Hematochezia - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Loss of blood is termed bleeding. It can be external or outside the body when there is a wound or cut. Bleeding can be internal (inside the body) due to an internal organ injury. Some types of bleeding, like gastrointestinal bleeding, unusual vaginal bleeding, and bleeding while coughing, can be a symptom of an underlying diseased condition. Bleeding can lead to other problems. A bruise is bleeding under the skin, and conditions like stroke are caused by bleeding in the brain. Severe bleeding requires immediate medical attention and a visit to the emergency room and care.

What Is Hematochezia?

Hematochezia is a bright red-colored bleeding from the colon, fairly close to the anus. Blood travels a short distance, so it is fresh when it leaves the anus. This blood might be noticed in stool and can also come separately. Hematochezia tends to cause minor bleeding than melena does.

What Are the Symptoms of Hematochezia?

Symptoms that accompany hematochezia are:

• Change in bowel habits.

• Abdominal pain.

• Fever.

• Diarrhea.

• Weight loss.

• Nausea and vomiting.

What Are the Causes of Hematochezia?

Hematochezia leads to bloody stools, and they are caused by different potential causes. They originate in the gastrointestinal tract, usually in the colon. The obvious causes are:

• Diverticulitis - Small bulging pouches in the digestive tract, and these pouches become inflamed and irritated in diverticulitis.

• Anal Fissures - Commonly caused by damage in the lining of the anus and anal canal or the last part of the large intestine.

• Internal Hemorrhoids - Hemorrhoids lie in the rectum and cause discomfort.

• Colon Cancer - Small, non-cancerous clumps of cells called polyps form inside the colon. Over time these polyps turn cancerous.

• Neoplastic Polyps - Neoplastic polyps include adenomas and serrated types, and these polyps can turn cancerous.

• Inflammatory Bowel Disease - It is a condition that involves long-standing inflammation of tissues of the digestive tract, and this includes ulcerative colitis and Crohn’s disease.

• Benign Tumors - Benign tumors tend to grow slowly in distinct borders, and these tumors are not problematic.

• Ischemic Colitis - This condition occurs when the blood flow of the large intestine is temporarily reduced.

How Is Hematochezia Diagnosed?

It is important not to neglect the symptom and to have a proper evaluation of blood in the stool. A detailed history and examination can help in locating the site of bleeding. Tests for anemia, clotting disorder, and the presence of H.pylori infection are done. Some tests are done to determine the cause of bleeding. They are:

• EGD (Esophagogastroduodenoscopy): This is a procedure that includes inserting an endoscope, a long flexible tube with a tiny camera head, through the mouth. This scope travels from the mouth, esophagus, stomach, and duodenum. This helps in identifying the source of bleeding. This procedure also helps take a biopsy, which removes tissue samples for examination under a microscope.

• Nasogastric Lavage: This procedure involves removing the stomach contents from the stomach through the nose. If the stomach does not contain evidence of blood, bleeding may stop more likely in the lower digestive tract.

• Barium X-Ray: A procedure that uses a contrast material, barium, that helps illuminate the digestive tract in the X-ray. This barium solution can be inserted or swallowed into the rectum.

• Colonoscopy: A colonoscope is inserted through the rectum into the colon and helps in identifying the abnormalities of the colon.

• Enteroscopy: A procedure that is similar to colonoscopy and EGD. This helps in the examination of the small intestine, and this technique involves swallowing a capsule with a tiny camera that captures and transmits images.

• Radionuclide Scanning: This procedure involves injecting small amounts of radioactive material into veins and using a special camera to capture images of blood flow and detect the bleeding site.

• Angiography: This procedure involves injecting a special dye into the vein, which makes blood vessels visible in the computerized tomography scan or an X-ray. This test detects bleeding leaks and identifies the site of bleeding.

• Laparotomy: This surgical procedure is done when all other tests fail and find the cause of bleeding.

What Is the Treatment Provided for Hematochezia?

The treatment of hematochezia depends on the cause and site of bleeding:

• Endoscopic Clips: Closing of bleeding blood vessels or other sources of tissue bleeding in the gastrointestinal tract.

• Endoscopic Thermal Probe: This procedure involves burning the blood vessel or tissue that causes an ulcer.

• Endoscopic Intravariceal Cyanoacrylate Injection: An injection is given near the affected area containing special glue that stops bleeding in enlarged stomach veins.

• Band Ligation: The procedure involves placing small bands around hemorrhoids and swollen veins to cut off the blood supply, which may dry up and fall off.

• Angiographic Embolization: The technique involves injecting particles into the affected blood vessels.

• Endoscopic Injections: The health care provider may inject a liquid near the site of bleeding, which will stop the flow of blood.

What Is the Differential Diagnosis of Hematochezia?

Differential diagnoses of hematochezia are:

• Hemorrhoids (swollen veins in the anus, and lower rectum that is similar to varicose veins).

• Malignancies.

• Angiodysplasia (an abnormal tortuous, dilated small vessel in the submucosal and mucosal layers of the gastrointestinal tract).

• Crohn’s disease.

• Diverticular disease.

• Radiation proctitis (this condition occurs as a result of radiation therapy for malignancies to the organ in the pelvic region that includes the rectum, prostrate, and other reproductive organs).

• Ischaemic or infectious colitis.

• Helicobacter pylori infection.

• Anal fissures.

• Colorectal cancer.

• Ulcers.

Conclusion

Hematochezia causes bright red blood in stool, and this can result due to many underlying causes. Individuals who bleed need attention and long-term management of the medical emergencies of hemorrhage. Optimal care is required for long-term treatment that maximizes wellness and minimizes the morbidity of the underlying condition. Surgery is indicated if the bleeding does not stop. In the majority of individuals, bleeding stops by initial management. Conditions like acid peptic disease should be treated aggressively to prevent reoccurrence. Shunt procedures are rarely recommended. Precipitating causes like analgesic use are avoided. Early therapeutic intervention is possible during reoccurrence. Therefore individuals should be educated about hematochezia. Regardless of any symptoms and signs experienced, it is better to consult the healthcare provider to evaluate the underlying condition.