Rectal bleeding and rectal conditions

19 Rectal bleeding and rectal conditions





Questions



image What are the causes of rectal bleeding?

image What are the causes of haemorrhoids?

image What management options would you offer a patient with haemorrhoids?



Rectal bleeding


Rectal bleeding is a common presentation; bright red blood is passed around or with the stool or found on the paper.



Clinical features


‘Red flag’ features are change of bowel habit, weight loss and rectal bleeding. Causes of rectal bleeding (Fig. 3.19.1):


image common
— haemorrhoids: their presence does not exclude other concurrent causes (e.g. cancer), especially in the elderly

— rectal polyps: bleeding may be the only symptom

— anal fissure: painful with bright red blood

— colorectal polyps and cancer: must be excluded in those over 50 years; rectal cancer presents with bleeding more commonly than colon cancer

image occasional
— irritable bowel disease (Crohn’s disease ulcerative colitis)

— acute diverticulitis: more common in patients > 60 years

— trauma (maybe non-accidental injury in children)

image rare
— blood clotting disorders

— anal varices (portal hypertension)

— angiodysplasia: acquired malformation of intestinal blood vessels, often elderly patients

— intussusception: recurrent like jelly, in infants.

image

Fig. 3.19.1 Rectal bleeding.



Investigations


Initial investigations include:


image rectal examination: to detect rectal masses; haemorrhoids are not palpable

image FBC: associated anaemia

image protoscopy: to visualize perianal condition

image sigmoidoscopy: to exclude rectal cancer
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Rectal bleeding and rectal conditions

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