The Press

What blood in stools might mean

- CATHY STEPHENSON

Bleeding from the anus or rectum (the lower part of the gastro-intestinal tract) is really common, affecting around 10 per cent of adults each year in New Zealand.

However, despite potentiall­y indicating something serious happening in the bowel, this kind of bleeding is often seen as a bit of a ‘‘shameful’’ symptom, something to be hidden and not talked about.

It’s important to know that ALL bleeding from the gut needs to be discussed with a doctor, and the sooner the better if any further testing needs to happen.

Bleeding from the lower gut can signify many things, but the most serious, and the one we all want to rule out, is bowel cancer. Other conditions that cause this symptom can range from mild and annoying ones, to life-long and debilitati­ng, and include: ❚ Haemorrhoi­ds or piles (the equivalent of varicose veins in the rectum). ❚ Anal fissures (splits or tears in the lining of the anus). ❚ Diverticul­ar disease (little pouches in the wall of the gut, especially the colon, that can be prone to bleeding or infection). ❚ Inflammato­ry bowel disease, such as Crohn’s disease or ulcerative colitis. ❚ Polyps – these small growths can occur in the bowel wall, and are usually benign; however, some are ‘‘pre-cancerous’’ and require removal. ❚ Angiodyspl­asia – this condition causes new, enlarged blood vessels to grow in the inner wall of the colon; these vessels are fragile, and can bleed profusely at times. ❚ Peptic ulcers – ulcers in the stomach or duodenum are common, and can cause bleeding higher up in the gut. ❚ Infections – some types of gastroente­ritis (gut infection) can cause diarrhoea that is streaked with blood or mucous. ❚ Other abnormalit­ies of the gut including Meckels diverticul­um, or more widespread issues such as generalise­d bleeding disorders, can also present for the first time with bleeding from the lower gut. It is important to figure out what other symptoms you have so that your doctor can work out what tests may or may not be appropriat­e.

First, the type of bleeding you have can be a big clue as to what is going on: if the bleeding is bright red, and largely separate from the bowel motion, it is likely it is from lower down in the gut (the rectum or anus itself); if the bleeding is mixed through your stool, or is darker in colour (sometimes even black), it is probably from higher up in the gut (the stomach, duodenum or colon).

If the bleeding is associated with a sharp pain, felt low down around the anus itself, it is probably due to something ‘‘local’’ to that area, such as a haemorrhoi­d or fissure, rather than an issue higher up the gut.

As a rule of thumb, small amounts of bright red blood, separate to the stool, and associated with pain, tend to be less worrying – this doesn’t mean that you shouldn’t book an appointmen­t with a doctor as soon as possible, but does mean you probably don’t need to panic.

If your bleeding is associated with whole body symptoms (known as systemic symptoms), such as weight loss, poor appetite, nausea, vomiting, or fevers, then it is likely that whatever the cause of the bleeding is, it is not just localised to the gut – this might include cancer, but also infections or inflammati­on such as Crohn’s disease or ulcerative colitis.

Whatever you think is going on, it is really important to get any bleeding at all checked out – the old saying ‘‘Better safe than sorry’’ really does ring true here. Over the large number of years I have been seeing patients, I have been surprised over and over again by conditions I didn’t predict – a bowel cancer unexpected­ly in a younger patient, and a very mild benign diagnosis of diverticul­ar disease in someone very elderly whom I was sure was dying.

If you book an appointmen­t to see your doctor, the first thing that they should do is get a clear understand­ing of exactly what your bleeding is like: has it happened before, is it a lot of bleeding or a tiny amount, is it associated with pain or any other symptoms, is there a family history of bowel problems?

If they or you are concerned that there has been a big bleed (either you have seen a lot of blood, had black bowel motions, or feel symptomati­c of anaemia with fainting, dizziness or shortness of breath), they may need to send you to hospital for immediate assessment. However it is more likely that tests can be done routinely as an out-patient to try and figure out what is going on.

The most useful tests are a rectal examinatio­n (a finger inserted into the back passage to check for obvious masses caused by haemorrhoi­ds or tumours), stool samples to rule out infection, blood tests to look for anaemia and other things, and a camera inserted into the lower bowel, either via a sigmoidosc­ope or a colonoscop­y. This is a relatively simple procedure and, depending on what method is used, it can also sometimes be used to treat simple things such as polyps at the same time.

For more informatio­n call Healthline on 0800 611 116 or talk to your doctor. ❚ Dr Cathy Stephenson is a GP and forensic medical examiner.

 ??  ?? All bleeding from the gut needs to be discussed with a doctor, and the sooner the better if any further testing needs to happen.
All bleeding from the gut needs to be discussed with a doctor, and the sooner the better if any further testing needs to happen.
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