Bleeding from the rectum is one of the most common problems patients go to the doctor with. Seeing blood near the anus is frightening for the patient and many want to quickly seek medical help to get rid of it. The first thought that comes to mind is the possibility of cancer and even after being convinced it isn’t there, they take a long time to overcome their fear. Here is a list of some of the questions these patients often ask and their possible answers:
- I’m bleeding from my rectum. Do I have cancer?
Answer: Not necessary. In fact, cancer is a relatively rare cause of rectal bleeding. The most common cause is bleeding or hemorrhoids. Other causes include anal fissures, anorectal fistulas, inflammation of the colon (colitis), and abnormal growth of benign tissue (polyps).
- I have rectal bleeding with pain every time I have a bowel movement. Do I have stacks?
Answer: Pain is a very rare symptom of hemorrhoids. Usually, hemorrhoids usually cause painless fresh rectal bleeding. However, hemorrhoids can be painful if a blood clot develops in the external hemorrhoid (called a thrombosed hemorrhoid). Bleeding from the rectum with pain is not caused by hemorrhoids, but by a crack in the anus.
- What is an anal fissure?
Answer: Fissure is a hole in the skin that covers the anal canal. This is usually the result of a constipation problem and can be extremely painful. The pain is not always but sometimes associated with bleeding.
- Do I need surgery for rectal bleeding?
Answer: Rectal bleeding such as hemorrhoids, anal fissures and intestinal irritation can be treated without surgery in most cases. However, surgery may be necessary in some cases, especially when initial non-surgical methods have failed.
- What tests do I need to diagnose the source of the bleeding?
Answer: The best way to find the source of the bleeding is to enter the area from below (endoscopy of the lower gastrointestinal tract) and look inside the intestines. There are three types of endoscopy for the lower GI tract: a) proctoscopy, b) flexible sigmoidoscopy, and c) colonoscopy.
Proctoscopy involves inserting a very small tube through the anus and viewing the lower end of the rectum. This can be done easily in the outpatient clinic and is excellent for diagnosing hemorrhoids.
Flexible sigmoidoscopy is a limited colonoscopy that looks at about 70 cm of the colon from the anus. It is different for patients suffering from fresh rectal bleeding.
Colonoscopy is performed for people with a change in bowel habits (diarrhea or recent constipation) with or without rectal bleeding. It examines the entire length of the colon and sometimes the last part of the small intestine.
- Colonoscopy? I’ve heard it’s very painful.
A: Colonoscopy is performed under anesthesia and most patients find the test tolerable. However, we can also do it under heavy sedation (short-term general anesthesia) if the patient wishes, and it is painless.
- Is colonoscopy dangerous?
Answer: Colonoscopy is a very safe procedure if performed with care and caution. Complications, such as perforation and bleeding, are extremely rare.
- I’ve been diagnosed with piles. Do I need surgery?
Answer: Most hemorrhoids do not require surgery. The decision depends a bit on how big the hemorrhoids are and whether they come from the anus. Most hemorrhoids can be treated nonsurgically. Large hemorrhoids may require surgery.
- Is surgery the only way to treat fissures?
Answer: No, not at all. Many fissures can be healed with medication. Some require surgery, especially when initial medical treatments have failed.
- What are abnormal tissue growths (polyps)?
Answer: It is a wart-like swelling that arises from the inner lining (mucous membrane) of the intestine. This can cause bleeding through the rectum.
- Do I need interventional surgery for polyps?
Answer: Not necessary. Most polyps can be removed through the colonoscope and no conventional surgery is needed. However, larger polyps may require interventional surgery.
- What is Fistula?
Answer: Fistula is an abnormal connection between the rectum and the inside of the skin. It often causes infection and discharges more.
- What is the treatment for fistulas?
Answer: Most can be treated with simple surgery that requires an overnight stay in the hospital. However, some more complex cases may require more extensive surgery.
- Can colon cancer be cured?
Answer: Colon cancer is completely curable if detected early. Many early colon cancers are curable with surgery, but some may require chemotherapy after surgery. Survival rates (expressed as five-year survival rates) are greater than 90% for stage A cancer and approach 75% for stage B cancer. Even in stage C cancer (i.e., those involving regional lymph nodes), the survival rate for more than five years after surgery and chemotherapy is over 50%.
Dr. Jai Chowdhuri, General Surgery Consultant, Naraiafter Multispecialty Hospital, Barasat