas. Bowel blockage can also be accompanied by painful abdominal cramps, bloating and constipation.
Nausea and vomiting are symptoms of a range of conditions, which may be benign or serious. If you experience persistent nausea, signs of dehydration or vomiting that lasts for more than 24 hours, seek immediate medical treatment.
Anemia is a blood disorder characterized by a deficiency of red blood cells or hemoglobin. In patients with colon or rectal cancer, intestinal bleeding may cause anemia. Depending on the location of the bleeding within the colon, anemia can be the first sign that blood loss is occurring.
Common symptoms of anemia include skin pallor (paleness), increased heart rate, fatigue, dizziness and irregular menstruation.
Unexplained Weight Loss, Loss of Appetite and Feeling Weak
Losing weight, losing your appetite or feeling weak are all possible signs of colon or rectal cancer along with many other unrelated conditions. In patients with colon or rectal cancer, these symptoms are usually related. Persistent diarrhea can cause weight loss. Stomach pain and nausea can reduce your appetite so that you don’t consume enough food to maintain your weight. All these issues, as well as anemia, can lead to weakness.
Pain in the pelvic area is not common in patients with colon or rectal cancer. If it occurs, it may indicate that the cancer has spread to the pelvic area.
Rectal Bleeding: Possible Causes
What causes rectal bleeding?
Although rectal bleeding is common, only about one-third of those affected seek treatment. Symptoms usually develop quickly, and most causes are treatable and not serious. In some cases, rectal bleeding can be a symptom of a serious disease, such as colorectal cancer. Therefore, all rectal bleeding should be reported to the primary care physician. He or she can do a rectal examination or order tests like a colonoscopy to determine the cause of the bleeding. Rectal bleeding can be caused by:
- anal fissure
- anal abscess or fistula
- inflammatory bowel disease (IBD)
- large polyps
What are hemorrhoids, the most common cause of rectal bleeding?
Hemorrhoids are swollen veins in the rectum (internal hemorrhoids) or the anus (external hemorrhoids). Hemorrhoids, also called piles, can commonly develop because of chronic constipation or straining at stools, pregnancy, work strain (heavy lifting, etc.), obesity, or anal intercourse. Hemorrhoid treatment includes addressing the underlying causes, such as treating the constipation or straining habits, or changing work habits if necessary. Sometimes surgical treatment is necessary and may include one of the following methods:
- Rubber band ligation: a rubber band placed around the base of the hemorrhoid cuts off circulation to the bulk of the hemorrhoid and causes the hemorrhoid to wither away.
- Sclerotherapy: the injection of a chemical solution around the blood vessel shrinks the hemorrhoid.
- Laser: a precise laser beam is used to burn away small hemorrhoids.
- Hemorrhoidal arterial ligation: uses a Doppler probe to locate and tie the blood vessels feeding the hemorrhoid, to shrink it.
- Procedure for prolapsed hemorrhoids (PPH): puts hemorrhoids that have come out of the anal canal back in their original positions.
- Hemorrhoidectomy: surgical removal of the hemorrhoid.
What is an anal fissure?
An anal fissure, a split or tear in the lining of the anus, causes bleeding and burning pain after bowel movements. The usual cause is passing a very hard stool. The pain is caused by a spasm of the sphincter muscle. This happens as a protective measure by the body as stool passes through and expands the tear. Bleeding is result of trauma to the existing tear. Fissures may be mistaken for and misdiagnosed as hemorrhoids.Fissures often improve by themselves, but if they don’t, an ointment or medication applied locally to relax the muscle can relieve the pain. Surgery may be needed for a chronic or recurrent fissure or if excessive sphincter spasms prevent the tear from healing on its own.
What is a perianal abscess?
There are small glands that open inside the anus, believed to help with passing stool. An infection can occur when one of these glands becomes blocked. The pocket of pus that results from the blockage is an abscess. The abscess can be drained under local anesthesia in the doctor’s office. Large abscesses need drainage under anesthesia. About a third of all perianal abscesses will develop into an anal fistula.
What is a fistula?
An anal fistula is a consequence of an infection in the perianal area. A fistula is a connection between two spaces. An anal fistula is a connection between the anus or rectum to the skin around the anus. Fistulas usually start as infections in the anal gland that is naturally present in the anus. They require surgery in order to heal. Some anal fistulas have other causes like inflammatory bowel disease, tuberculosis, or radiation. Others can result from surgery in that area.
What are diverticulosis and diverticulitis?
Diverticulosis develops when small pouches (diverticuli) form in weakened sections of intestine lining and protrude through the bowel wall, usually in the sigmoid colon. Diverticuli are a common finding among older people in Western societies and are diagnosed when seen on a colonoscopy or sigmoidoscopy. Diverticulosis is a benign disorder but bleeding and infection can occur and are associated complications. Diverticuli generally occur without symptoms, unless they become blocked and infected, causing diverticulitis. Symptoms of diverticulitis include abdominal pain, fever, and a sudden change in bowel habits. Treatment may include a special diet, antibiotics, or surgery.
What is inflammatory bowel disease (IBD)?
Inflammatory bowel disease (IBD) is an inflammation of the small or large intestine. There are two types of IBD. One type of IBD is Crohn’s disease, marked by patches of inflammation occurring anywhere in the digestive tract. The other type of IBD, colitis, is marked by inflammation in the large bowel.There are several other types of colitis, including:
- Infectious colitis (caused by an infection that attacks the large bowel)
- Ischemic colitis (the result of a poor blood supply to the colon)
- Radiation colitis (following radiotherapy, usually for prostate, rectal, or gynecological cancer)
- Ulcerative colitis (ulcers/sores in the large intestine lining)
IBD symptoms may include:
- Rectal bleeding
- Abdominal pain and/or cramping
- Intestinal blockage
Treatment of inflammatory bowel disease is critical and may involve a special diet, medication to eliminate or reduce inflammation, and/or surgery.
What are ulcers?
Ulcers are sores in the stomach lining or in the first section of the small intestine (the duodenum,) caused by an imbalance of digestive fluids in the stomach and the duodenum. While abdominal pain is the most common symptom of ulcers, many ulcers produce no obvious symptoms.Ulcers that bleed into the gastrointestinal tract may cause black stool, sometimes with a tar-like appearance. Ulcers are usually successfully treated without surgery, and successful treatment may also prevent new ulcers from forming. Treatment methods may include:
- Special diet
- Medications that neutralize gastric acid, or reduce the secretion of gastric acid
- Medications that strengthen gastric acid resistance in the stomach and the duodenum
Since rectal bleeding can sometimes be a symptom of colorectal cancer – cancer of the colon or rectum – this is the primary reason rectal bleeding should not be ignored. Colorectal cancer is a common form of cancer that can usually be cured if diagnosed and treated early enough. Colorectal cancer occurs when the normal growth and division of the cells lining the large bowel goes out of control, initially resulting in the formation of a polyp(s). A polyp can appear similar to a small mushroom that is attached to the lining of the large bowel. Polyps that become large can bleed.While there are many types of polyps that are not cancerous, certain polyps are considered precancerous and can develop into cancer if left untreated. Therefore, removing polyps before they develop such severe changes can prevent cancer. Colonoscopy is the procedure used by physicians to locate and remove polyps to prevent colorectal cancer.People having an increased risk of colorectal cancer include those who have a family history of colorectal cancer, and people who have previously had cancer or polyps.When colorectal cancer occurs, treatment may include:
- Radiation treatment
The early stages of colorectal cancer may have no apparent symptoms. Thus, regular screening is important, particularly for individuals who are at increased risk.
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Gastrointestinal (GI) bleeding is a common clinical problem frequently requiring hospitalization. It can vary in degrees, from massive life-threatening hemorrhage to a slow, insidious chronic blood loss. The overall mortality for severe GI bleeding is approximately 8 percent, but this number is diminishing with the arrival of superior diagnostic techniques and newer medical treatments. Many bleeding episodes resolve on their own, but it is still imperative that the bleeding site be determined. An exact diagnosis may prevent a recurrence of bleeding and may help us treat future episodes more effectively. Also, making an accurate diagnosis can allow a patient to be treated appropriately for the underlying condition that caused the bleeding in the first place.
What are the symptoms?
The symptoms of GI bleeding depend on the acuteness and on the source of the blood loss.
Mild, chronic GI blood loss may not show any active bleeding, but can still result in an iron deficiency anemia. Many of these patients never notice any blood loss, but it occurs in small amounts with the bowel movement so that it is not noticeable. Blood in the stool often can be detected by hemoccult testing (testing for blood in your stool) during a routine office examination.
In more severe cases of chronic or acute bleeding, symptoms may include signs of anemia, such as weakness, pallor, dizziness, shortness of breath or angina. More obvious bleeding may present with hematemesis (bloody vomit), which may either be red or dark and coffee-like in appearance.
Blood in the stool could either be bright red, burgundy and clotted, or black and tarry in appearance, depending on the location of the bleeding source. A black, tarry stool (melena) often indicates an upper GI source of bleeding although it could originate from the small intestine or right colon. Other causes of a black stool might include iron or ingestion of bismuth (Pepto-Bismol). Hematochezia, or bright red blood can be mixed in with the stool or after the bowel movement and usually signifies a bleeding source close to the rectal opening. This is frequently due to hemorrhoids; however, you should never assume rectal bleeding is due to hemorrhoids. Conditions like rectal cancer, polyps, ulcerations, proctitis or infections can also cause this type of bright red blood.
How is it diagnosed?
If it is suspected that the bleeding is in the upper gastrointestinal tract, then an upper GI endoscopy is usually the first step. This is a flexible video endoscope that is passed through the mouth and into the stomach while the patient is sedated. It allows the doctor to examine the esophagus, stomach and duodenum for any potential bleeding sites. If a site is detected, therapeutic measures can be used to control the bleeding. For example, a bleeding ulcer may be controlled with use of cautery, laser photo therapy, injection therapy or tamponade.
If the bleeding is suspected to be in the lower GI tract or colon, then a colonoscopy is usually performed. In a colonoscopy, a video colonoscope is passed through the rectum and across the entire colon, while the patient is sedated.
Other diagnostic methods for detecting a bleeding source might include a nuclear bleeding scan, angiography, or barium GI studies.
In the case of chronic low-grade or occult bleeding which may result in anemia, the work-up to discover the source of the bleeding is usually done on an outpatient basis. Generally this consists of a colonoscopy and/or upper endoscopy to look for any potential sources of chronic blood loss.
Once the cause for the blood loss is determined, appropriate treatment and management recommendations can be made.
How is GI bleeding treated?
If GI bleeding is very active or severe in nature, it may require hospitalization. Shock can occur when blood loss approaches approximately 40 percent of blood volume. If there is evidence of hypotension (low blood pressure) or a fast heart rate, dizziness, or light-headedness, then treatment would include IV fluids and monitoring of the blood count, with blood transfusions given, if necessary.
While in the hospital, the patient will continue to be monitored closely and certain medications will be employed in an attempt to stop the bleeding. In addition, diagnostic tests are performed.
In some cases, GI bleeding will stop spontaneously.
If the bleeding persists, despite all of the above-mentioned therapeutic techniques, then surgery might be required as a last resort.
What causes GI bleeding?
The most common cause of an upper GI bleed is an ulceration, either in the duodenum (just beyond the stomach), in the stomach lining itself, or in the esophagus. Esophageal varices, or varicose veins, are usually the result of underlying chronic liver disease like cirrhosis and these can often bleed very briskly. A tear at the junction of the esophagus and stomach sometimes also occurs as a result of repeated vomiting or retching. In addition, tumors or cancers of the esophagus or stomach can also cause bleeding.
Factors that may aggravate upper GI bleeding include use of anti-inflammatory medications (in particular aspirin other arthritis drugs), underlying chronic liver disease, thinning of the blood from certain medications like Coumadin, or underlying medical problems like chronic renal disease, cardiac or pulmonary diseases.
The most common cause of bleeding from the lower GI tract or colon is diverticulosis. This accounts for over 40 percent of these cases. If diverticular disease is not found, then a patient could have an angiodysplasia which is a tiny blood vessel lining the colon that sometimes can bleed briskly or ooze chronically. Colon cancers or colon polyps might also produce lower GI bleeding, as well as different causes for colitis. Colitis is an inflammation or ulceration of the lining of the colon that could be due to ulcerative colitis, Crohn’s disease, radiation therapy, or poor circulation to the colon itself.
For More Information
To learn more about this topic, please visit:
American College of Gastroenterology
What is rectal bleeding?
Rectal bleeding often reveals itself as bright red blood on the toilet paper—usually after a bowel movement—or by turning the toilet bowl water red. Rectal bleeding can also present as extremely dark stool, ranging in color from deep red/maroon to black, and sometimes appearing tar-like (melena).
The color of the blood can indicate where the bleeding is coming from:
- Bright red blood usually indicates bleeding low in the colon or rectum
- Dark red or maroon blood usually indicates bleeding higher in the colon or the small bowel
- Melena usually means bleeding in the stomach, such as bleeding from ulcers
Not all rectal bleeding is visible to the eye. In some cases, rectal bleeding can only be seen by looking at a stool sample through a microscope. There is also a test, called a Hemoccult® test that can be done in a doctor’s office.
What are the symptoms associated with rectal bleeding?
The symptoms of rectal bleeding may include:
- Rectal pain and/or pressure
- Bright red blood in/on the stool, on underwear, and/or in the toilet
- Red, maroon, or black stool color
- Stool that has a tar-like appearance
- Feeling lightheaded or dizzy
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Hi, so last easter (2017) was when i first noticed some bright red blood on the toilet paper. This happened each time i went to the loo over the next 10 days or so. Although i only went about 4 times as i was that nervous about seeing more blood. Also, my entire life up until the last couple of months, I would usually only pass a stool about every other day, obviously sometimes it was consecutive days and other times it was longer than 2 days but I’m guessing that I would generally go every other day, so I didn’t think much of it, although it could have been slight constipation. However i also had another symptom. Just before I started passing blood with the stools, my gut started making gurgling nosies, and there was a lot of flatulence (gas). I could tell the noises weren’t from my stomach and it wasn’t hunger. When the noises and flatulance stopped after about 10 days, so did the bleeding (from what i could see anyway).
Skip forward to a few days ago and there was blood on the toilet paper once again, but only the once this time (i think) and i am passing gas frequently with a gurgling abdomen. This time, i am also experiencing some pain in the abdomen area (around where i think the colon is). The pain seems like it could just be trapped gas but i am not sure. Also, there have been two occasions over the last week where i think i have shown signs that I might faint (cold sweat, lightheaded) but haven’t. I’m not sure if this is connected, because the weather is extremely hot at the moment and it might just be dehydration, or it could be that both times, i was worrying quite a lot about my symptoms and it could have just been me worrying myself sick with stress. Also, if its IBD it could be to do with anemia.
The first time I didn’t go to see a doctor as I thought with the gurgling abdomen it might have just been some kind of bug. But i told myself that if the symptoms come back I would go to a doctor.
Looking online, my symptoms would suggest colorectal cancer or inflammatory bowel disease, but after looking into IBD more, and reading other people’s experience with it, it seems less likely to be that. Others have said they would need to rush to the toilet 10 times a day and that their flare ups would last for months. This hasn’t been the case for me. That’s why i think it might be cancer.
Im scared that after doing nothing about it for 16 months, if it is cancer, I might have missed the opportunity to catch it early. I also have no idea how to tell my parents and this is another reason why I’m scared of going to the doctors as I wouldn’t want to burden them with this. I would also have to justify why i left it so long and I don’t know if i can. Another thing I’m worried about is that if it is cancer, and it’s at a survivable stage, will chemotherapy stop me from having children one day. Im 20, so when I realised it might be cancer, one of the first things that came to mind is that I might not live to be able to have kids, which really got to me, but now I’ve found out that chemotherapy can also make you infertile.
Any help would be massively appreciated, especially in relation to telling my parents about my symptoms, or whether I should wait and first go to the doctor alone, and then tell them if there is cause for concern. Thanks.
Anal fissures are tears, or cracks, in your anus. Fissures are sometimes confused with hemorrhoids. These are inflamed blood vessels in, or just outside, the anus. Both fissures and hemorrhoids often result from passing hard stool.
Fissures result from the stretching of your anal mucosa beyond its normal capacity. This often happens when stools are hard due to constipation. Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for your wound to heal. The spasm then leads to further tearing of the mucosa when you have bowel movements. This cycle leads to the development of a chronic anal fissure in approximately 40% of patients.
You may have these symptoms with an anal fissure:
- Pain during and after a bowel movement
- Visible tear or cut in the area
- Bright red bleeding during or after a bowel movement
Certain factors raise the risk for anal fissures, including:
- Constipation with straining to pass hard stool
- Eating a low-fiber diet
- Intense diarrhea
- Recent weight loss surgery, because it leads to frequent diarrhea
- Vaginal childbirth
- Minor trauma, especially trauma caused by high-level mountain biking
- Any inflammatory condition of the anal area
Anal fissures may also result from inflammatory bowel disease, surgery, or other medical treatments that affect bowel movements or the anus.
Your healthcare provider will make a diagnosis based on:
- Your personal health history
- Your description of symptoms
- Rectal exam
Because other conditions can cause symptoms similar to an anal fissure, your healthcare provider might also order tests to find out whether there is blood in your stool.
An acute anal fissure typically heals within 6 weeks with conservative treatment. Some disappear when constipation is treated. Anal fissures that last for 6 weeks or more are called chronic anal fissures. These fail conservative treatment and need a more aggressive, surgical approach.
People whose anal fissures don’t heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. The reduced blood flow prevents healing. Medicine, Botox injections, and even some topical treatments that improve blood flow, may help anal fissures heal.
Other treatments include:
- Changing your diet to increase fiber and water, steps that will help regulate your bowel movements and reduce both diarrhea and constipation
- Taking warm baths for up to 20 minutes a day
- Taking stool softeners, such as fiber supplements, as needed
- Using topical medicines, such as nitrates or calcium blockers
- Having surgery, such as a lateral internal sphincterectomy. During the surgery, the pressure inside the anus is released. This allows more blood to flow through the area to heal and protect tissues.
The risks from Botox injections and medicines used to treat anal fissures are relatively mild. Complications from surgery include the risk for infection, bleeding, and persistent gas and fecal incontinence, or uncontrolled bowel movements.
Complications seen with anal fissures include:
- Pain and discomfort
- Reduced quality of life
- Difficulty with bowel movements. Many people even avoid going to the bathroom because of the pain and discomfort it causes
- Possible recurrence even after treatment
- Uncontrolled bowel movements and gas
Living with anal fissures
If you have an anal fissure, take these precautions to avoid making it worse and avoid recurrences:
- Take all medicines as prescribed.
- Get the recommended amount of fiber in your diet. Avoid constipation or large or hard bowel movements.
- Drink enough water to stay well hydrated.
- Maintain a routine bowel habit. Ask your healthcare provider about what this should be for you.
- Avoid spicy foods while you have an anal fissure, because they may make symptoms worse.
When to call the healthcare provider
Contact your healthcare provider if you notice blood in your stool or if your bowel movements are so painful that you are avoiding going to the bathroom.