Rectal Bleeding
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Diagnosis
The Medical History – What is the patient’s age? Older
people tend to have polyps and cancer more often. Is there anal pain and
a hard, large stool associated with bleeding? A tear of the anus
(fissure) may be the answer. Does blood drip into the toilet after a
bowel movement? Bleeding hemorrhoids may be the problem. The color and
frequency of the bleeding are additional considerations. In most cases,
the medical history provides clues, but never the final answer.
- The Visual and Digital Exam – The physician will inspect the anal area looking for tears and hemorrhoids. A finger or digital exam can provide additional information. In men, the prostate is also examined.
- Endoscopy – There are several types of examinations of the inside of the colon using a lighted flexible tube called an endoscope. In the office, the physician may perform a sigmoidoscopy which takes 5-10 minutes and examines only the last 1 to 2 feet of the colon. However, the bleeding lesion may be located beyond the reach of the sigmoidoscope. So, colonoscopy may be the best initial exam. Colonoscopy is an examination of the entire 5 to 6 feet of the colon. It is usually performed under sedation.
- Barium Enema X-ray – This is a complementary exam that uses liquid barium inserted by enema into the rectum. X-rays highlight abnormal shadows, such as tumors, diverticuli and colitis. By itself, however, it does not identify an actual bleeding point.
