Causes of Rectal bleeding
Rectal bleeding Causes: Book Excerpts
Rectal bleeding as a complication of other conditions:
Other conditions that might have
Rectal bleeding as a complication may,
potentially, be an underlying cause of Rectal bleeding.
Our database lists the following as having
Rectal bleeding as a complication of that condition:
Rectal bleeding as a symptom:
Conditions listing Rectal bleeding
as a symptom may also be potential underlying causes of Rectal bleeding.
Our database lists the following as having
Rectal bleeding as a symptom of that condition:
Medications or substances causing Rectal bleeding:
The following drugs, medications, substances or toxins are some of the possible
causes of Rectal bleeding as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 54
medications causing Rectal bleeding
Drug interactions causing Rectal bleeding:
When combined, certain drugs, medications, substances or toxins may react
causing Rectal bleeding as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Coumadin (Warfarin) and Mevacor (Lovastatin) interaction
- Coumadin (Warfarin) and Advil (Ibuprofen) interaction
- Coumadin (Warfarin) and Motrin (Ibuprofen) interaction
- Coumadin (Warfarin) and Nuprinl (Ibuprofen) interaction
- Coumadin (Warfarin) and Aleve (Naproxen) interaction
- more interactions...»
See full list of 87
drug interactions causing Rectal bleeding
Related information on causes of Rectal bleeding:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Rectal bleeding may be found in:
Causes of Rectal bleeding: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Rectal bleeding.
Hemorrhoids:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
External hemorrhoids
–Located below the pectinate line
–Typically painful
-
Internal hemorrhoids
–Located above the pectinate line
–Typically not painful, unless thrombosis
occurs
-
Pregnancy
–Up to 35% of pregnant females will develop hemorrhoids around the time of delivery, with most cases occurring after a vaginal delivery and/or a prolonged labor
-
Condylomata acuminatum (genital warts)
- Rectal prolapse
–External protrusion of the rectum
–Complete prolapse versus partial full thickness prolapse versus prolapse of mucosa only
–Partial rectal prolapse or mucosa-alone rectal prolapse is typically concentric, thus can be differentiated from internal prolapsing hemorrhoids that tend to have separation between cushions and inflammation
-
Rectal polyp
-
Rectal or anal cancer
-
Hypertrophied anal papilla (polypoid structure at pectinate line)
-
External skin tag
–Redundant fold of tissue along the external anal margin
-
Perirectal abscess
-
Anal fissure or fistula
-
Rectal varices
–Develop secondary to portal hypertension
-
Rectal cavernous hemangioma
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Rectal Pain:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Anal fissure
–Acute fissure presents with pain and bleeding (noticed on toilet paper) immediately following defecation
–Chronic fissure presents with long-standing itching and mild pain, with or without bleeding
-
Perianal abscess (with or without associated fistula formation
-
Thrombosed hemorrhoid
-
Levator ani syndrome
-
Proctalgia fugax (rectal muscle spasm)
-
Coccyodynia/coccygodynia
-
Fecal impaction
-
Neoplasm (rectal, pelvic, or cauda equina)
-
Idiopathic
-
Inflammatory bowel disease (ulcerative proctitis, Crohn's disease)
-
Solitary rectal ulcer syndrome
–Misnomer: May be multiple, not restricted to rectum, and lesion may be polypoid
–Neoplasm is a concern
-
Pruritus ani
-
Trauma
-
Anal sex
-
Constipation
-
Diarrhea
-
Less common causes (“zebras”) include familial rectal pain, endometriosis, pelvic inflammatory disease, prostatitis, myopathies, foreign bodies, and compression or inflammation of sacral nerves
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
GI Bleeding - Melena & Hematochezia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Anatomic lesions
–Diverticular bleeding causes 30–50% of all cases of massive rectal bleeding; associated with mild, crampy pain, but can be painless; not associated with diverticulitis
–Meckel's diverticulum - Vascular lesions
–Angiodysplasia (arteriovenous malformation): Most frequent cause in older patients; bleeding tends to be episodic and self-limited; painless; increased risk with increased age
- Neoplastic lesions
–Colon cancer or polyps: Causes 10% of cases of lower GI bleeding in patients >50 years; generally low-grade, recurrent bleeding
–Rectal cancer
–Small bowel tumors
- Inflammatory lesions
–Colitis/ulcers (e.g., inflammatory bowel disease, infectious colitis, ischemic colitis, radiation colitis)
–Ischemic colitis generally presents with abdominal pain
–Ulcerative colitis more associated with gross rectal bleeding
–Crohn's disease more commonly associated with diffuse crampy abdominal pain, whereas ulcerative colitis is more localized to left lower quadrant
- Anorectal lesions
–Hemorrhoids are the most common cause of rectal bleeding in patients younger than 50 years old; usually painless bleeding
–Fissures
–Polyps
–Idiopathic rectal ulcers
-
Aortoenteric fistula: Must be suspected in any patient with a known aortic graft (e.g., prior aortic aneurysm repair or occlusive aortic disease)
-
Idiopathic in up to 15% of cases
-
Upper GI bleeding
-
Systemic bleeding disorders (e.g., hemophilia, excessive anticoagulation, thrombocytopenia)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Melena:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Colon cancer
On the right side of the colon, early tumor growth may cause melena accompanied by abdominal aching, pressure, or cramps. As the disease progresses, the patient develops weakness, fatigue, and anemia. Eventually, he also experiences diarrhea or obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction.
With a tumor on the left side, melena is a rare sign until late in the disease. Early tumor growth commonly causes rectal bleeding with intermittent abdominal fullness or cramping and rectal pressure. As the disease progresses, the patient may develop obstipation, diarrhea, or pencil-shaped stools. At this stage, bleeding from the colon is signaled by melena or bloody stools.
Ebola virus
Melena, hematemesis, and bleeding from the nose, gums, and vagina may occur later with Ebola virus. Patients usually report an abrupt onset of a headache, malaise, myalgia, a high fever, diarrhea, abdominal pain, dehydration, and lethargy on the fifth day of illness. Pleuritic chest pain, a dry hacking cough, and pharyngitis have also been noted. A maculopapular rash develops between days 5 and 7 of the illness.
Esophageal cancer
Melena is a late sign of esophageal cancer, a malignant neoplastic disease that’s three times more common in men than in women. Increasing obstruction first produces painless dysphagia, then rapid weight loss. The patient may experience steady chest pain with substernal fullness, nausea, vomiting, and hematemesis. Other findings include hoarseness, a persistent cough (possibly hemoptysis), hiccups, a sore throat, and halitosis. In the later stages, signs and symptoms include painful dysphagia, anorexia, and regurgitation.
Esophageal varices (ruptured)
Ruptured esophageal varices is a life-threatening disorder that can produce melena, hematochezia, and hematemesis. Melena is preceded by signs of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. Agitation or confusion signals developing hepatic encephalopathy.
Gastritis
Melena and hematemesis are common. The patient may also experience mild epigastric or abdominal discomfort that’s exacerbated by eating, belching, nausea, vomiting, and malaise.
Mallory-Weiss syndrome
Mallory-Weiss syndrome is characterized by massive bleeding from the upper GI tract due to a tear in the mucous membrane of the esophagus or the junction of the esophagus and the stomach. Melena and hematemesis follow vomiting. Severe upper abdominal bleeding leads to signs and symptoms of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. The patient may also report epigastric or back pain.
Mesenteric vascular occlusion
Mesenteric vascular occlusion is a life-threatening disorder that produces slight melena with 2 to 3 days of persistent, mild abdominal pain. Later, abdominal pain becomes severe and may be accompanied by tenderness, distention, guarding, and rigidity. The patient may also experience anorexia, vomiting, a fever, and profound shock.
Peptic ulcer
Melena may signal life-threatening hemorrhage from vascular penetration. The patient may also develop decreased appetite, nausea, vomiting, hematemesis, hematochezia, and left epigastric pain that’s gnawing, burning, or sharp and may be described as heartburn or indigestion. With hypovolemic shock come tachycardia, tachypnea, hypotension, dizziness, syncope, and cool, clammy skin.
Small-bowel tumors
Small-bowel tumors may bleed and produce melena. Other signs and symptoms include abdominal pain, distention, and an increasing frequency and pitch of bowel sounds.
Thrombocytopenia
Melena or hematochezia may accompany other manifestations of bleeding tendency: hematemesis, epistaxis, petechiae, ecchymoses, hematuria, vaginal bleeding, and characteristic blood-filled oral bullae. Typically, the patient displays malaise, fatigue, weakness, and lethargy.
Typhoid fever
Melena or hematochezia occurs late in typhoid fever and may occur with hypotension and hypothermia. Other late findings include mental dullness or delirium, marked abdominal distention and diarrhea, marked weight loss, and profound fatigue.
Yellow fever
Melena, hematochezia, and hematemesis are ominous signs of hemorrhage, a classic feature, which occurs along with jaundice. Other findings include a fever, a headache, nausea, vomiting, epistaxis, albuminuria, petechiae and mucosal hemorrhage, and dizziness.
Other causes
Drugs and alcohol
Aspirin, other nonsteroidal anti-inflammatory drugs, or alcohol can cause melena as a result of gastric irritation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Rectal pain:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Abscess (perirectal)
A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, commonly high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as a fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Anal fissure
An anal fissure is a longitudinal crack in the anal lining that causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus and, occasionally, stool.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hemorrhoids:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Hemorrhoids probably result from increased venous pressure in the hemorrhoidal plexus. Predisposing factors include occupations that require prolonged standing or sitting; straining due to constipation, diarrhea, coughing, sneezing, or vomiting; heart failure; hepatic disease, such as cirrhosis, amebic abscesses, or hepatitis; alcoholism; anorectal infections; loss of muscle tone due to old age, rectal surgery, or episiotomy; anal intercourse; and pregnancy.
Hemorrhoids are more common in whites, in persons of higher socioeconomic classes, and in persons who live in rural areas. However, actual incidence figures are unknown because many patients with hemorrhoids self-medicate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Melena:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Colon cancer
On the right side of the colon, early tumor growth may cause melena accompanied by abdominal aching, pressure, or cramps. As the disease progresses, the patient develops weakness, fatigue, and anemia. Eventually, he also experiences diarrhea or obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction.
With a tumor on the left side, melena is a rare sign until late in the disease. Early tumor growth commonly causes rectal bleeding with intermittent abdominal fullness or cramping and rectal pressure. As the disease progresses, the patient may develop obstipation, diarrhea, or pencil-shaped stools. At this stage, bleeding from the colon is signaled by melena or bloody stools.
Ebola virus
Melena, hematemesis, and bleeding from the nose, gums, and vagina may occur later with this disorder. Patients usually report abrupt onset of headache, malaise, myalgia, high fever, diarrhea, abdominal pain, dehydration, and lethargy on the fifth day of illness. Pleuritic chest pain, dry hacking cough, and pharyngitis have also been noted. A maculopapular rash develops between days 5 and 7 of the illness.
Esophageal cancer
Melena is a late sign of this malignant neoplastic disease that’s three times more common in men than women. Increasing obstruction first produces painless dysphagia, then rapid weight loss. The patient may experience steady chest pain with substernal fullness, nausea, vomiting, and hematemesis. Other findings include hoarseness, persistent cough (possibly hemoptysis), hiccups, sore throat, and halitosis. In the later stages, signs and symptoms include painful dysphagia, anorexia, and regurgitation.
Esophageal varices (ruptured)
This life-threatening disorder can produce melena, hematochezia, and hematemesis. Melena is preceded by signs of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. Agitation or confusion signals developing hepatic encephalopathy.
Gastric cancer
Melena and altered bowel habits may occur late with this uncommon cancer. More common findings include insidious onset of upper abdominal or retrosternal discomfort and chronic dyspepsia, which are unrelieved by antacids and exacerbated by food. Anorexia and slight nausea often occur, along with hematemesis, pallor, fatigue, weight loss, and a feeling of abdominal fullness.
Gastritis
Melena and hematemesis are common. The patient may also experience mild epigastric or abdominal discomfort that’s exacerbated by eating; belching; nausea; vomiting; and malaise.
Malaria
Melena may accompany persistent high fever and orthostatic hypotension in severe malaria. Other features include hemoptysis, vomiting, abdominal pain, diarrhea, oliguria, and headache, seizures, delirium, or coma. These findings are interspersed throughout the malarial paroxysm—chills, then high fever, and then profuse diaphoresis.
Mallory-Weiss syndrome
This condition is characterized by massive bleeding from the upper GI tract due to a tear in the mucous membrane of the esophagus or the junction of the esophagus and the stomach. Melena and hematemesis follow vomiting. Severe upper abdominal bleeding leads to signs and symptoms of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. The patient may also report epigastric or back pain.
Mesenteric vascular occlusion
This life-threatening disorder produces slight melena with 2 to 3 days of persistent, mild abdominal pain. Later, abdominal pain becomes severe and may be accompanied by tenderness, distention, guarding, and rigidity. The patient may also experience anorexia, vomiting, fever, and profound shock.
Peptic ulcer
Melena may signal life-threatening hemorrhage from vascular penetration. The patient may also develop decreased appetite, nausea, vomiting, hematemesis, hematochezia, and left epigastric pain that’s gnawing, burning, or sharp and may be described as heartburn or indigestion. With hypovolemic shock come tachycardia, tachypnea, hypotension, dizziness, syncope, and cool, clammy skin.
Small-bowel tumors
These tumors may bleed and produce melena. Other signs and symptoms include abdominal pain, distention, and increasing frequency and pitch of bowel sounds.
Thrombocytopenia
Melena or hematochezia may accompany other manifestations of bleeding tendency: hematemesis, epistaxis, petechiae, ecchymoses, hematuria, vaginal bleeding, and characteristic blood-filled oral bullae. Typically, the patient displays malaise, fatigue, weakness, and lethargy.
Typhoid fever
Melena or hematochezia occurs late in this disorder and may occur with hypotension and hypothermia. Other late findings include mental dullness or delirium, marked abdominal distention and diarrhea, marked weight loss, and profound fatigue.
Yellow fever
Melena, hematochezia, and hematemesis are ominous signs of hemorrhage, a classic feature, which occurs along with jaundice. Other findings include fever, headache, nausea, vomiting, epistaxis, albuminuria, petechiae and mucosal hemorrhage, and dizziness.
Other causes
Drugs and alcohol
Aspirin, other nonsteroidal anti-inflammatories, or alcohol can cause melena as a result of gastric irritation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Rectal pain:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abscess (perirectal)
This abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, often high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Abscess (prostatic)
This disorder occasionally produces rectal pain. Common associated findings include urine retention and frequency, dysuria, and fever. A rectal examination may reveal prostatic tenderness and gas.
Anal fissure
This longitudinal crack in the anal lining causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus, and occasionally stool.
Cryptitis
This disorder results when particles of stool that are lodged in the anal folds decay and cause infection, which may produce dull anal pain or discomfort and anal pruritus.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
Proctalgia fugax
With this disorder, muscle spasms of the rectum and pelvic floor produce sudden, severe episodes of rectal pain that last up to several minutes and then disappear. The patient may report being awakened by the pain, which is sometimes associated with stress or anxiety and relieved by food and drink.
Rectal cancer
Rectal pain, bleeding, tenesmus, and a hard, nontender mass are typical findings in this rare form of cancer.
Other causes
Anal intercourse
Shearing forces may cause inflammation or tearing of the mucous membranes and discomfort.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hematochezia [Rectal bleeding]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Amyloidosis
Hematochezia occasionally occurs when this disorder affects the GI tract. Massive, rapid hematochezia may precipitate signs of shock, such as hypotension and tachycardia. Associated signs and symptoms include hypoactive or absent bowel sounds, abdominal pain, malabsorption, diarrhea, and renal disease. The patient may also have a stiff, enlarged tongue, resulting in dysarthria.
Anal fissure
Slight hematochezia characterizes this disorder; blood may streak the stools or appear on toilet tissue. Accompanying hematochezia is severe rectal pain that may make the patient reluctant to defecate, thereby causing constipation.
Angiodysplastic lesions
Most common in elderly patients, these arteriovenous lesions of the ascending colon typically cause chronic, bright red rectal bleeding. Occasionally, they may result in life-threatening blood loss and signs of shock, such as tachycardia and hypotension.
Anorectal fistula
Blood, pus, mucus, and occasionally stools may drain from this type of fistula. Other effects include rectal pain and pruritus.
Coagulation disorders
Patients with a coagulation disorder (such as thrombocytopenia or disseminated intravascular coagulation) may experience GI bleeding marked by moderate to severe hematochezia. Bleeding may also occur in other body systems, producing such signs as epistaxis and purpura. Associated findings vary with the specific coagulation disorder.
Colitis
Ischemic colitis commonly causes bloody diarrhea, especially in elderly patients. Rectal bleeding may be slight or massive and is usually accompanied by severe, cramping lower abdominal pain and hypotension. Other effects include abdominal tenderness, distention, and absent bowel sounds. Severe colitis may cause life-threatening hypovolemic shock and peritonitis.
Ulcerative colitis typically causes bloody diarrhea that may also contain mucus. Blood loss may be slight or massive and is preceded by mild to severe abdominal cramps. Associated signs and symptoms include fever, tenesmus, anorexia, nausea, vomiting, hyperactive bowel sounds and, occasionally, tachycardia. Weight loss and weakness occur late.
Colon cancer
Bright red rectal bleeding with or without pain is a telling sign, especially in cancer of the left colon. This type of tumor usually causes early signs of obstruction, such as rectal pressure, bleeding, and intermittent fullness or cramping. As the disease progresses, the patient also develops obstipation, diarrhea or ribbon-shaped stools, and pain that’s typically relieved by passage of stools or flatus. Stools are grossly bloody.
Cancer of the right colon may initially cause melena and abdominal aching, pressure, and dull cramps. As the disease progresses, the patient may also experience diarrhea, anorexia, weight loss, anemia, weakness and fatigue, vomiting, an abdominal mass, and signs of obstruction, such as abdominal distention and abnormal bowel sounds.
Colorectal polyps
These polyps are the most common cause of intermittent hematochezia in adults younger than age 60, but they don’t always produce symptoms. When located high in the colon, polyps may cause blood-streaked stools that yield a positive response when tested with guaiac. If the polyps are located closer to the rectum, they may bleed freely.
Crohn’s disease
Hematochezia is not a common sign of this disorder unless the perineum is involved. If rectal bleeding does occur, it’s likely to be massive. The chief clinical features of Crohn’s disease include fever, abdominal distention and pain with guarding, diarrhea, hyperactive bowel sounds, anorexia, nausea, and fatigue. Palpation may reveal a mass in the colon.
Diverticulitis
Most common in elderly patients, this disorder can suddenly cause mild to moderate rectal bleeding after the patient feels the urge to defecate. The bleeding may end abruptly or may progress to life-threatening blood loss with signs of shock. Associated signs and symptoms may include left-lower-quadrant pain that’s relieved by defecation, alternating episodes of constipation and diarrhea, anorexia, nausea and vomiting, rebound tenderness, and a distended tympanic abdomen.
Dysentery
Bloody diarrhea is common in infection with Shigella, Amoeba, and Campylobacter, but rare with Salmonella. Abdominal pain or cramps, tenesmus, fever, and nausea may also occur.
Esophageal varices (ruptured)
In this life-threatening disorder, hematochezia may range from slight rectal oozing to grossly bloody stools and may be accompanied by mild to severe hematemesis or melena. Signs of shock, such as tachycardia and hypotension, may follow or occasionally precede overt signs of bleeding. Typically, the patient has a history of chronic liver disease.
Food poisoning (staphylococcal)
The patient may have bloody diarrhea 1 to 6 hours after ingesting food toxins. Accompanying signs and symptoms, which last a few hours, include severe, cramping abdominal pain, nausea and vomiting, and prostration.
Hemorrhoids
Hematochezia may accompany external hemorrhoids, which typically cause painful defecation, resulting in constipation. Less painful internal hemorrhoids usually produce more chronic bleeding with bowel movements, which may eventually lead to signs of anemia, such as weakness and fatigue.
Leptospirosis
The severe form of this infection—Weil’s syndrome—produces hematochezia or melena along with other signs of bleeding, such as epistaxis and hemoptysis. The bleeding is typically preceded by a sudden frontal headache, severe thigh and lumbar myalgia, cutaneous hyperesthesia, and conjunctival suffusion. Bleeding is followed by chills, a rapidly rising fever, and perhaps nausea and vomiting. Fever, headache, and myalgia usually intensify and persist for weeks. Other findings may include right-upper-quadrant tenderness, hepatomegaly, and jaundice.
Peptic ulcer
Upper GI bleeding is a common complication in this disorder. The patient may display hematochezia, hematemesis, or melena, depending on the intensity and amount of bleeding. If the peptic ulcer penetrates an artery or vein, massive bleeding may precipitate signs of shock, such as hypotension and tachycardia. Other findings may include chills, fever, nausea and vomiting, and signs of dehydration, such as dry mucous membranes, poor skin turgor, and thirst. Most patients have a history of epigastric pain that’s relieved by foods or antacids; some also have a history of habitual use of tobacco, alcohol, or nonsteroidal anti-inflammatory drugs.
Rectal melanoma (malignant)
This rare form of rectal cancer typically causes recurrent rectal bleeding that arises from a painless, asymptomatic mass.
Small-intestine cancer
This disorder occasionally produces slight hematochezia or blood-streaked stools. Its characteristic features include colicky pain and postprandial vomiting. Other common signs and symptoms include anorexia, weight loss, and fever. Palpation may reveal abdominal masses.
Typhoid fever
About 10% of patients with typhoid fever develop hematochezia, which is occasionally massive. However, melena is more common. Both signs of bleeding occur late and may be accompanied by marked abdominal distention, diarrhea, significant weight loss, mental dullness, and profound fatigue. Earlier signs and symptoms are pathognomonic rose spots, headache, chills, fever, constipation, dry cough, conjunctivitis, and epistaxis.
Ulcerative proctitis
In this disorder, the patient typically has an intense urge to defecate but passes only bright red blood, pus, or mucus. Other common findings include acute constipation and tenesmus.
Other causes
Heavy metal poisoning
Bloody diarrhea is accompanied by cramping abdominal pain, nausea, and vomiting. Other signs may include tachycardia, hypotension, seizures, paresthesia, depressed or absent deep tendon reflexes, and an altered level of consciousness.
Tests
Certain procedures, especially colonoscopy, polypectomy, and proctosigmoidoscopy, may cause rectal bleeding. Bowel perforation is rare.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gastrointestinal Bleeding:
Differential Overview
(Field Guide to Bedside Diagnosis)
Upper GI
❑ Peptic ulcer disease
❑ Gastritis
❑ Mallory-Weiss tear
❑ Esophageal varices
❑ Esophagitis
❑ Epistaxis
❑ Esophageal cancer
❑ Gastric cancer
Lower GI
❑ Infectious diarrhea
❑ Diverticular bleeding
❑ Hemorrhoids
❑ Anal fissure
❑ Inflammatory bowel disease
❑ Angiodysplasia
❑ Colon cancer
❑ Mesenteric ischemia
❑ Aortoenteric fistula
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Rectal Pain:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Hemorrhoid
❑ Rectal fissure
❑ Prostatitis
❑ Anal fistula
❑ Pruritus ani
❑ Fecal impaction
❑ Coccydynia
❑ Perirectal abscess
❑ Infected pilonidal cyst
❑ Ulcerative proctitis
❑ Infective proctitis
❑ Proctalgia fugax
❑ Anal carcinoma
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hemorrhoids:
Causes
(Handbook of Diseases)
Hemorrhoids result from activities that increase intravenous pressure, resulting in distention and engorgement. Predisposing factors include prolonged sitting, straining at defecation, constipation, low-fiber diet, pregnancy, and obesity.
Other factors include hepatic disease, such as cirrhosis, amebic abscesses, or hepatitis; alcoholism; and anorectal infections.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Melena:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Colon cancer
On the right side of the colon, early tumor growth may cause melena accompanied by abdominal aching, pressure, or cramps. As the disease progresses, the patient develops weakness, fatigue, and anemia. Eventually, he also experiences diarrhea or obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction.
With a tumor on the left side, melena is a rare sign until late in the disease. Early tumor growth commonly causes rectal bleeding with intermittent abdominal fullness or cramping and rectal pressure. As the disease progresses, the patient may develop obstipation, diarrhea, or pencil-shaped stools. At this stage, bleeding from the colon is signaled by melena or bloody stools.
Ebola virus
Melena, hematemesis, and bleeding from the nose, gums, and vagina may occur later with Ebola virus. Patients usually report abrupt onset of headache, malaise, myalgia, high fever, diarrhea, abdominal pain, dehydration, and lethargy on the fifth day of illness. Pleuritic chest pain, dry hacking cough, and pharyngitis have also been noted. A maculopapular rash develops between days 5 and 7 of the illness.
Esophageal cancer
Melena is a late sign of esophageal cancer that’s three times more common in males than females. Increasing obstruction first produces painless dysphagia, then rapid weight loss. The patient may experience steady chest pain with substernal fullness, nausea, vomiting, and hematemesis. Other findings include hoarseness, persistent cough (possibly hemoptysis), hiccups, sore throat, and halitosis. In the later stages, signs and symptoms include painful dysphagia, anorexia, and regurgitation.
Esophageal varices (ruptured)
Esophageal varices is a life-threatening disorder that can produce melena, hematochezia, and hematemesis. Melena is preceded by signs of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. Agitation or confusion signals developing hepatic encephalopathy.
Gastric cancer
Melena and altered bowel habits may occur late with gastric cancer. More common findings include insidious onset of upper abdominal or retrosternal discomfort and chronic dyspepsia, which are unrelieved by antacids and exacerbated by food. Anorexia and slight nausea often occur, along with hematemesis, pallor, fatigue, weight loss, and a feeling of abdominal fullness.
Gastritis
Melena and hematemesis are common. The patient may also experience mild epigastric or abdominal discomfort that’s exacerbated by eating; belching; nausea; vomiting; and malaise.
Malaria
Melena may accompany persistent high fever and orthostatic hypotension in severe malaria. Other features include hemoptysis, vomiting, abdominal pain, diarrhea, oliguria, and headache, seizures, delirium, or coma. These findings are interspersed throughout the malarial paroxysm — chills, then high fever, and then profuse diaphoresis.
Mallory-Weiss syndrome
Mallory-Weiss syndrome is characterized by massive bleeding from the upper GI tract due to a tear in the mucous membrane of the esophagus or the junction of the esophagus and the stomach. Melena and hematemesis follow vomiting. Severe upper abdominal bleeding leads to signs and symptoms of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. The patient may also report epigastric or back pain.
Mesenteric vascular occlusion
Mesenteric vascular occlusion is a life-threatening disorder that produces slight melena with 2 to 3 days of persistent, mild abdominal pain. Later, abdominal pain becomes severe and may be accompanied by tenderness, distention, guarding, and rigidity. The patient may also experience anorexia, vomiting, fever, and profound shock.
Peptic ulcer
Melena may signal life-threatening hemorrhage from vascular penetration. The patient may also develop decreased appetite, nausea, vomiting, hematemesis, hematochezia, and left epigastric pain that’s gnawing, burning, or sharp and may be described as heartburn or indigestion. With hypovolemic shock comes tachycardia, tachypnea, hypotension, dizziness, syncope, and cool, clammy skin.
Small-bowel tumors
Small-bowel tumors may bleed and produce melena. Other signs and symptoms include abdominal pain, distention, and increasing frequency and pitch of bowel sounds.
Thrombocytopenia
Melena or hematochezia may accompany other manifestations of bleeding tendency: hematemesis, epistaxis, petechiae, ecchymoses, hematuria, vaginal bleeding, and characteristic blood-filled oral bullae. Typically, the patient displays malaise, fatigue, weakness, and lethargy.
Typhoid fever
Melena or hematochezia occurs late in typhoid fever and may occur with hypotension and hypothermia. Other late findings include mental dullness or delirium, marked abdominal distention and diarrhea, marked weight loss, and profound fatigue.
Yellow fever
Melena, hematochezia, and hematemesis are ominous signs of hemorrhage, a classic feature, which occurs along with jaundice. Other findings include fever, headache, nausea, vomiting, epistaxis, albuminuria, petechiae and mucosal hemorrhage, and dizziness.
Other causes
Drugs and alcohol
Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or alcohol can cause melena as a result of gastric irritation.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Melena:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Colon cancer
On the right side of the colon, early tumor growth may cause melena accompanied by abdominal aching, pressure, or cramps. As the disease progresses, the patient develops weakness, fatigue, and anemia. Eventually, he also experiences diarrhea or obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction.
With a tumor on the left side, melena is a rare sign until late in the disease. Early tumor growth commonly causes rectal bleeding with intermittent abdominal fullness or cramping and rectal pressure. As the disease progresses, the patient may develop obstipation, diarrhea, or pencil-shaped stools. At this stage, bleeding from the colon is signaled by melena or bloody stools.
CULTURAL CUE:Ask your patient about his religious and ethnic background to determine if they put him at risk for colon cancer. Colon cancer is more prevalent in Jewish people of Eastern European descent.
Esophageal cancer
Melena is a late sign of esophageal cancer, a malignant neoplastic disease. Increasing obstruction first produces painless dysphagia, then rapid weight loss. The patient may experience steady chest pain with substernal fullness, nausea, vomiting, and hematemesis. Other findings include hoarseness, persistent cough (possibly hemoptysis), hiccups, sore throat, and halitosis. In the later stages, signs and symptoms include painful dysphagia, anorexia, and regurgitation.
Esophageal varices (ruptured)
This life-threatening disorder can produce melena, hematochezia, and hematemesis. Melena is preceded by signs of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. Agitation or confusion signals developing hepatic encephalopathy.
Gastric cancer
Melena and altered bowel habits may occur late with gastric cancer. More common findings include insidious onset of upper abdominal or retrosternal discomfort and chronic dyspepsia that are unrelieved by antacids and are exacerbated by food. Anorexia and slight nausea usually occur, along with hematemesis, pallor, fatigue, weight loss, and a feeling of abdominal fullness.
CULTURAL CUE:Asian countries, such as Korea, China, Taiwan, and Japan, have higher rates of gastric cancer than the United States.
Gastritis
Melena and hematemesis are common in gastritis. The patient may also experience mild epigastric or abdominal discomfort that’s exacerbated by eating, belching, nausea, vomiting, and malaise.
Mallory-Weiss syndrome
Mallory-Weiss syndrome is characterized by massive bleeding from the upper GI tract due to a tear in the mucous membrane of the esophagus or the junction of the esophagus and the stomach. Melena and hematemesis follow vomiting. Severe upper abdominal bleeding leads to signs and symptoms of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. The patient may also report epigastric or back pain.
Mesenteric vascular occlusion
Mesenteric vascular occlusion is a life-threatening disorder that produces slight melena with 2 to 3 days of persistent, mild abdominal pain. Later, abdominal pain becomes severe and may be accompanied by tenderness, distention, guarding, and rigidity. The patient may also experience anorexia, vomiting, fever, and profound shock.
Peptic ulcer
Melena may signal life-threatening hemorrhage from vascular penetration in patients with peptic ulcers. The patient may also develop decreased appetite, nausea, vomiting, hematemesis, hematochezia, and left epigastric pain that’s gnawing, burning, or sharp and may be described as heartburn or indigestion. With hypo-volemic shock come tachycardia, tachypnea, hypotension, dizziness, syncope, and cool, clammy skin.
Small-bowel tumors
Small-bowel tumors may bleed and produce melena. Other signs and symptoms include abdominal pain, distention, and increasing frequency and pitch of bowel sounds.
Thrombocytopenia
With thrombocytopenia, melena or hematochezia may accompany other manifestations of bleeding tendency: hematemesis, epistaxis, petechiae, ecchymoses, hematuria, vaginal bleeding, and characteristic blood-filled oral bullae. Typically, the patient displays malaise, fatigue, weakness, and lethargy.
Other causes
Drugs and alcohol
Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or alcohol can cause melena as a result of gastric irritation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Rectal pain:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abscess
A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing, local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously high in the rectum or even in the lower abdomen and is accompanied by an indurated anal mass. The patient may also develop such associated signs and symptoms as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
A prostatic abscess occasionally produces rectal pain. Common associated findings include urine retention and frequency, dysuria, and fever. A rectal examination may reveal prostatic tenderness and gas.
Anal fissure
An anal fissure is a longitudinal crack in the anal lining that causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints of an anorectal fistula include pruritus and drainage of pus, blood, mucus and, occasionally, stool.
Cryptitis
Cryptitis results when particles of stool that are lodged in the anal folds decay and cause infection, which may produce dull anal pain or discomfort and anal pruritus. Intense pain may occur when the anal sphincter contracts.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
Proctalgia fugax
With proctalgia fugax, muscle spasms of the rectum and pelvic floor produce sudden, severe episodes of rectal pain that last up to several minutes and then disappear. The patient may report being awakened by the pain, which is sometimes associated with stress or anxiety and relieved by food and drink.
Other causes
Anal intercourse
Shearing forces may cause inflammation or tearing of the mucous membranes and discomfort.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Gastrointestinal Bleeding:
Principal Causes of Gastrointestinal Bleeding
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Uppergastrointestinal bleeding
- Nose
- Mouth and pharynx
- Esophagus
- Esophagitis
- Gastroesophageal reflux
- Caustic ingestion
- Infection
- Foreign body
- Varices
- Duplication
- Gastroesophageal junction
- Mallory-Weisstear
- Stomach
- Gastritis
- Ulcer
- Duplication
- Vascular malformation
- Neoplasm
- Duodenum
- Ulcer
- Foreign body
- Varices
- Duplication
- Vascular malformation
- Hemobilia
- Other
- Swallowed blood
- Coagulopathy
- Hemorrhagic disease of the newborn(vitamin K deficiency)
- Disseminated intravascular coagulation
- Drugs
- Lower gastrointestinal bleeding
- Intestine
- Cow milk/soyprotein sensitivity
- Necrotizing enterocolitis
- Infectious colitis
- Henoch-Schönlein purpura
- Intussusception
- Congenital aganglionic megacolon (Hirschsprungdisease)
- Meckel diverticulum
- Volvulus with malrotation
- Inflammatory bowel disease
- Intestinal polyps
- Solitaryjuvenile polyps/juvenile intestinal polyposis
- Adenomatous polyposis of the colon
- Peutz-Jeghers syndrome
- Benign lymphoid hyperplasia
- Duplication
- Vascular malformation
- Neoplasm
- Rectum and anus
- Anal fissure
- Trauma
- Sexual abuse
- Hemorrhoids
- Other
- Swallowed blood
- Coagulopathy
- Drugs
- Factitious bleeding
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Melena:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Colon cancer.On the right side of the colon, early tumor growth may cause melena accompanied by abdominal aching, pressure, or cramps. As the disease progresses, the patient develops weakness, fatigue, and anemia. Eventually, he also experiences diarrhea or obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction.
With a tumor on the left side of the colon, melena is a rare sign until late in the disease. Early tumor growth commonly causes rectal bleeding with intermittent abdominal fullness or cramping and rectal pressure. As the disease progresses, the patient may develop obstipation, diarrhea, or pencil-shaped stools. At this stage, bleeding from the colon is signaled by melena or bloody stools.
Ebola virus.Melena, hematemesis, and bleeding from the nose, gums, and vagina may occur later with Ebola virus. Patients usually report an abrupt onset of headache, malaise, myalgia, high fever, diarrhea, abdominal pain, dehydration, and lethargy on the fifth day of illness. Pleuritic chest pain, a dry hacking cough, and pharyngitis have also been noted. A maculopapular rash develops between days 5 and 7 of the illness.
Esophageal cancer.Melena is a late sign of esophageal cancer. Increasing obstruction first produces painless dysphagia, then rapid weight loss. The patient may experience steady chest pain with substernal fullness, nausea, vomiting, and hematemesis. Other findings include hoarseness, a persistent cough (possibly hemoptysis), hiccups, a sore throat, and halitosis. In the later stages, signs and symptoms include painful dysphagia, anorexia, and regurgitation.
Esophageal varices (ruptured).Ruptured esophageal varices is a life-threatening disorder that can produce melena, hematochezia, and hematemesis. Melena is preceded by signs of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. Agitation or confusion signals developing hepatic encephalopathy.
Gastritis.Melena and hematemesis are common with gastritis. The patient may also experience mild epigastric or abdominal discomfort that's exacerbated by eating, belching, nausea, vomiting, and malaise.
Mallory-Weiss syndrome.
Mallory-Weiss syndrome is characterized by massive bleeding from the upper GI tract due to a tear in the mucous membrane of the esophagus or the junction of the esophagus and the stomach. Melena and hematemesis follow vomiting. Severe upper abdominal bleeding leads to signs and symptoms of shock, such as tachycardia, tachypnea, hypotension, and cool, clammy skin. The patient may also report epigastric or back pain.
Mesenteric vascular occlusion.Mesenteric vascular occlusion is a life-threatening disorder that produces slight melena with 2 or 3 days of persistent, mild abdominal pain. Later, abdominal pain becomes severe and may be accompanied by tenderness, distention, guarding, and rigidity. The patient may also experience anorexia, vomiting, fever, and profound shock.
Peptic ulcer.With a peptic ulcer, melena may signal life-threatening hemorrhage from vascular penetration. The patient may also develop decreased appetite, nausea, vomiting, hematemesis, hematochezia, and left epigastric pain that's gnawing, burning, or sharp and may be described as heartburn or indigestion. With hypovolemic shock come tachycardia, tachypnea, hypotension, dizziness, syncope, and cool, clammy skin.
Small-bowel tumors.Small-bowel tumors may bleed and produce melena. Other signs and symptoms include abdominal pain, distention, and an increasing frequency and pitch of bowel sounds.
Thrombocytopenia.Melena or hematochezia may accompany other manifestations of bleeding tendency that occurs with thrombocytoenia: hematemesis, epistaxis, petechiae, ecchymoses, hematuria, vaginal bleeding, and characteristic blood-filled oral bullae. Typically, the patient displays malaise, fatigue, weakness, and lethargy.
Typhoid fever.Melena or hematochezia occurs late in typhoid fever and may occur with hypotension and hypothermia. Other late findings include mental dullness or delirium, marked abdominal distention and diarrhea, marked weight loss, and profound fatigue.
Yellow fever.Melena, hematochezia, and hematemesis are ominous signs of hemorrhage, a classic feature of yellow fever, which occurs along with jaundice. Other findings include fever, headache, nausea, vomiting, epistaxis, albuminuria, petechiae and mucosal hemorrhage, and dizziness.
Other causes
Drugs and alcohol.Aspirin, other nonsteroidal anti-inflammatory drugs, or alcohol can cause melena as a result of gastric irritation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Rectal pain:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abscess (perirectal).A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that's exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, commonly high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Anal fissure.An anal fissure causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula.Anorectal fistula causes rectal pain to develop when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus and, occasionally, stools.
Hemorrhoids.Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient's fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Hematochezia [Rectal bleeding]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anal fissure.Slight hematochezia characterizes anal fissure; blood may streak the stools or appear on toilet tissue. Accompanying hematochezia is severe rectal pain that may make the patient reluctant to defecate, thereby causing constipation.
Angiodysplastic lesions.Most common in elderly patients, these arteriovenous lesions of the ascending colon typically cause chronic, bright red rectal bleeding. Occasionally, this painless hematochezia may result in life-threatening blood loss and signs of shock, such as tachycardia and hypotension.
Coagulation disorders.Patients with a coagulation disorder (such as thrombocytopenia and disseminated intravascular coagulation) may experience GI bleeding marked by moderate to severe hematochezia. Bleeding may also occur in other body systems, producing such signs as epistaxis and purpura. Associated findings vary with the specific coagulation disorder.
Colitis.Ischemic colitis commonly causes bloody diarrhea, especially in elderly patients. Hematochezia may be slight or massive and is usually accompanied by severe, cramping lower abdominal pain and hypotension. Other effects include abdominal tenderness, distention, and absent bowel sounds. Severe colitis may cause life-threatening hypovolemic shock and peritonitis.
Ulcerative colitis typically causes bloody diarrhea that may also contain mucus. Hematochezia is preceded by mild to severe abdominal cramps and may cause slight to massive blood loss. Associated signs and symptoms include fever, tenesmus, anorexia, nausea, vomiting, hyperactive bowel sounds and, occasionally, tachycardia. Weight loss and weakness occur late.
Colon cancer.Bright red rectal bleeding with or without pain is a telling sign of colon cancer especially in cancer of the left colon.
Usually, a left colon tumor causes early signs of obstruction, such as rectal pressure, bleeding, and intermittent fullness or cramping. As the disease progresses, the patient also develops obstipation, diarrhea or ribbon-shaped stools, and pain, which is typically relieved by the passage of stools or flatus. Stools are grossly bloody.
Early tumor growth in the right colon may cause melena, abdominal aching, pressure, and dull cramps. As the disease progresses, the patient develops weakness and fatigue. Later, he may also experience diarrhea, anorexia, weight loss, anemia, vomiting, an abdominal mass, and signs of obstruction, such as abdominal distention and abnormal bowel sounds.
Colorectal polyps.Colorectal polyps are the most common cause of intermittent hematochezia in adults younger than age 60; however, sometimes such polyps produce no symptoms. When located high in the colon, polyps may cause blood-streaked stools. The stools yield a positive response when tested with guaiac. If the polyps are located closer to the rectum, they may bleed freely.
Diverticulitis.Most common in the elderly patient, diverticulitis can suddenly cause mild to moderate rectal bleeding after the patient feels the urge to defecate. The bleeding may end abruptly or may progress to life-threatening blood loss with signs of shock. Associated signs and symptoms may include left lower quadrant pain that's relieved by defecation, alternating episodes of constipation and diarrhea, anorexia, nausea and vomiting, rebound tenderness, and a distended tympanic abdomen.
Dysentery.Bloody diarrhea is common in infection with Shigella, Amoeba, and Campylobacter, but rare with Salmonella. Abdominal pain or cramps, tenesmus, a fever, and nausea may also occur.
Esophageal varices (ruptured).In esophageal varices, a life-threatening disorder, hematochezia may range from slight rectal oozing to grossly bloody stools and may be accompanied by mild to severe hematemesis or melena. This painless but massive hemorrhage may precipitate signs of shock, such as tachycardia and hypotension. In fact, signs of shock occasionally precede overt signs of bleeding. Typically, the patient has a history of chronic liver disease.
Food poisoning (staphylococcal).The patient may have bloody diarrhea 1 to 6 hours after ingesting food toxins. Accompanying signs and symptoms include severe, cramping abdominal pain; nausea and vomiting; and prostration, all of which last a few hours.
Hemorrhoids.Hematochezia may accompany external hemorrhoids, which typically cause painful defecation, resulting in constipation. Less painful internal hemorrhoids usually produce more chronic bleeding with bowel movements, which may eventually lead to signs of anemia, such as weakness and fatigue.
Leptospirosis.The severe form of leptospirosis—Weil's syndrome—produces hematochezia or melena along with other signs of bleeding, such as epistaxis and hemoptysis. The bleeding is typically preceded by a sudden frontal headache and severe thigh and lumbar myalgia that may be accompanied by cutaneous hyperesthesia. Conjunctival suffusion is indicative. Bleeding is followed by chills, a rapidly rising fever and, perhaps, nausea and vomiting. A fever, a headache, and myalgia usually intensify and persist for weeks. Other findings may include right upper quadrant tenderness, hepatomegaly, and jaundice.
Peptic ulcer.Upper GI bleeding is a common complication in peptic ulcer. The patient may display hematochezia, hematemesis, or melena, depending on the rapidity and amount of bleeding. If the peptic ulcer penetrates an artery or vein, massive bleeding may precipitate signs of shock, such as hypotension and tachycardia. Other findings may include chills, a fever, nausea and vomiting, and signs of dehydration, such as dry mucous membranes, poor skin turgor, and thirst. The patient typically has a history of epigastric pain that's relieved by foods or antacids; he may also have a history of habitually using tobacco, alcohol, or NSAIDs.
Ulcerative proctitis.Ulcerative proctitis typically causes an intense urge to defecate, but the patient passes only bright red blood, pus, or mucus. Other common signs and symptoms include acute constipation and tenesmus.
Other causes
Diagnostic tests.Certain procedures, especially colonoscopy, polypectomy, hemorrhoidectomy, and proctosigmoidoscopy, may cause rectal bleeding. Bowel perforation is rare.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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