Rectal bleeding is one of the more common symptoms that a colorectal surgeon sees in the office. There are many different causes of blood in the stool; some, like hemorrhoids, are benign and are easily treated. Others, like colon and rectal cancer, are more worrisome and require different treatments. Most people become alarmed when they see blood in their stool and it is a worthwhile topic to discuss.
The most common reason for rectal bleeding is hemorrhoids. You may be thinking I don’t have hemorrhoids. So remember, internal hemorrhoids can cause rectal bleeding without pain. In addition, you should be reassured that the most common cause of rectal bleeding is benign and surgery isn’t typically required (I talk about office treatment of hemorrhoids in a previous post here).
In case you didn’t read the post about treating hemorrhoids, I’ll say it again: Treatment always begins with fiber. Most of us don’t get enough fiber in our diet. I typically recommend a fiber supplement with psyllium fiber (Metamucil™ or Konsyl™ or psyllium husk).
However, in my specialty, we believe that anyone who has bleeding should have it investigated. While most bleeding is caused by benign causes such as hemorrhoids or anal fissures, there are other reasons for bleeding such as colon and rectal cancer, Crohn’s diseas and ulcerative colitis. I, unfortunately, have plenty of stories of patients who thought that their bleeding was due to hemorrhoids only to later find out that cancer was causing the bleeding. Obviously, the treatment options are different!
There are several options available to investigate the causes of rectal bleeding. They range from anoscopy (which only looks at the anus and the hemorrhoids), to sigmoidoscopy (which evaluates the rectum and the lower portion of the colon), and colonoscopy (which evaluates the entire colon, a structure that is about 6 feet long in case you’re wondering). Which procedure you should have depends on several factors, such as the amount of bleeding, the frequency of bleeding, how long you have been bleeding, if there is cancer in your family, and your age.