Rectal bleeding

Patients present with any degree of bleeding from a smear on the toilet tissue to severe haemorrhage. Various causes are presented in Figure 32.4 .

iscihaeinic lc ¡lis iscihaeinic lc ¡lis carononna anal Assure

OOlltlS

solitary ulcer cH rectum haemorrhoids

Fig. 32.4 Various causes of rectal bleeding carononna anal Assure

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solitary ulcer cH rectum haemorrhoids

Fig. 32.4 Various causes of rectal bleeding

Local causes of bleeding include excoriated skin, anal fissure, a burst perianal haematoma and anal carcinoma. A characteristic pattern of bright bleeding is found with haemorrhoids. It is usually small non-prolapsing haemorrhoids that bleed.

The nature of the blood (e.g. bright red, dark red or black) and the nature of the bleeding (e.g. smear, streaked on stool, mixed with stool, massive) gives an indication of the source of the bleeding Table 32.2 . Black tarry (melaena) stool indicates bleeding from the upper gastrointestinal tract and is rare distal to the lower ileum. Patients with melaena should be admitted to hospital.

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