Anal Bleeding - Causes, Symptoms & Treatment

What is Anal Bleeding?

Anal bleeding refers to the presence of blood in your stools, on toilet paper post-bowel movement, or in the toilet bowl. This condition can scare many of us, as the sight of blood tends to hint at something severe. However, the causes of anal bleeding can range from minor issues such as hemorrhoids or anal fissures to more serious conditions like colorectal cancer.

In India, anal bleeding is not an uncommon issue. Although precise numbers are hard to come by due to variations in reporting and cultural inhibitions around discussing such matters, it is clear that a significant number of people experience this condition at some point in their lives.

Anal bleeding can affect anyone irrespective of age or gender. Recognizing and understanding its potential causes is vital for appropriate treatment and prevention. Remember, while most instances of anal bleeding aren’t serious, it’s always better to consult your doctor for timely diagnosis and treatment.

What Causes Anal Bleeding?

Anal bleeding can be a symptom of various underlying health issues. Here are some common causes:

• Anal fissures: These are small tears in the lining of the anus that can cause sudden, bright red bleeding during or after bowel movements.
• Haemorrhoids: These are swollen veins in the anus or lower rectum that can rupture and bleed, often resulting in bright red blood on the toilet paper or stool.
• Constipation and hard stools: Straining during bowel movements can lead to the formation of anal fissures or exacerbation of haemorrhoids, which subsequently bleed.
• Colorectal polyps: These are growths in the colon or rectum that can bleed, often resulting in red or dark red blood in the stool.
• Inflammatory bowel diseases: Conditions like ulcerative colitis can cause rectal bleeding, often accompanied by diarrhoea and abdominal pain.
• Colorectal cancer: Although a less common cause, tumours in the colon or rectum can bleed, signaling a potentially serious condition.

Less common causes include infections, damage to the upper gastrointestinal tract, and bleeding disorders. The colour of the blood can offer clues about the source of the bleeding. Bright red blood typically suggests a lower gastrointestinal source, while darker red or black, tarry stools might point to an upper GI bleed.

Types of Anal Bleeding

Anal bleeding can occur due to various conditions and can present in different ways. Here are some common types of anal bleeding:

Bright Red Blood on Toilet Paper:

• Often associated with conditions like hemorrhoids or anal fissures.
• Indicates bleeding close to the anus.

Blood in Stool:

• Can be mixed with the stool or visible on the surface.
• Associated with conditions such as hemorrhoids, anal fissures, diverticulosis, or colorectal cancer.

Maroon or Black Stools:

• Indicates bleeding higher up in the gastrointestinal tract.
• Associated with conditions such as peptic ulcers, gastric varices, or upper GI bleeding.

Rectal Bleeding:

• Blood that appears in the toilet bowl, on stool, or on toilet paper.
• Commonly associated with hemorrhoids, anal fissures, diverticulitis, inflammatory bowel disease (IBD), or colorectal cancer.

Diagnosis and Evaluation of Anal Bleeding

To identify the exact cause of anal bleeding, doctors may use a variety of evaluation techniques. Initially, they may ask about the bleeding, including its frequency, colour and any associated symptoms. This information can help them determine the most likely cause and appropriate next steps.

In addition to gathering information about your symptoms, doctors may perform a physical examination. This could include an inspection of the anus and rectum to look for obvious signs of disease, such as hemorrhoids or anal fissures.

If needed, your doctor might order further tests. These could include an anoscopy (inspection of the inside of the anus), sigmoidoscopy or colonoscopy (examination of the lower part or entire length of the colon respectively). These tests can provide a more detailed view of your lower gastrointestinal tract and help identify the source of bleeding.

How Anal Bleeding Can be Treated?

Anal bleeding treatment depends largely on its cause. For conditions like haemorrhoids or anal fissures, simple lifestyle changes such as increasing fibre intake and drinking more fluids can help. Topical ointments might also be beneficial in relieving symptoms. In some cases, minor procedures might be required to treat these conditions.

For more serious conditions like inflammatory bowel disease or colorectal cancer, advanced medical or surgical treatments may be required. These could range from medication to control inflammation in case of inflammatory bowel diseases, to surgery if there’s a tumour present in the colon or rectum.

Always remember, it’s crucial to seek medical attention for any rectal bleeding. It might be a symptom of a more serious condition. Prompt diagnosis and treatment are key to managing these conditions effectively and ensuring your long-term health.

When Is Anal Bleeding Considered Serious?

Anal bleeding is not a condition to be brushed aside lightly. It could potentially be a sign of a severe ailment, especially when partnered with other worrying symptoms such as:

• Continuous bleeding that doesn’t cease
• Severe pain or cramping in the abdomen
• Dizziness, confusion, or fainting spells
• Bloody diarrhoea
• Stools that exhibit a black, tarry, or maroon hue

Bright red blood, whilst not necessarily indicating an emergency, still calls for a medical examination, particularly if the symptom persists for more than just a couple of days. It is crucial to treat sudden, severe bleeding or bleeding accompanied by further distressing symptoms as an urgent medical issue.

Prevention of Anal Bleeding

While it’s impossible to entirely prevent anal bleeding because it can be caused by various factors, there are ways to reduce the risk. Maintaining a high-fiber diet can help avoid constipation and lessen the strain during bowel movements. Regular exercise and drinking plenty of water can also contribute to regular bowel function. If you’re experiencing anal bleeding, it’s essential to consult with your family doctor who may then recommend you to see a gastroenterologist – a doctor who specializes in digestive disorders – for further evaluation and treatment.

Myths & Facts About Anal Bleeding

There are several misconceptions and facts about anal bleeding that you should be aware of:

• Myth: Anal bleeding is always caused by piles (hemorrhoids).

Fact: While piles are indeed a frequent cause, anal bleeding can also come from anal tears (fissures), polyps, inflammatory bowel diseases, and colorectal cancer.

• Myth: Anal bleeding is normal and not a cause for worry.

Fact: Any amount of rectal bleeding is abnormal and demands immediate evaluation by a doctor.

• Myth: Bright red blood indicates a more serious condition than darker blood.

Fact: The hue of the blood merely offers clues about its source. Bright red blood tends to come from a lower source, while darker blood usually indicates a higher origin in the digestive tract.

When to Consult a Doctor for Anal Bleeding?

Never hesitate to consult your doctor if you notice any amount of anal bleeding. Regardless of whether it’s accompanied by other symptoms or not, it’s better to seek expert advice promptly to exclude any severe conditions. Your family physician should be your first point of contact, who can then guide you towards the right specialist, potentially a gastroenterologist.

Questions to Ask Your Doctor About Anal Bleeding

In this situation, consider asking your doctor:

1. What could be causing my anal bleeding?
2. Is my anal bleeding serious?
3. How much bleeding is considered as normal?
4. What should I do if I experience anal bleeding?
5. How will you diagnose the cause of my anal bleeding?
6. What treatment options are available for rectal bleeding?
7. Can I prevent future episodes of anal bleeding? If so, how?
8. Is rectal bleeding a potential sign of cancer?
9. Could my bleeding be caused by haemorrhoids?
10. When should I seek further help if the issue persists?