MANAGE YOUR RECTAL AND ANAL BLEEDING Rectal aNd ANal bleeding caN cause a lot of aNd injectioN sclerotherapy; aNd operative room aNd infectioN coNcern, as it is aN unusual experience. The ligatioN aNd excision. caN occur aNd Nature of the bleeding caN often be a clue as to ANAL FISSURE - Simply put, a fissure is a cut. are associated the underlying cause. See a COLORECTAL It is in an area that reQuires constant use. A fissure complicatioNs. SURGEON to properly investigate aNd maNage is usually caused by a hard stool. This stretches aNd Symptoms of this coNdition. tears the opening. Anal fissures result in severe pain diverticulitis include Rectal bleeding often reveals itself as bright red oN defecation, bleeding, with aNal sphincter spasm, abdominal pain, blood oN the toilet paper—usually after a bowel aNd further tearing. Typically bleeding is seen as a fever, aNd a sudden POLYP TO CANCER PROGRESSION movement—or by turning the toilet bowl water red. streak of blood oN a hard stool. chaNge in bowel habits. Treatment may include a People having aN increased risk of colorectal Rectal bleeding caN also present as extremely dark special diet, aNtibiotics, or surgery. caNcer include those who have a family history of stool, raNging in color from deep red/marooN to DIVERTICULAR DISEASE colorectal caNcer, aNd people who have previously black, aNd sometimes appearing tar-like (melena). had caNcer or polyps. The color of the blood caN indicate where the INFLAMMATORY BOWEL DISEASE bleeding is coming from: (IBD) is an inflammation of the small or large COLONOSCOPY is the most effective way of • Bright red blood usually indicates bleeding low intestine. There are two types of IBD. One type examining the lining of the colon and rectum. By in the coloN or rectum of IBD is Crohn’s disease, marked by patches of using a fiberoptic scope designed to bend and turn • Dark red or maroon blood usually indicates inflammation occurring anywhere in the digestive with your bowel, the doctor caN perform biopsies bleeding higher in the coloN or the small bowel tract. The other type of IBD, colitis, is marked by aNd remove pre-caNcerous polyps. • Melena usually means bleeding in the stomach, inflammation in the large bowel. By removing pre-cancerous polyps, over 90% such as bleeding from ulcers There are several other types of colitis, including: of colorectal caNcers caN be prevented. The exam ANAL FISSURE • Infectious colitis (caused by an infection that is performed at the hospital as aN outpatient CAUSES Medical treatment includes avoidance of attacks the large bowel) procedure. AN intravenous line is placed so that Although rectal bleeding is common, oNly constipation by fiber supplement, laxatives, and • Ischemic colitis (the result of a poor blood you caN be given sedatioN (twilight sleep). After the about oNe-third of those affected seek treatment. stool softeners; aNd applicatioN of Nifedipine supply to the colon) sedatioN takes effect, Symptoms usually develop quickly, aNd most causes ointment to relax the sphincter muscles. If Not • Radiation colitis (following radiotherapy, the scope is inserted are treatable aNd Not serious. IN some cases, rectal healed by medical treatment, then a surgical usually for prostate, rectal, or gyNecological aNd the entire bleeding caN be a symptom of a serious disease, treatment option includes Botox injection to relax caNcer) bowel is checked such as colorectal caNcer. Therefore, all rectal sphincter muscles, cutting the sphincter muscles • Ulcerative colitis (ulcers/sores in the large for abNormalities. bleeding should be reported. partially, and advancement flap. intestine lining) If polyps are found, Rectal bleeding caN be caused by: IBD symptoms may include: they are removed • hemorrhoids ANAL PRURITIS (also kNowN as “pruritis • Fever during the exam aNd • anal fissure ani”) is persistent itching of the skin around • Rectal bleeding sent to pathology to • anal abscess or fistula the aNus. This coNditioN caN cause intolerable • Diarrhea be aNalyzed. • anal pruritis discomfort. Regardless of the cause, the problem • Abdominal pain and/or cramping COLONOSCOPY • diverticulosis/diverticulitis is exacerbated by a self-escalating “itch-scratch- • Intestinal blockage • inflammatory bowel disease (IBD) itch” cycle. The skin gets thinned out aNd bleeds Treatment of inflammatory bowel disease is OFFICE EVALUATION OF RECTAL • ulcers easily oN wiping. Causes include over cleaning critical aNd may involve a special diet, medicatioN BLEEDING • large polyps which caN remove Natural oils that protect the skin, to eliminate or reduce inflammation, and/or • colon cancer increased moisture, aNd food aNd drinks (mainly surgery. Colorectal surgeoNs would perform aNoscopy, coffee). Treatment includes avoiding soap, dietary proctosigmoidoscopy and flexible sigmoidoscopy HEMORRHOIDS are a Normal part of the restrictioNs, keeping area dry, avoid scratching, aNd COLONIC POLYPS AND CANCER in the office. They are also equipped with providing aNatomy. We are borN with them. We have two sets; applying aNti-fungal aNd steroid creams. Since rectal bleeding caN sometimes be a office based treatment for the commoN coNditioNs interNal aNd exterNal. Symptomatic hemorrhoids symptom of colorectal caNcer – caNcer of the causing rectal bleeding. are swollen (enlarged, dilated) veins inside aNd ANAL ABSCESS results when aN aNal coloN or rectum – this is the primary reasoN rectal outside the glaNd becomes infected. It causes severe pain in bleeding should Not be igNored. Colorectal caNcer aNus. Enlarged the regioN around the aNus. There may also be is a commoN form of caNcer that caN usually be hemorrhoids are discharge of pus or blood from the aNus with aN cured if diagNosed aNd treated early enough. usually caused offensive odor. This collectioN caN happen in the Colorectal caNcer occurs when the Normal by increased aNatomical spaces around the aNal caNal. ANal growth aNd divisioN of the cells lining the large pressure, such as abscess is treated by making aN opening in the skin bowel goes out of coNtrol, initially resulting in the straining when Near the aNus to drain the pus from the infected formatioN of a polyp. A polyp caN appear similar to coNstipated. cavity aNd thereby relieve the pressure. Often this a small mushroom that is attached to the lining of Hemorrhoids caN be doNe in the office using local aNesthetic. the large bowel. Polyps that become large caN bleed. may cause pain, While there are maNy types of polyps that are bleeding, blood DIVERTICULOSIS develops when small Not caNcerous, certain polyps are coNsidered clots, aNd itching. pouches (diverticuli) form in weakened sectioNs precaNcerous aNd caN develop into caNcer if left OFFICE EVALUATION OF RECTAL ANATOMY OF HEMORRHOIDS of intestine lining aNd protrude through the bowel untreated. Therefore, removing polyps before they BLEEDING Medical treatment includes avoidance of wall, usually in the sigmoid colon. Diverticuli develop such severe chaNges caN prevent caNcer. Colorectal surgeoNs treat a majority of the causes constipation by fiber supplement, laxatives, are a common finding among older people and ColoNoscopy is the procedure used by physiciaNs of rectal bleeding with coNservative treatment aNd stool softeners; aNd applicatioN of topical are diagNosed when seen oN a coloNoscopy or to locate aNd remove polyps to prevent colorectal aNd office based procedures. See your Colorectal hemorrhoidal aNd steroid ointments. Surgical sigmoidoscopy. caNcer. Surgeon for further evaluation and management treatment includes office based rubber baNding Diverticulosis is a benign disorder but bleeding of rectal and anal bleeding..