Rectal Bleeding: What a Doctor Wants You to Know

The first thing most people worry about when they have minor rectal bleeding is that they have a cancer. Of course, colon cancer is what I worry most about, too. But it’s the cause of rectal bleeding only 1 to 2 percent of the time.

Two problems are usually responsible for blood on the paper, on the stool or in the toilet: hemorrhoids and anal fissures. The good news is that both problems are usually easy to fix.

Age and family history matter

If you’re older than 30 or have a family history of colon cancer, the first step is a colonoscopy. Colonoscopy is easy, usually painless, and rules out cancer so you don’t have to worry. If we find a polyp that is causing the bleeding, we can remove it before a cancer ever develops.

If you’re under 30, have no family history of colon cancer, and the source of pain and bleeding is obvious, then I usually won’t suggest colonoscopy right away because:

• When a hard stool causes pain and bleeding, it’s usually an anal fissure, or tear in the tissue. Chronic constipation, prolonged diarrhea, straining and anal intercourse can all cause anal fissures.

• When rectal bleeding is painless and develops after heavy lifting, a long car trip, pregnancy or constipation, it usually means internal hemorrhoids. Anything that places continual pressure on veins in the anus can engorge them. Over time, they can get bigger and bigger. Then when you get a hard stool, it scrapes them and they bleed.

A note about hemorrhoids: They’re our friends, but they get a bad rap. These are natural veins that enlarge, becoming cushions of soft tissue that line our butt muscles (the sphincters). This creates a stronger seal so gas won’t escape when we walk. Hemorrhoids also help continence up to 30 percent.

Two problems, one solution

Using stool softeners and drinking lots of water will clear up most anal fissures and hemorrhoids. Stool softener bulks up, or softens, the stool, and drinking water moves the stool through faster. Then you just sit on the toilet and go — there’s no strain. When stool comes out easily, bleeding is less likely.

If bleeding continues despite using fiber and water — or if you can’t think of any cause for the bleeding — then you need to see a doctor. An evaluation and colonoscopy exam will rule out polyps, cancer, inflammatory bowel disease (IBD) or other problems that require treatment.

Surgical options

Colorectal surgeons have different surgical options to treat hemorrhoids:

• One is to choke the veins with rubber bands, called hemorrhoid banding. We do this in the office, without anesthesia.
• We can also use staples or sutures to tie off the veins in an outpatient procedure.

These procedures are pretty painless and work well for internal hemorrhoids.

Over-the-counter remedies

If you have hemorrhoids inside, you often have them outside too. Internal hemorrhoids bleed and are painless. External hemorrhoids swell, hurt and can itch.

Over-the-counter preparations stop hemorrhoid pain and ease swelling. Some people use them for internal hemorrhoids, but they rarely stop bleeding. While these products are very safe, try not to use them long-term because they contain witch hazel and can cause itching.

A change of habits will do you good

Once you feel better, remember that it’s important to change your bowel habits. Hemorrhoids and fissures will return even if you’ve had surgery unless you fix the habits — like constipation and straining — that caused them.

Source: Cleveland Clinic