What is Hematochezia?
Hematochezia is the presence of blood in the stools usually from the lower gastrointestinal tract, colon or rectum or the haemorrhoids. Blood in the stools represents that there is bleeding in the digestive tract.
The severity of bleeding may vary, mild bleeding can be treated by the physician at the clinic, but severe bleeding or blood loss may require hospitalisation for diagnosis and treatment. Patients with severe bleeding may feel week ness, fatigue or low blood pressure due to substantial blood loss from the body.
In some cases, the blood appearing in the stools is black and sticky in colour as well. This type of bleeding occurs from the upper gastrointestinal tract which keeps the blood in the body for a long time as a result bacteria present breaks it down into chemicals.
This condition is called as Melena. Usually, any bleeding happening in the colon or the lower portion of the gastrointestinal tract does not break into smaller chemicals; hence there is not much smell.
In some cases, bleeding happening at the site is very slow that is difficult for the naked eye to observe or notice any reddish colouration in the stool. This is referred as occult bleeding. This is usually diagnosed only in labs when a person undergoes a stool test. The causes for this are similar as Hematochezia. This condition also causes anaemia as in hematochezia.
Hematochezia causes: The various causes of Hematochezia include:
- Anal fissures: It is a small cut in the inner anal lining, this happens when a person is passing a hard stool
- Diverticulosis: it is the formation of pockets or bulging through the weaker areas. It usually occurs in the lower part of the intestine mostly colon
- Colon Cancer: Tumor formation in the colon which could be metastatic or not
- Angiodysplasias: It is the formation of vascular lesions in the gastrointestinal tract which leads to bleeding
- Colitis: Inflammation of the colon
- Ulcerative/Ischemic colitis: These are chronic diseases of the colon and are caused by the body’s immune system. Ischemic colitis, on the other side, is the formation of a clot in one of the artery, supplying blood to the colon.
- Proctitis: Inflammation of the rectal lining
- Meckel’s diverticula: It is the small bulge in the small intestine present at the time of birth
- Peptic ulcers: Ulcers in the stomach, duodenum or small intestine may be caused due to some bacterial infection which may result in hematochezia.
- Oesophagal blood loss: Cut in the varicose vein or cut into the oesophagus can cause blood drainage
Hematochezia symptoms: Signs and symptoms of Hematochezia include:
The typical symptom is blood in the stool, the colour of the blood may vary depending on the disease it is associated. The colour of blood in stool may range from bright red to black.
Other general symptoms include abdominal pain, dizziness, weakness, fatigue etc.
Symptoms may also vary by conditions:
Inflammatory Bowel Disease (IBD): This is also accompanied by other symptoms like diarrhoea, constipation, pain in the abdomen, bloating etc.
Haemorrhoids: It includes pain, irritation, and itching in the anal region. It could also be associated with inflammation in the anal area.
Colon Cancer: Sudden loss of weight, change in the routine of bowel movement, rectal pain, incomplete bowel evacuation, thin stools etc.
Diagnosis of Hematochezia:
It is essential to identify the cause of hematochezia. Therefore a doctor will perform various test to determine the actual cause of the bleeding. Some of the tests include:
Patient history: Doctor will check for the patient medical history to see if there is any other related issue with the patient that could have resulted in hematochezia.
Physical exam: The Doctor will also do a physical test and check if there is an injury or a tumour near the anal cavity
Blood test: It is done to check if there is an infection in the blood, anaemia or problem with blood clotting
Nasogastric Lavage: It is the process that helps the doctor to investigate if the hematochezia is due to the bleeding from the upper digestive tract.
Esophagogastroduodenoscopy: This is used to check for bleeding or ulcers in the oesophagus of the person. It is performed using a device called endoscope which is inserted through the mouth of the person.
Colonoscopy and Barium X-Ray: Colonoscopy is done using a colonoscopy which is a long flexible tube of the thickness of a finger. It also has a camera and source of light to get the visualisation of inside. It is used to see if there is any bleeding or ulcers in the later part of the intestine majorly Colon.
Radionuclide scanning: This includes the use of a radioactive substance which is inserted in the veins along with a camera which helps to diagnose the area where leakage is situated.
Enteroscopy: This is a procedure similar to colonoscopy and is used to diagnose bleeding or ulcers in the small intestine.
MRI and CT angiography: These are the latest techniques and the use is still under investigation. In this, the MRI and CT scan are done along with visceral angiography.
Laparotomy: If the entire above test does not provide conclusive evidence, then Laparotomy is done, which involves doing a large incision in the abdominal cavity of the person.
Treatment of Hematochezia:
Hematochezia Treatment should be done depending on the results of diagnosis.
A person suffering from hematochezia should visit a gastroenterologist, colorectal or general surgeon. Treatment would vary depending on the diagnosis.
Blood volume: Patient who had a severe loss of blood from the body should be given blood transfusion first to restore the anaemic conditions. One can also be prescribed with iron tablets to restore the blood level in the body
Haemorrhoids: In case the reason for blood in the stool is this, the following measure should be taken:
Home remedies which include:
Inclusion of fibre in the diet which helps in preventing constipation, and the addition of vitamin B5 which helps in better digestion of the food
Aloe vera is another vital ingredient, the inclusion of which helps to keep the digestive system hydrated and prevents any tears in the digestive tract. It also assists to diminish inflammation of the gastrointestinal tract
Flax seeds are made of high amount of fibre and help in preventing constipation and keep the stools soft
Hot Sitz bath can also be done by the person which helps in providing relief and also reducing inflammation
The physician may also recommend some cream, ointment or suppository which can reduce the discomfort to the person.
Diverticulitis: In case the patient is diagnosed with diverticulitis, then he should start with the medications which include hyoscyamine, dicyclomine along with antibiotic treatment. But in case the drugs don’t cure; then surgery is required which includes removing out the affected part.
Colorectal cancer: In case, the person is diagnosed with colorectal cancer. The treatment would start depending on the stage of cancer. If the diagnosis of the cancer is made at an early stage, then the treatment is more straightforward using medications.
But in case the diagnosis is made at a later stage, the treatment involves surgery which involves the removal of the affected part.
However, in both the cases, chemotherapy needs to be done to remove any chances of metastasis or relapse of cancer. Apart from the medicinal part, the patient also needs to make changes in his dietary habits which includes:
- Avoid smoking and alcohol: The person should avoid intake of alcohol and tobacco as these aggravate the situation
- Avoid high-calorie foods
- Include fibrous foods in the daily diet.
H Pylori and colitis: To treat these, one can start treatment using antibiotics and anti-inflammatory drugs to reduce inflammation of the colon.
The doctor may also use many methods to stop the leakage or flow of blood at the leakage site. These include:
- Endoscopic thermal probe: This technique is primarily used in case of bleeding from the upper gastrointestinal tract, i.e. bleeding associated with gastric or duodenal ulcers. It involves coagulation of the blood vessels using a thermal contact
- Endoscopic clips: These include flexible endoscopes to treat the bleeding due to peptic ulcers
- Endoscopic injection: This consists in inserting of a liquid near the source of bleeding to stop the bleeding.
- Angiographic embolisation: It is a selective stopping the large flow of blood by inserting emboli in the blood.
- Endoscopic intravariceal cyanoacrylate injection: This involves giving an injection near the affected site. In this case, glue is inserted which helps to stop massive bleeding in the stomach
- Band ligation: This procedure involves using of mall rubber bands around haemorrhoids or veins to top the supply of blood. Slowly these veins dry and fall.
Time of recovery and treatment usually depends on the cause of the bleeding. In the majority of the cases, the reason behind haemorrhoids or fissures which are comparatively easy to treat.
However, whenever there is bleeding or hematochezia, it should not be ignored and should be discussed with the doctor at the earliest. Early diagnosis of the disease can help in a faster cure and rapid recovery of the person.