What Causes Bright Red Blood In Stool – Hematochezia refers to the passage of fresh, bright red blood in the stool and is often indicative of blood originating from the gastrointestinal (GI) tract. The lower GI tract is anatomically defined as the region distal to the ligament of Treitz, which is a thin band of tissue that connects and supports the end of the duodenum and the beginning of the jejunum. Hematochezia should not be confused with melena, which refers to the presence of dark, tarry stools originating from the upper GI tract, which is located close to the ligament of Treitz.
Causes of hematochezia in adults are common with inflammatory bowel disease (IBD), including ulcerative colitis; hemorrhoids; and bleeding from a diverticulum in the colon. In addition, peptic ulcer disease and heart diseases are causes of upper gastrointestinal bleeding that can produce hematochezia when severe.
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Ulcerative colitis is a type of inflammatory bowel disease that involves an autoimmune attack of the large intestine (ie, the colon), causing inflammation and ulceration of the mucosal lining. Ulcerative colitis can lead to hematochezia due to bleeding from the ulcer.
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Hemorrhoids are swollen veins in the lower rectum and can be painless or painful, depending on whether they are internal or external, respectively. They are usually caused by straining during bowel movements and are associated with obesity and pregnancy. When the walls of the blood vessels in the hemorrhoid become too thin as a result of increased pressure in the lower rectum, especially from straining, hematochezia can occur.
Diverticulosis is a condition that occurs when small pouches (i.e., diverticulum) grow and push outward through the wall of the colon, which can cause bleeding. Genetics such as a high-fat, low-fiber diet make an individual more likely to develop diverticular pouches.
Peptic ulcer disease occurs when the protective mucosal lining of the stomach and duodenum of the small intestine breaks down due to infection with the bacteria Helicobacter pylori (H. pylori) or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). If the wound is severe, rapid bleeding can occur, and immediate treatment is important because of the risk for hypovolemic shock.
Esophageal varices refer to the presence of enlarged veins in the esophagus due to obstruction of flow through the portal vein, which is often caused by acute liver injury. Backflow of blood can lead to rupture of the esophageal vein, which manifests as a lot of blood loss and melena (ie, dark, tarry stools) or hematochezia.
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In older individuals, an arteriovenous malformation (AVM) can lead to multiple, often smaller, aneurysms. AVM is an arterial lesion that can occur anywhere including the GI tract, is common in the colon and is age-related; chronic kidney disease; and types of heart disease, such as aortic stenosis. Less common causes of coronary artery disease in adults include cancer and ischemic colitis (ie, inflammation of the colon).
Causes of hematochezia in newborns include necrotizing enterocolitis and midgut volvulus. Necrotizing enterocolitis refers to the death of tissue in parts of the colon due to reduced blood flow, and midgut volvulus occurs when the intestine changes during fetal development.
Signs and symptoms of hematochezia usually include bright red blood in the stool that is seen either in the toilet or on the toilet paper when cleaning as well as feeling pain or pressure in the rectum. In many cases, an individual with hematochezia may be unaware of their hematochezia and may not report any symptoms. In some cases, individuals may experience abdominal pain, vomiting, diarrhea, weakness, difficulty breathing, palpitations, and even syncope (ie, fainting) depending on the cause and severity of the bleeding. Hematochezia that occurs for a long time can lead to excessive blood loss that causes anemia, which can lead to palpitations, shortness of breath, and syncope. Excessive and rapid blood loss can also cause hypovolemia and shock. Also, bleeding associated with an underlying malignancy (ie, colorectal cancer) may present with unexpected weight loss.
Hematochezia can be diagnosed on the patient’s history if the individual is seeking medical attention because of passing blood in the stool or is experiencing associated symptoms, such as shortness of breath or lightheadedness. The doctor can ask questions to confirm the presence of bleeding, estimate the amount and speed of blood loss, identify the source and possible causes, and determine how bad the bleeding is. Diagnosis includes a thorough physical exam followed by a more focused digital exam where a gloved, lubricated finger is inserted into the rectum to feel for anything unusual, such as growths, rectal fissures, or hemorrhoids. The doctor may order laboratory tests, including hemoglobin levels, to check for anemia. You can also perform an upper endoscopy and colonoscopy, which are procedures where the doctor inserts a small tube with a camera through the esophagus and rectum, respectively. The procedures are usually done under anesthesia and allow the doctor to see where the bleeding is coming from. Computed tomography (CT) angiograms can be done to visualize the origin of the bleeding, and if there is active bleeding, a nuclear red blood cell scan can be used to find the source of the gastrointestinal bleeding. A nuclear red blood cell scan uses a small amount of radioactive material to label red blood cells (RBCs), so they can be visualized and tracked throughout the body.
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Hematochezia is treated by restoring the individual’s blood volume to help prevent hypovolemia and shock, which are medical emergencies. The second step in treatment usually involves finding the source of the bleeding. Then, depending on the site and the cause, the doctor can use a combination of pharmacological treatment, endoscopic cauterization (ie, a procedure that uses a hot probe to destroy blood vessels), and surgery. In the case of hemorrhoids, a topical treatment or suppository containing hydrocortisone can help reduce the pain. IBD can be treated with medications that control inflammation, such as aminosalicylates (ie, balsalazide, mesalamine, olsalazine) or antibiotics (ie, azathioprine and mercaptopurine).
Diverticulosis is usually treated with supportive care, such as a high fiber diet, and is likely to resolve on its own. Ischemic colitis can also be self-limiting and can be treated with supportive care, such as rest and intravenous fluids. If severe, antibiotics (eg, metronidazole, ciprofloxacin) can be administered to reduce the risk of infection and necrosis.
AVM and colon cancer may require the use of more invasive methods, such as endoscopic cauterization and surgery, respectively. Necrotizing enterocolitis is usually treated with feeding tube management and surgery, depending on how severe it is. Finally, midgut volvulus can be reduced or reversed with surgery.
Hematochezia refers to the passage of blood in the stool with origins from the lower gastrointestinal tract. It usually occurs due to inflammatory diseases, hemorrhoids, and diverticulosis in adults; coronary artery disease and colon cancer in older adults; and necrotizing enterocolitis and midgut volvulus in infants and children. A common symptom of hematochezia is bright red blood that appears in the sink or on the toilet paper after wiping. Individuals with hematochezia may also feel weak and lightheaded due to loss of blood and have symptoms such as abdominal pain, vomiting, or diarrhea. Diagnosis is made by a qualified physician after a thorough interview and physical examination, sometimes followed by colonoscopy, CT scans, and nuclear red blood cell scans. Treatment depends on the cause but generally includes restoring the amount of blood lost, finding the source of the bleeding, and stopping the bleeding. Medicines and topical creams can be used to treat the underlying causes of hematochezia, and in severe cases, surgery may be required.
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Diverticular disease. At the National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 25, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis#:~:text=Diverticulosis%20is%20a%20condition%20that,pe% 20this%20condition%20diverticular%20disease.
Ishikawa, S., Mukai, S., Hirata, Y., Kohata, A., Kai, A., Namba, Y., Okimoto, S., Fujisaki, S., Fukuda, S., Takahashi, M., Fukuda, T., & Ohdan, H. (2020). Rectal vascular malformation treated by transcatheter embolization. Case Reports in Gastroenterology, 14(1):7-14. DOI: 10.1159/000505090
Liu, J. J., & Saltzman, J. R. (2009). Endoscopic treatment of hemostasis: how should it be done? Canadian Journal of Gastroenterology, 23(7): 484. DOI: 10.1155/2009/857125
Walker, H.K., Hall, W.D., & Hurst, J.W. (Eds.). (1990). Clinical methods: History, physical, and laboratory tests (3rd ed). Butterworths. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK411/If you’ve been bleeding lately, hopefully you’re not ignoring it as no big deal. Seeing bright red blood on the toilet paper or in the toilet bowl is a sure sign that something is not right in your body at that time, especially in your gastrointestinal system. Sometimes it may be that you are struggling with constipation or maybe it is hemorrhoid symptoms, but sometimes the cause of rectal bleeding may be more serious. (1)
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If you see bright blood in your stool, try to remain calm because hope is nothing serious. Rectal bleeding is usually caused by a small tear or straining, but rectal bleeding can also be caused by serious health problems such as cancer.
It is very important to identify the main cause of rectal bleeding. If you know that it is something that is not important, then there are many natural remedies to choose from, but if it is the most important.
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