Punjab: General Physician Dr SPS Grover highlights the causes of rectal bleeding and the importance of early diagnosis and treatment. Dr SPS Grover, General Physician, New Ruby Multi-Speciality Hospital, Jalandhar, shared information on the management of rectal bleeding in diabetic patients. What happens in case of rectal bleeding? Rectal bleeding, also known as hematochezia, refers to the passing of blood from the rectum. It can range from a small streak of blood in the stool or on the toilet paper to a large amount of blood. Rectal bleeding can be accompanied by abdominal pain and this condition can affect any patient, whether or not they have been diagnosed with diabetes before the bleeding event. How likely is a diabetic patient to develop rectal bleeding? Diabetic patients may experience abdominal pain and rectal bleeding due to problems in the lower gastrointestinal tract. While rectal bleeding can occur in any patient, the incidence is approximately 33-87 per 100,000 patients, whether or not they have diabetes.
How does a doctor diagnose this condition?
Diagnosis involves taking a detailed clinical history, performing a physical examination, and performing hematological and biochemical investigations. Endoscopy and radiographic imaging are also important. Rectal bleeding can occur anywhere in the intestine, from the ligament of Treitz to the anus.
What are the causes of rectal bleeding?
Rectal bleeding can be caused by many conditions, including anal fissures, scarring carcinoma of the colon and rectum, inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis, bacillary dysentery, and conditions such as intussusception or mesenteric infarction in the small intestine.
What is the usual age group for this condition?
Rectal bleeding is common in individuals under the age of 40, especially children. Constipation is a common trigger. However, mesenteric infarction usually affects the elderly, especially those with a history of metabolic syndrome, diabetes, or heart disease.
Why does rectal bleeding cause shock for the patient?
Patients often experience severe shock due to the pain associated with bowel movements, which can last from minutes to hours. This pain may make the patient afraid to use the bathroom. Blood may appear on the toilet paper or as streaks on the stool. In severe cases, patients may lift their legs, scream out in pain, or even collapse due to the severity of the bleeding.
What treatments are available for rectal bleeding?
In patients with diabetes, it is important to treat rectal bleeding and abdominal pain promptly, as their slow healing and low immunity can complicate recovery. Conditions such as ulcerative colitis and Crohn’s disease require long-term treatment with medication. About 90% of patients recover with medical treatment, while about 10% may require surgery, such as colectomy for ulcerative colitis or fistulectomy for Crohn’s disease. Polyps in the large intestine can often be removed endoscopically. Ischemic colitis requires immediate medical intervention and cancer of the large intestine may require surgical resection, sometimes followed by radiation therapy. Diverticular disease usually responds to medical management, but sometimes surgery may be required. Advanced diagnostic tools such as double balloon enteroscopy, spiral enteroscopy, capsule endoscopy, CT angiography, and catheter angiography can help detect lesions. Biopsy samples may be needed for further analysis. In cases of significant blood loss, especially in patients with anemia, immediate care is important.
How can rectal bleeding be stopped?
Stopping rectal bleeding depends on its underlying cause. For example, bleeding related to hemorrhoids can be reduced by avoiding constipation, reducing spicy foods, and cutting down on junk food. A high-fiber diet is beneficial to prevent stomach problems. In diabetic patients, a complete medical history, physical examination, and relevant tests are necessary to confirm the diagnosis and provide appropriate treatment to improve the patient’s chances of recovery and save their life.
