Rectal Bleeding - Should I Be Concerned?
Dr. Ergen Muso is a gastroenterologist practicing in Bedford, NH. Dr. Muso specializes in the digestive system and its diseases that affect the gastrointestinal tract, which includes organs from the mouth to the anus as well as liver disorders. Gastroenterology includes conditions such as hepatitis, peptic ulcer disease,... more
At some point in our lifetime, each of us will have experienced an episode of rectal bleeding. This brings a lot of stress and worries into our everyday life. We start researching on Google, and the first explanation you see is colon cancer. This brings even more stress. Should I be concerned about it?
Rectal bleeding has many causes. In this topic, I will be discussing more minimal bleeding that we see mixed with stool or in toilet paper rather than perfuse bleeding which suggests different causes. In >90% of cases, usually benign etiologies (meaning not cancer) appear to account for these episodes of minimal rectal bleeding. However, 10% of cases could suggest a serious diagnosis such as colorectal cancer.
Common causes and presentation of minimal rectal bleeding include:
- Hemorrhoids
- Anal Fissures
- Polyps
- Proctitis/Inflammatory bowel disease
- Cancer
Each case of rectal bleeding should have a careful clinical assessment initially by your primary care physician or gastroenterologist. Studies have shown that even careful assessments can be unreliable both for determining the side of bleeding and to rule out significant pathology. What does this mean? The goal of the clinical assessment is to identify those who are at risk for a serious cause of bleeding and therefore require additional testing. Indications for additional testing include:
- Constitutional symptoms (fever, weight loss)
- Change in bowel habits
- Family history of colon cancer
- Melena
- Age >50
Additional testing may require laboratory tests, imaging such as CT scan or MRI, or procedures such as colonoscopy.
In conclusion, each case of rectal bleeding is different and requires a discussion with your primary care physician or gastroenterologist to see if further tests are required. The evaluation with a physician can put those worries to ease. Yes, it could be just hemorrhoids - but what if it's not?
