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MANAGE YOUR RECTAL AND ANAL BLEEDING

Rectal and Anal bleeding can cause a lot of concern, as it is an unusual experience. The nature of the bleeding can often be a clue as to the underlying cause. See a COLORECTAL SURGEON to properly investigate and manage this condition.

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

CAUSES

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.

Rectal bleeding can be caused by:

·         hemorrhoids

·         anal fissure

·         anal abscess or fistula

·         anal pruritis

·         diverticulosis/diverticulitis

·         inflammatory bowel disease (IBD)

·         ulcers

·         large polyps

·         colon cancer

HEMORRHOIDS are a normal part of the anatomy. We are born with them. We have two sets; internal and external. Symptomatic Hemorrhoids are swollen (enlarged, dilated) veins inside and outside the anus. Enlarged hemorrhoids are usually caused by increased pressure; such as straining when constipated. Hemorrhoids may cause pain, bleeding, blood clots, and itching.

Medical treatment includes avoidance of constipation by fiber supplement, laxatives, and stool softeners; and application of topical hemorrhoidal and steroid ointments. Surgical treatment includes office based rubber banding and injection sclerotherapy; and operative room ligation and excision.

ANAL FISSURE - Simply put, a fissure is a cut. It is in an area that requires constant use. A fissure is usually caused by a hard stool. This stretches and tears the opening. Anal fissures result in severe pain on defecation, bleeding, with anal sphincter spasm, and further tearing. Typically bleeding is seen as a streak of blood on a hard stool.

  Medical treatment includes avoidance of constipation by fiber supplement, laxatives, and stool softeners; and application of Nifedipine ointment to relax the sphincter muscles. If not healed by medical treatment then surgical treatment option includes Botox injection to relax sphincter muscles, cutting the sphincter muscles partially, and advancement flap.

ANAL PRURITIS (also known as “pruritis ani”) is persistent itching of the skin around the anus. This condition can cause intolerable discomfort. Regardless of cause, the problem is exacerbated by a self-escalating “itch-scratch-itch” cycle. The skin gets thinned out and bleeds easily on wiping. Causes include over cleaning can remove natural oils that protect the skin, increased moisture, food and drinks (mainly coffee). Treatment includes avoiding soap, dietary restrictions, keeping area dry, avoid scratching, anti fungal and steroid creams.

ANAL ABSCESS results when an anal gland becomes infected. It causes severe pain in the region around the anus. There may also be discharge of pus or blood from the anus with an offensive odor. This collection can happen in the anatomical spaces around the anal canal. Anal abscess is treated by making an opening in the skin near the anus to drain the pus from the infected cavity and thereby relieve the pressure. Often this can be done in the office using local anesthetic.

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 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. Symptoms of diverticulitis include abdominal pain, fever, and a sudden change in bowel habits. Treatment may include a special diet, antibiotics, or surgery.

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:

·         Fever

·         Rectal bleeding

·         Diarrhea

·         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.

COLONIC POLYPS AND CANCER

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. 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.

COLONOSCOPY is the most effective way of examining the lining of the colon and rectum. By using a fiberoptic scope designed to bend and turn with your bowel, the doctor can perform biopsies and remove pre-cancerous polyps.

By removing pre-cancerous polyps, over 90%of colorectal cancers can be prevented. The exam is performed at the hospital as an outpatient procedure. An intravenous line is placed so that you can be given sedation (twilight sleep). After the sedation takes effect, the scope is inserted and the entire bowel is checked for abnormalities. If polyps are found, they are removed during the exam and sent to pathology to be analyzed.

OFFICE EVALUATION OF RECTAL BLEEDING

Colorectal surgeons would perform anoscopy, proctosigmoidoscopy and flexible sigmoidoscopy in the office. Also they are equipped with providing office based treatment for the common conditions causing rectal bleeding.

OFFICE EVALUATION OF RECTAL BLEEDING

Colorectal surgeons treat majority of the causes of rectal bleeding with conservative treatment and office based procedures. Discuss with your Colorectal Surgeon for further evaluation and management of rectal and anal bleeding.

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MARCH IS COLORECTAL CANCER AWARENESS MONTH

Invasive colorectal cancer is a preventable disease. Early detection through colonoscopy is the most important factor in the recent decline of colorectal cancer.

The American Cancer Society estimates that 95,520 new cases of colon cancer will be diagnosed in the United States in 2017.

Colorectal cancer is a multifactorial disease process. Risk factors include – -  Genetic factors -  Environmental exposures – Diet with high red meat, high animal fat, low fibers, and low fruits and vegetables -  Lifestyle choices – Smoking, alcohol, sedentary lifestyle, obesity -  Inflammatory bowel disease.

Colon cancer is now often detected during screening procedures. Other common clinical presentations include - -  Iron-deficiency anemia -  Rectal bleeding -  Abdominal pain -  Change in bowel habits -  Intestinal obstruction or perforation

Screening for colorectal cancer and adenomatous polyps should start at age 50 years in asymptomatic men and women.

Screening for colorectal cancer should start at an earlier age and be more frequent and more stringent for individuals who carry an increased or high risk of developing colorectal cancer, such as persons with any of the following: -  Prior history of polyps -  Prior history of colorectal cancer -  Family history of colon cancer -  History of inflammatory bowel diseases

Common myths about colonoscopy -  Bowel cleaning is a worse experience – With newer preps and combination prep bowel cleaning is not as bad an experience -  Procedure is painful – With propofol anesthesia and using carbondioxide for gas, it is a painless procedure -  Risk of infection – The scopes are thoroughly processed prior to the procedure and so there is no risk of infection -  Risk of perforation – This is very minimal

Worse than a colonoscopy – Getting diagnosed with colon cancer