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Different types of bleeding may occur from the rectum, varying in a great many ways. The most common one is fresh red, usually spotting, appearing through the anus during the opening of the bowels. It is important to differentiate this type of bleeding from the other types.
Imagine the man’s gastrointestinal system as a “tube” with a beginning and an end. This tube’s opening is the mouth, from here, the food passes through the esophagus into the stomach and then into the small bowels that continue in the colon. The final 20 cm part of the colon is the rectum from which the stool is excreted through the anus. The anus is opened and closed by a relatively wide muscle ring. The section at the muscle ring is called the anal canal. In this multiple “tubular system”, bleeding may occur at numerous levels for different reasons, and bleeding at different levels may have very different symptoms.
From the point of view of our current subject, the most important thing to understand is that fresh red blood may appear through the anus only in rectal bleedings. For all other bleedings from upper levels, the blood has already been either clotted or digested, or perhaps it has stained the stool tar black. So we can safely say that fresh red bleeding through the anus comes from the rectum. Summarizing: stomach bleeding, small bowel diseases or colon tumors do not cause fresh red bleeding through the anus.
Bleedings from the rectum can be divided into two large groups based on their symptoms. One is the aforementioned fresh red spotting bleeding, which usually occurs on or after the opening of the bowels. The other one is when already clotted blood – its appearance is similar to the plum jam, is excreted through the anus.
It is necessary to differentiate these two clinical pictures because there are other causes behind the symptoms, so their treatment is different. When there is such a degree of bleeding above the ring-like sphincter of the anus, in the so-called rectal ampulla, so that the blood accumulated can be clotted, the source of bleeding is located in the rectal ampulla already mentioned. In contrast, fresh red bleeding during bowel movements comes from the anus, or from its inner immediate surroundings, that is the so-called anal canal.
In setting the diagnosis, fresh red bleeding or clotted blood are a decisive starting point. Fresh red bleeding can be caused:
- external hemorrhoid
- internal hemorrhoid
- cracking of the mucous membrane of the anus or the anal canal
- a so-called polypus growing from these parts of the mucous membrane (which is benign lesion)
- a similar but already malignant tumor
- rectal fistula (whose symptoms are rather different and rarely appears in the form of an isolated fresh spotting bleeding)
The above listed causes can and must be differentiated from each other on proctological examination.
The steps of the proctological examination:
- accurate survey of the medical history
- examination of the anus and its surroundings
- the so-called rectal, manual /(digital)/ examination, the palpation of the anus, anal canal and rectal ampulla.
- with the help of an anoscope, which is a fine tool minimally thicker than the human finger, and its light source, the anal canal and the lower 5 cm section of the rectal ampulla can be visualized
- if necessary, the higher sections can also be visualized with the so-called rectoscope
- rectoscopy may be required in such cases when the source or cause of bleeding are not rectal, but this test is not required for purely fresh red rectal bleeding
With the clinical tests listed here, it can be clearly determined that the source of bleeding is caused by an external or internal hemorrhoid, or mucous membrane cracking, or a polypus or cancer formed in this section. The aforementioned rectal fistula can also be clearly distinguished from other diseases by the clinical tests. The visualization of the further 15-20 cm section of the rectum, the so-called rectoscopy may be necessary if there is actually a clotted bleeding or if the clinical picture is unclear. The causes of bleeding from the rectal ampulla may be:
- Bleeding internal hemorrhoid
- Polypus in the ampulla
- Post-operative bleeding
- Other rare diseases
When we set up a clear diagnosis, targeted therapy can begin only then. Treatments for various disorders may have common parts but, for the sake of success, each disease requires special treatment.
The disorders accompanied with fresh red spotting bleeding are generally not serious. Of course their complaints can be very unpleasant. At the same time, it may be a source of error if, without proper clinical examination, we are diagnosing and treating only on the basis of the some symptoms. Therefore, in the case of fresh red rectal bleeding, a specialist examination with precise clinical steps is needed to find out what causes the symptoms.