Hematochezia refers to the presence of blood in the stool, which may indicate an underlying issue, though it does not always occur. It often suggests bleeding somewhere in the gastrointestinal (GI) tract. Blood may appear in significant amounts on toilet paper or in the toilet bowl after defecation, or it may be in such small amounts that it is only detectable through specific tests.
Symptoms of Hematochezia
Some individuals may not notice bleeding, even if blood is present in the stool, and may not experience other symptoms. However, others may present specific symptoms depending on the bleeding site, cause, duration, and severity. These symptoms include:
Abdominal pain.
Vomiting.
Weakness.
Difficulty breathing.
Diarrhea.
Heart palpitations.
Fainting.
Unexplained weight loss.
Causes and Risk Factors of Hematochezia
The following are common causes of hematochezia:
Diverticular Disease
Diverticula are small pouches that protrude from the walls of the colon. Although usually harmless, they may become infected or bleed.
Anal Fissures
Tears in the anal lining, often caused by passing large or hard stools, may result in painful bleeding.
Anal Fistula
An anal fistula forms between the end of the intestine and the skin near the anus. It can become infected and lead to bleeding.
Colitis
Inflammation of the colon, caused by infections or inflammatory bowel disease, is a common cause of hematochezia.
Angiodysplasia
Fragile and abnormal blood vessels in the GI tract can result in bleeding.
Peptic Ulcers
Ulcers affecting the stomach lining, duodenum, or upper small intestine may bleed. These ulcers are often caused by Helicobacter pylori bacteria or overuse of certain medications such as aspirin, ibuprofen, or naproxen.
Polyps or Cancer
Certain polyps can grow, bleed, and potentially become cancerous. Colon and rectal cancers are notable causes of hematochezia.
Esophageal Issues
Esophageal varices or tears may lead to significant blood loss.
Medications
Blood-thinning medications can increase the risk of GI bleeding.
Food Allergies
Allergies to proteins in milk or other foods may inflame the stomach and intestines, leading to blood in the stool.
Structural GI Abnormalities
Conditions like intestinal malrotation increase the risk of hematochezia, particularly in children.
Necrotizing Enterocolitis
This condition causes inflammation and tissue death in the colon, leading to bleeding and other symptoms.
Complications of Hematochezia
If untreated, hematochezia can lead to severe complications, including:
Anemia.
Severe blood loss.
Shock.
Diagnosis of Hematochezia
Diagnosis involves the following:
Physical Examination
The physician evaluates symptoms, such as stool color and the location of bleeding.
Black, tarry stools suggest upper GI tract issues like ulcers.
Bright red or maroon stools indicate lower GI tract bleeding.
Gastric Lavage
This involves removing stomach contents through a tube inserted via the nose to determine whether bleeding originates in the upper or lower GI tract.
Esophagogastroduodenoscopy (EGD)
An endoscope is inserted through the mouth to examine the esophagus, stomach, and duodenum. A camera on the endoscope detects bleeding, and tissue samples may be taken for microscopic examination.
Colonoscopy
An endoscope is inserted through the rectum to inspect the colon for bleeding, and tissue samples may be taken for analysis.
Enteroscopy
Similar to EGD and colonoscopy, this procedure examines the small intestine. Patients may swallow a capsule with a camera that transmits images as it passes through the GI tract.
X-ray Imaging
Barium is administered orally or rectally to enhance the visibility of the GI tract on X-rays.
Radionuclide Scanning
Small amounts of radioactive material are injected into a vein, and specialized cameras track blood flow to locate bleeding sites.
Angiography
A special dye is injected into blood vessels to highlight bleeding sites on X-rays or CT scans.
Abdominal Surgery
If other diagnostic methods fail, exploratory surgery may be required to locate the bleeding source.
Other Tests
Physicians may order tests to check for clotting disorders, anemia, or infections such as Helicobacter pylori.
Treatment of Hematochezia
Treatment depends on the underlying cause and may include:
1. Medications
Antibiotics for Helicobacter pylori.
Antacids to reduce stomach acid.
Anti-inflammatory drugs for colitis.
2. Therapeutic Procedures
Some diagnostic procedures may also be used to treat bleeding:
Injecting chemicals at the bleeding site.
Using lasers or electric currents to stop bleeding.
Applying clips or bands to close bleeding vessels.
If these methods fail, angiographic procedures may deliver medications directly to the bleeding site to stop blood flow.
3. Surgery
Surgical intervention may be required for conditions like cancer, diverticulitis, or inflammatory bowel disease to remove damaged sections of the colon or tumors.
Prevention of Hematochezia
Preventive measures include:
Eating a high-fiber diet to reduce constipation and prevent hemorrhoids or anal fissures.
Soaking in warm baths to alleviate pain from anal fissures or hemorrhoids.
Engaging in physical activities like walking.
Avoiding prolonged sitting on the toilet.