Most people don't like the sight of blood – particularly their own blood, and even less so if it's coming from the rear end. Dr Joe Kosterich talks about bleeding from the anus, including what it means and what causes it, when it becomes a problem that needs a doctor's help, and simple ways to treat it.
First and foremost, this is a fairly common phenomenon. Through the course of one's life, it is fairly likely that at some point in time when you sit on the toilet, there will be some blood that comes away. Obviously, in a once-off situation for the vast majority of people, it's not going to be a problem. So what do we need to do about bleeding from the anus, and how can we start to sort out when it is versus it isn't a problem?
When we're talking about bleeding, it surprisingly can mean a few different things: how much or little blood there is, is it separate to the bowel motion or is it mixed in with the bowel motion, is the colour bright red or is it a darker colour? All of these things have some significance. Presence of other symptoms are important as well: if when wiping yourself you notice a lump or swelling, or if there is pain down around the anus. These things are significant and pointers.
So, what are the more common causes of bleeding from the anus? The two most common are haemorrhoids and anal fissures. A haemorrhoid is like a varicose vein, but happens to be at the anus rather than in the legs. The blood vessel swells a little bit and then some of that blood gets trapped in the vessel. This will typically present as something that's sore and painful, with a bit of a swelling or a lump. That's if it's an external haemorrhoid (i.e. outside of the anus). People can also get internal haemorrhoids, where you may not feel the lump but you will get the bleeding. Typically it's painful when you're passing the bowel motions.
Fissures are tears in the lining, and you can sort of think of it as the equivalent of a mouth ulcer but at the far end. These also tend to be quite painful, particularly when you are sitting on the toilet, and will also be associated with blood. This blood will typically be bright red, a bit like you've cut yourself. Sometimes people just notice it on the paper and nowhere else. If this happens in a once-off situation and never again, it's not particularly a cause for alarm.
There are, however, other causes of bleeding from the anus which can be more serious. The one that people worry about, and rightly so, is bowel cancer. Most of the time, bleeding, if it is from bowel cancer, will tend to be more than a once-off, and there generally won't be any soreness or any pain around the anus. Blood may be a little bit more mixed in with the stools. Unfortunately, these things are not absolute, so certainly if bleeding is going on for more than a few days, it is worth going along and seeing your doctor. That doesn't mean that there is a major problem, but it does mean that you should get it checked.
What are simple measures we can do if we do have some bleeding? The most important thing is to think why this might have occurred. Certainly in Western countries, the most common reason for bleeding from the bowel (which is related to haemorrhoids) is if we're having to push or strain with bowel motions. So making sure you're drinking enough water and having plenty of fibre in your diet is important. Now, people will sometimes say, "Well, I'm getting enough fibre."
How much or how little fibre you need is not a function of what you think is the right amount – it's a function of what's going on at the far end. If you're eating every day, then in the normal course of events, you should be going to the toilet once a day and there shouldn't be any effort involved. If on a regular basis you're really having to push or strain to move things along, then the gut is having to work harder than it would like to. That is a signal that the body does require more fibre and probably more water.
Things like haemorrhoids and fissures can be treated fairly easily. There are some over-the-counter preparations. If it's not settling, then certainly see your doctor. There are some items on prescription.
If bleeding is continuing or if it is a darker colour, or is associated with pain in the abdomen or other symptoms of concern such as nausea, then you certainly need to go and see your doctor, and this may well need to be investigated.
The sort of test that is most likely to be done is a colonoscope, where a flexible tube is inserted into the anus (which you will be pleased to know is done under sedation), and a gastroenterologist can have a look through the bowel (sort of like a telescope) and see what's there. Again, in most instances, there may be nothing serious and that's a good result. Equally, if there is some early cancer or something else that needs treatment, then it is better to find out about it sooner.
To summarise, bleeding from the anus is going to be fairly common. It is potentially a sign of something serious, but in most instances it won't be. Does that mean you should ignore it? No, it doesn't. Can you do simple things first? Absolutely. If those simple things are not bringing about improvement and resolution, then that's the time to go and see your doctor, and in some instances further investigations may need to be done. The key message is: if you can keep your bowels regular and make sure your getting enough water and plenty of fibre in your diet, your chances of having bleeding is going to go down significantly.
For more information, see Rectal Bleeding.
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