Overview

Blood coming from the anus or rectal bleeding has various possible causes and may occur as a result of a weaker or abnormal area along your digestive tract. Hemorrhoids are the most common cause of rectal bleeding.  While hemorrhoids and other causes of rectal bleeding may be just minor inconveniences, blood coming from the anus can be a serious concern if you are losing a lot of blood.

The rectum is the last portion of the large bowel that ends before the anus. Bleeding from this can be mild, serious, or in some cases, life-threatening. The presence of blood coming from the anus must be carefully checked as it could be indicative of something wrong somewhere in the gastrointestinal tract. 

Rectal bleeding is medically known as hematochezia, which refers to the discharge of bright red blood from the anus, usually mixed with stool and blood clots and faint. Most rectal bleeding comes from the anus, rectum, or colon and may be associated with diarrhea. The color of the blood that comes out of the anus depends on the location of the bleeding in the gastrointestinal tract. The blood will be a bright red is the bleeding site is closer to the anus such as the sigmoid colon, rectum, and anus . If the bleeding site is in the transverse colon and the right colon, which are several feet away from the anus, the blood tends to be dark red or maroon in color.

In some individuals, bleeding could be black, tarry and foul-smelling. The black, tarry, and smelly stool is known as melena. Melena happens when the blood stays in the colon long enough for the colon bacteria to break it down into chemicals that are black. Melena, therefore, signifies bleeding from the upper gastrointestinal tract, such as bleeding from ulcers in the stomach, which stays in the gastrointestinal tract for longer before exiting the body. At times, when there is massive bleeding from the right colon or ulcers of the stomach, the blood will rapidly transit through the gastrointestinal tract and result in bright red blood coming from the anus. In situations like these, the blood moves rapidly through the colon that there is not enough time for the bacteria to turn the blood into black.

There are times when the bleeding from the gastrointestinal tract is too slow to cause rectal bleeding. In these individuals, bleeding like mouth ulcer is occult or not visible to the naked eye. The blood may be found only by testing the stool for blood in the laboratory.  Occult bleeding may have the same causes as rectal bleeding, resulting in the same symptoms as blood coming from the anus.

Causes

Causes of blood coming from the anus or rectal bleeding range from mild to serious. Mild cases of rectal bleeding include:

• Anal fissures or small tears in the lining of the anus
• Hemorrhoids or irritated veins in the anus or rectum
• Constipation or passing of hard, dry stools
• Polyps, the small tissue growths in the lining of the colon or recti, that can bleed when passing stool

More serious causes of rectal bleeding include:

• Anal cancer
• Colon cancer
• Intestinal infection, or infection caused by bacteria, such as salmonella
• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis

Less common causes of rectal bleeding include allergic reactions to certain foods to blood-clotting disorders.

Diagnosis and Treatment

A physician typically performs a physical examination of an individual with rectal bleeding. If necessary, he will also perform some diagnostic tests, such as:

• Vital signs – Elevated heart rate and low blood pressure indicate significant blood loss. An elevated temperature suggests an infection.
• Abdominal examination – A doctor will inspect the anus for possible external sources of bleeding such as foreign body, trauma, or hemorrhoids. A finger examination can assess for tenderness, presence of masses, and the character of stool.

Depending on the severity and type of bleeding, a healthcare professional may perform special tests to aid in the diagnosis, such as:

• Blood tests – Blood samples will be taken to assess the extent of blood loss, the possibility of infection, and the clotting ability of blood.
• Nasogastric tube – A medical professional may have to pass a flexible tube through the nose into the stomach to check for active bleeding. This procedure may be uncomfortable but can be a vital diagnostic test.

Scope examinations

A healthcare professional may perform any of the following procedures:

• Anoscopy – A metal or plastic scope is placed into the anus for a quick examination of the rectum.
• Flexible sigmoidoscopy – A flexible tube is inserted into the rectum to evaluate the rectum and lower end of the colon.
• Colonoscopy – A doctor inserts a soft tube equipped with a light and camera into the rectum and pushes it into the colon. The doctor can view the entire large colon. This procedure can find areas of bleeding, irregularities in periods, or masses, and be used for the screening of colon cancer.
• Barium enema X-ray – This procedure uses liquid barium inserted into the rectum. An X-ray highlights problem areas such as diverticula or tumors although it cannot distinguish active bleeding sites.
• CT scan – This scan helps diagnose diverticulitis or tumors in the bowels
• Angiography – It involves a contrast dye study to evaluate active areas of brisk bleeding.
• Nuclear medicine studies – A tagged red blood cell scan pinpoints areas of slow bleeding.

Treatment

The mode of treatment for blood coming from the anus depends on the source and cause of the bleeding.

• Regardless of where bleeding comes, the treatment of blood loss starts by stabilizing the condition of the patient.
• Initially, medical professionals will provide oxygen to the patient and monitor the heart. An IV will be started to administer fluids and for a possible blood transfusion.
• Further treatment options depend on the suspected source of bleeding. A general surgeon, a specialist in colitis, and gastroenterologist, will be involved in making the treatment plan.
• Admission to a hospital may be necessary when a marked amount of blood loss has occurred, if bleeding does not stop, or if vital signs have not return to normal.

A doctor can use cauterization in the bleeding area and surrounding tissue through the endoscope, or place a clip on a bleeding blood vessel. 

The different techniques to stem bleeding from the anus are always not enough. There are times when the individual who is bleeding from the anus will need surgery. Once the bleeding is under control, the patient may have to take medicine to keep bleeding from coming back.

Home remedies for rectal bleeding

When there is minimal rectal bleeding, like a small streak of blood on a toilet tissue, the source of the problem could be hemorrhoids. Home therapy may be used. A doctor should evaluate and treat all other causes of rectal bleeding.

Self-care of rectal bleeding may include the use of rectal ointments and suppositories, which may be bought over-the-counter. If the symptoms do not improve within one week of treatment, or when the person is older than 40 years of age, a doctor should conduct a further evaluation.

Simple home care of blood coming from the anus includes the following:

• Drinking 8 to 10 glasses of water every day
• Decrease straining with bowel movements
• Bathing or showering daily to cleanse the skin around the anus
• Avoid sitting on the toilet too long
• Increase fiber in the diet using supplements or fiber-rich foods such as prunes.
• Taking a sitz bath. This is a warm water bath deep enough to cover the hips and buttocks. It can help relieve some symptoms of pain, itching, and discomfort of hemorrhoids.
• Apply ice packs to the affected area to decrease pain
• Avoiding drinking alcohol because it can contribute to dehydration, which is one cause of constipation.

Follow-up for rectal bleeding

Follow-up of rectal bleeding treatment is important, especially if there are causes that resulted in heavy bleeding and also helps with  kidney disease.

• See the doctor as scheduled
• Take all prescribed medications as directed by the doctor
• Watch signs of continued rectal bleeding. They will require a re-evaluation

Risks of Having Blood Coming from Anus

Rectal bleeding is common in the general population and maybe an early symptom of bowel cancer. The most useful factors that help identify higher-risk groups are rectal bleeding in combination with a change in bowel habit, looser stools, increased frequency of defecation, and age greater than 60 years.

When to Seek Medical Attention

Severe rectal bleeding may constitute a medical emergency. Go to the nearest emergency room of a hospital if you experience any of the following symptoms:

• Confusion
• Cold, clammy skin
• Fainting
• Continuous rectal bleeding
• Rapid breathing
• Painful abdominal cramping
• Severe nausea
• Severe anal pain

Schedule an appointment to see your doctor when you have experienced less than severe rectal bleeding, such as tiny drops of blood from the rectum. A small amount of rectal bleeding and abdominal pain can immediately turn into a large amount. Seeking treatment in the early stages is important.