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ANORECTAL CONDITIONS

 

Rectal Bleeding

 

What are the different types of rectal bleeding?

Rectal bleeding or blood per rectum is any blood passed from your anus. Bright red blood usually comes from your lower rectum and anus although it may also be from your colon, intestine, or stomach if bleeding is extensive. Darker, maroon colored stool may be from your colon or small intestine. Sometimes stool may be tarry in color, which usually implies bleeding from higher in your GI tract such as your stomach. Bleeding may be a small amount, which appears only on tissue paper when wiping, it may drip in the toilet bowel with bowel movements or it may be more voluminous or mixed in your stool.

What causes rectal bleeding?

Rectal bleeding may be caused by a number of problems including hemorrhoids, anal fissure (or tear in your anus), constipation with hard stool passage, diarrhea that has irritated your anus, infections such as abscess or fistula, or more serious conditions such as inflammation, infection or cancers of your GI tract.

What should I do if I have rectal bleeding?

All rectal bleeding should be evaluated by a physician. Early detection is key. While hemorrhoids are the most common cause of rectal bleeding, it should never be assumed that hemorrhoids are the cause until you have had a thorough exam including a digital rectal exam, and and/or other procedures such as anoscopy or colonoscopy to exclude more serious problems. If you are experiencing rectal bleeding, call now to make an appointment for a consultation with Dr. Zaghiyan in her office in Los Angeles.

How is rectal bleeding treated?

Colorectal surgeons are trained in the diagnosis, medical and surgical treatments for rectal bleeding. Rectal bleeding is treated by identifying the cause of bleeding and treating that particular condition. Hemorrhoids can usually be managed with steroid creams and office based procedures. Sometimes when hemorrhoids are more extensive, surgery may be recommended. Anal fissure can generally be treated with high fiber diet, warm baths and topical creams but in some cases surgery may be necessary if your symptoms do no resolve with conservative measures. Abscesses can usually be unroofed in the office or as outpatient surgery under anesthesia. Fistulas may need surgical repair.

If your symptoms suggest that bleeding may be from your colon a colonoscopy may be recommended. Sometimes an upper endoscopy or other tests such as capsule endoscopy, double balloon enteroscopy, or bleeding scans may be necessary to identify the source obscure GI bleeding.

Cancer Screening and Prevention

Colon cancer can be prevented. Detection and removal of polyps (the precursors to colon cancer) by screening colonoscopy has been shown to prevent cancer. The majority of colorectal cancers could have been prevented if appropriate colorectal screening was carried through. Most polyps and early cancers do not cause symptoms. In fact, most colon cancers do not cause symptoms until they are very large. The preferred test for colon cancer screening is colonoscopy because it is not only diagnostic, but also therapeutic (by removal of polyps – and thereby prevention of colon cancer).

When should you be screened for colorectal cancer?

All individuals who are average risk and not African American should have a screening colonoscopy beginning age 50, then every 10 years if no cancers or polyps are found.

African Americans have a higher risk of colorectal cancer. A screening colonoscopy is recommended beginning age 45 then every 10 years if no polyps or cancers are found.

A family history of colorectal cancer or polyps suggests a higher risk of colorectal cancer. Individuals with a family history of colorectal cancer should have a colonoscopy at age 40 or 10 years before the youngest affected relative.

Cancer in several close relatives may suggest your family carries a hereditary cancer syndrome. Individuals with colorectal cancer or various other cancers such as uterine or ovarian cancer in several close relatives, especially if cancers occurred at a young age, should have genetic counseling and potentially genetic testing to exclude the possibility of inherited forms of colorectal cancer such as hereditary non-polyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP). It may be recommended that colon cancer screening begin in the teens’ or 20’s for families who are at risk for one of these inherited cancer syndromes.

Polyps detected at the time of colonoscopy may put you at risk for developing new polyps or cancer. Individuals who have a polyp detected should have repeat colonoscopies every 3 to 5 years.

Inflammatory bowel disease (IBD) such as ulcerative colitis (UC) or Crohn’s disease (CD) may put you at higher risk of developing colorectal cancer. Individuals with a diagnosis of UC or CD with severe inflammation of the colon or rectum should have a colonoscopy with biopsies 8 years after initial diagnosis then every 2 years.

Women with a personal history of breast, ovarian or uterine cancer may have a higher risk of colon cancer and should have a colonoscopy starting age 40 then every 5 years.

Do not wait to be screened. Colon cancer is preventable. Call to make an appointment with Dr. Zaghiyan to discuss your screening options and any symptoms you are experiencing.