Questions Your Doctor May Ask - and Why!
During a consultation, your doctor will use various techniques in his assesment of the symptom: Rectal bleeding.
These may include a physical examination or other medical tests.
Your doctor may ask several questions when assessing
your condition. It is important to remember that your consultation is a two-way process and any extra information
you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
- How long have you been having the rectal bleeding?
Why: to establish if acute or chronic.
- How often does the rectal bleeding occur?
- Is it severe?
Why: presence of severe rectal bleeding would suggest angiodysplasia, ulcerative colitis, amebic dysentery, bacillary dysentery, intussusception, mesenteric thrombosis or embolism, diverticulitis, ischemic colitis and coagulation disorders. The site of the bleeding can be anywhere in the gastrointestinal tract since massive bleeding even from the stomach or duodenum may pass rapidly to rectum without becoming discolored to form melena (black tarry stool).
- Is the bleeding mixed well with the stool?
Why: suggests colon cancer, ulcerative colitis, Crohn's disease, Meckel's diverticulum, diverticulitis, large polyp and coagulation disorder.
- Is the blood on the toilet paper only?
Why: this suggests an anal cause.
- Is the stool black and tarry? see black stool
Why: usually due to bleeding from the upper gastrointestinal tract.
- What is the color of the blood?
- Does the bloody stool only occur with menstruation?
Why: suggests rectal endometriosis.
- Past medical history?
Why: e.g. ischemic colitis occurs in the setting of widespread peripheral vascular disease or cardiac disease; Acquired bleeding disorders can occur with liver disease, renal failure, lupus erythematosus and some cancers such as Multiple myeloma, myelofibrosis.
- Family history?
Why: colon or rectal cancer; bleeding disorders, ulcerative colitis, Crohn's disease.
- Medications?
Why: some medications can increase the risk of rectal bleeding and bloody stools e.g. high dose aspirin, non-steroidal anti-inflammatory medication, certain antibiotics including clindomycin, gentamycin, erythromycin.
- Alcohol history?
Why: to establish risk of chronic liver disease and portal hypertension and resultant varices and hemorrhoids.
Questions your doctor may ask about related symptoms:
Sometimes, other symptoms may be present and may help your doctor analyse
your condition. These may include:
- Diarrhea and/or mucous?
Why: if associated with rectal bleeding would suggest ulcerative colitis, Crohn's disease, amebic dysentery or bacterial dysentery (e.g. shigella, salmonella, campylobacter jejuni, yersinia enterocolitica, enteroinvasive and enterohemorrhagic E.Coli).
- Fever?
Why: may suggest bacterial dysentery, amebic dysentery, chronic liver disease secondary to alcoholism, ulcerative colitis.
- Easy bruising?
Why: purpura ( multiple small hemorrhages into the skin or mucous membranes); petechiae (small pinhead size purpura); ecchymoses ( large purpura) - may suggest a bleeding disorder.
- Symptoms of intestinal obstruction?
Why: e.g. colicky abdominal pain, vomiting, abdominal distension and absolute constipation - would suggest intussusception, mesenteric thrombosis, or embolism.
- Painful bowel movements?
Why: anal fissure, thrombosed hemorrhoid or ulcerative proctitis.
- Sensation of urgency or unsatisfied defecation?
Why: suggest a rectal cause.
- Anal itch?
Why: suggests hemorrhoids, fissure or diarrhea causing anal irritation.
- Constipation?
Why: may suggest hemorrhoids, anal fissure, diverticulitis, cancer of the rectum or left side of colon.
- Symptoms of ulcerative colitis?
Why: e.g. recurrent attacks of loose bloody stools; stools may also have pus and mucous; may have mild abdominal pain.
- Symptoms of Crohn's disease?
Why: e.g. recurrent diarrhea in a young person (20-40 years), blood and mucous in stools, colicky abdominal pain (especially in the right lower abdomen), fever, weight loss and malaise.
- Symptoms of iron deficiency anemia?
Why: e.g. lethargy, dizziness, depression, shortness of breath or angina. This would suggest significant rectal blood loss.
- Symptoms of bleeding disorders?
Why: e.g. easy bruising, bleeding gums, bleeding nose, blood in the urine, swollen painful joints.
» Next page: Types of Rectal bleeding
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