What is it about ?
Anal bleeding is a loss of fresh red blood, liquid or clotted, from the anus. We also talk about rectal bleeding or rectal bleeding. The rectum is the last part of the large intestine before the anus.
Anal bleeding should not be confused with melena. the melena refers to black stools caused by bleeding higher up in the digestive tract (gastrointestinal tract). These stools are smelly and very sticky. A melena should always be taken seriously.
Causes of anal bleeding
- hemorrhoids ;
- The hemorrhoids look like small pads in the anus. These are dilated veins (varicose veins) of the venous network under the lining of the anus (hemorrhoidal network).
- When you push to have a bowel movement (defecation), small cracks can form in the lining, causing the hemorrhoids to bleed. In this case, a few drops of bright red blood may flow into the bowl.
- Hemorrhoids are painless unless a blood clot (thrombosis) has formed. Hemorrhoids can be itchy, however.
- Hemorrhoids are common in people who tend to be constipated.
- Over time, the hemorrhoids can come out to the outside (prolapse).
- anal fissure;
- The anal fissures mainly affect young and middle-aged people.
- The first symptoms are pain and a burning sensation when defecating. Pain may persist for up to 2 hours.
- Often you will notice a few traces of bright red blood on the toilet paper.
- diverticula;
- Diverticula are small, pocket-shaped bulges that extend from the intestinal wall into the abdominal cavity and can bleed. The blood comes from a small artery at the edge of the diverticulum.
- Because the pressure in an artery is quite high, the bleeding can be heavy and prolonged. Blood can be on or mixed with the surface of the stool. In the long term, this prolonged (sometimes inconspicuous) bleeding can lead to anemia, which results in pallor and abnormal fatigue.
- Diverticula are a common cause of anal bleeding in older people.
- intestinal tumors;
- Intestinal tumors can be benign or malignant.
- The most common benign tumor is the polyp. It is a small, rod-shaped growth that grows on the inner wall of the intestine. The friction caused by the passage of stool can create lesions in the lining, which is accompanied by light bleeding.
- From malignant tumors (bowel cancer) can also cause anal bleeding. In this case, you often have other symptoms at the same time: a change in the rhythm of the stools, weight loss and stomach pain. Blood is often mixed with the stool. These tumors mostly occur in people over the age of 50.
- chronic inflammatory bowel disease (IBD);
- In inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis, the mucous membrane that lines the inside of the intestine is modified in various places: it becomes very fragile and bleeds at the slightest friction caused by the passage of stool.
- You also have other symptoms such as diarrhea, weight loss, and stomach pain.
- bacterial or viral infection;
- An infection can also cause bloody diarrhea.
- In this case, the symptoms are rather limited and only last for the time of the infection.
- small deformities of the blood vessels (angiodysplasias);
- These can sometimes cause severe rectal bleeding, especially in older people.
- ischemic colitis.
- It is a form of intestinal inflammation caused by poor local blood circulation.
- This intestinal inflammation occurs almost exclusively in older people after surgery in the tummy.
What is its frequency?
Every year, 1 in 5 people have bleeding from the anus.1 Only 5 out of 1,000 people consult their general practitioner for this problem. People who know they have hemorrhoids or cracks usually don’t worry about seeing a little blood on the toilet paper.
The common causes of anal bleeding are as follows:
- hemorrhoids: 16-35%;
- anal fissures: 5-9%;
- benign polyps: 2-12%;
- bowel cancer: 7%;
- chronic inflammatory bowel disease (IBD): 5%;
- diverticula: 1%.
In 30 to 40% of cases, the cause of anal bleeding is unknown.
How to recognize it?
You lose red, watery or clotted blood (clots) through the anus. Sometimes you just see a little red blood on the toilet paper, but the blood can also drip into the bowl, cover the surface of the stool, or get mixed with it.
How is the diagnosis made?
Discussion and examination by the general practitioner
The doctor will ask you questions about the nature and course of the bleeding. They will then look for other symptoms and ask you if any people in your family have or have had bowel disease.
The doctor will then examine your anus for the presence of hemorrhoids, anal fissures or fistula openings that could be the cause of the bleeding. He will then perform a internal review (digital rectal examination) with the finger. He may possibly insert a small metal tube to better visualize the inside of the rectum (the last part of the colon).
If the doctor suspects inflammation of the intestinal lining, he will also prescribe a blood test and an stool culture.
Specialist examination
If the doctor cannot clearly establish the cause of the bleeding, he will refer you to a specialist in gastrointestinal diseases (gastroenterologist). People over 50 and people with symptoms compatible with bowel cancer will also be referred to the specialist.
This will proceed to a endoscopy of the rectum (rectoscopy) or entire large intestine (colonoscopy). If he sees lesions, he will usually remove a piece of tissue (biopsy) for examination under a microscope.
A colonoscopy is also recommended when your stool exam as part of the national colorectal cancer screening program shows the presence of blood.
What can you do ?
In most cases, you can easily treat your anal bleeding. The majority of its causes are benign.
- If you have anal bleeding fromunknown origin, always consult the general practitioner.
- If you bleed profusely anus, go directly to the nearest hospital emergency department. This is because the bleeding can quickly lead to anemia, which can affect other vital functions, such as blood pressure and heart function.
- If you are suffering hemorrhoids or cracks, try to soften your stool by eating more fiber, that is, more fruits and vegetables, for example. Constipation can make symptoms worse.
What can your doctor do?
The doctor will first try to find the cause of the anal bleeding.
Processing
In the case of hemorrhoids and anal fissures, the drugs have limited effectiveness. Often these conditions heal on their own. Sometimes the doctor may prescribe a ointment.
In any case, you must do everything to avoid constipation. Your GP may prescribe medicine to soften your stools.
He can also place a rubber band ligation around a bleeding hemorrhoid or inject a product in the hemorrhoid to contract the vein. In severe cases, a surgical intervention can be considered.
Additional tests
If the doctor finds no external cause, a endoscopy of the large intestine (colonoscopy) is usually performed by a specialist.
- If, during this examination, this doctor finds bleeding intestinal polyps, he will immediately remove them and have them analyzed to see if they are benign or malignant.
- Diverticula are not treated, except in cases of abscess formation. If the diverticula are numerous and cause great inconvenience, a piece of colon will be removed.
If the lining of the intestine is inflamed and the specialist suspects a tumor, he will take a biopsy to confirm the diagnosis. The treatment of these conditions takes place in consultation with the specialist.
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