Patient Information

Rectal Bleeding

Understanding causes, investigation, and when to seek urgent advice for bleeding from the back passage.

What is Rectal Bleeding?

Rectal bleeding means passing blood from the back passage. Rectal bleeding is very common and is often caused by harmless conditions such as haemorrhoids or anal fissures. However, bleeding should never simply be ignored, particularly if symptoms are persistent or unexplained.

How rectal bleeding may appear

—Bright red

—Dark red

—Mixed with the stool

—Seen on the toilet paper

—Seen in the toilet bowl

—Associated with mucus

Common Causes

Haemorrhoids (Piles)

Swollen blood vessels around the anus commonly cause bright red bleeding, bleeding on wiping, itching or discomfort, and a lump around the anus.

Anal Fissure

A small tear in the lining of the anus, often causing sharp pain during bowel motions, bright red bleeding, and burning discomfort afterwards.

Diverticular Disease

Small pockets in the bowel wall which can occasionally bleed, sometimes in significant amounts.

Inflammatory Bowel Disease

Conditions such as ulcerative colitis or Crohn's disease may cause bleeding mixed with diarrhoea, urgency, abdominal pain, and weight loss.

Bowel Polyps

Small growths in the bowel lining. Most are benign, but some can develop into cancer over time and may cause intermittent bleeding.

Bowel Cancer

Although many patients with rectal bleeding do not have cancer, bleeding can occasionally be an important warning symptom that should always be assessed.

Symptoms Requiring Prompt Assessment

National guidelines (NG12) recommend urgent assessment if rectal bleeding is associated with:

·Persistent change in bowel habit

·Unexplained weight loss

·Iron deficiency anaemia

·Abdominal pain

·A lump in the abdomen or rectum

·Blood mixed within the stool

·Persistent bleeding without an obvious anal cause

·Family history of bowel cancer or polyps

·New symptoms in patients over 50 years of age

How Is Rectal Bleeding Investigated?

Clinical Examination & Blood Tests

Examination may include:

·Examination of the abdomen

·Examination of the anal area

·Digital rectal examination

Blood tests may look for:

·Anaemia

·Iron deficiency

·Inflammation

FIT Test (Faecal Immunochemical Test)

This stool test detects tiny amounts of blood within the stool that may not be visible to the eye. It helps determine whether further bowel investigation is needed.

Colonoscopy

The most detailed test for examining the bowel lining. A thin flexible camera is passed through the back passage. Polyps can often be removed and biopsies taken if required.

Advantages

·Most accurate examination of the bowel lining

·Allows biopsies and removal of polyps

·Can diagnose inflammation, polyps and cancer

Disadvantages

·Requires bowel preparation

·Usually involves sedation

·Small risks of bleeding or bowel perforation

CT Colonography

"Virtual Colonoscopy"

Uses a CT scanner to create detailed images of the bowel after gentle inflation of the colon with gas.

Advantages

·Less invasive than colonoscopy

·Usually no sedation required

·Helpful for patients who may not tolerate colonoscopy

Disadvantages

·Polyps cannot be removed

·Biopsies cannot be taken

·Colonoscopy may still be required if abnormalities found

CT Scan with Oral Contrast

Particularly useful for symptoms such as abdominal pain, weight loss, suspected inflammation, diverticular disease, or possible bowel obstruction.

Advantages

·Good overview of the abdomen and pelvis

·Helpful for identifying inflammation or disease outside the bowel

Disadvantages

·Does not assess the bowel lining in as much detail as colonoscopy

·Small polyps may be missed

·Biopsies and polyp removal not possible

What Happens if Polyps Are Found?

Polyps are common and are usually benign. Some can slowly develop into cancer over many years. If polyps are found during colonoscopy they are often removed immediately and sent for analysis. Some patients require future surveillance colonoscopy depending on the number, size, and type of polyps identified.

When Should I Seek Urgent Help?

—Heavy bleeding or passing clots

—Black or tarry stools

—Severe abdominal pain

—Dizziness or fainting

—Persistent vomiting

—Significant weakness or shortness of breath

Important Reassurance

Most rectal bleeding is caused by benign conditions such as haemorrhoids or fissures. Nevertheless, persistent or unexplained bleeding should always be assessed properly to exclude more serious causes. Early investigation is important and is often reassuring.

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