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Saturday, December 20, 2014

Dr. Peg's Prescription

Rectal bleeding usually more disconcerting than dangerous

You stagger out of bed in the morning, stumble into the bathroom and settle down to business. Some time later you rouse yourself, pull some paper from the roll, and — whoa. What is that? It isn’t supposed to be red. Is that blood?

It might be. Rectal bleeding, or hematochezia as the medical dictionaries like to call it, is a fairly common phenomenon. It can herald anything from yesterday’s news to tomorrow’s disaster. I’ll go through it from best to worst.

First of all, it could just be something you ate. Pickled beets, red Jell-O, a mortal’s blood — you get the idea. What goes in must come out and sometimes it comes out looking a lot like it did when it went in. If you aren’t sure it is from your food, keep a sharp lookout below, as it were, and see if it happens again.

As I’m sure you know, the anus is made of stretchy stuff. Tightly closed most of your life, it opens when pressure from above gives it the signal. Usually the tissue is elastic enough to accommodate the need, but sometimes either the load is too large or the pressure is too great and something has got to give. The result is a fissure, which is a crack or split in the skin of the anus. The circulation around the anus is abundant, so a fissure can produce an alarming amount of blood. Anal fissures often hurt, but they are not dangerous. Most of them heal within a few days.

If you have an anal fissure, increase the fluid and fiber in your diet so your stools will be soft and less painful. Sit in a warm tub for 10 minutes twice a day to soothe and heal the area. Try not to strain hard when you are on the toilet, or to sit there too long. Consider moist toilet paper for wiping.

Moving on, or rather up, or in, we come to the common hemorrhoid, the next most frequent cause of rectal bleeding. A hemorrhoid is a swollen vein in the wall of the rectum or anus. Remember when I said circulation is abundant? That means lots of veins. If you put pressure on a vein, it will swell. Pressure can simply be in the form of gravity, like if you sit or stand for a long time. Or it can be from more intense activity, like lifting weights. When you do that, you usually hold your breath and tighten your abs, right? This increases the pressure inside your belly and intestines, which can weaken the wall of one of those rectal veins, causing it to bulge. Further pressure, or trauma from a passing stool, can cause the bulging vein to bleed.

Hemorrhoids can itch, hurt, or be silent and invisible until they bleed.

Treatment for a bleeding hemorrhoid is similar to treatment for a fissure. Take the pressure off and allow your body time to heal.

Over-the-counter or prescription creams can be used to ease discomfort. Sometimes a clot can form inside the hemorrhoid. This is quite painful, and is treated surgically to remove the clot.

Anal fissures and hemorrhoids can be diagnosed in the clinic by your health provider. We do an external inspection first and if we see a fissure, we usually stop there. If not, we may look inside the anus with a rigid plastic tube called an anoscope. I know, I know — it sounds mortifying. But it is not as bad as it sounds; it is no bigger around than what usually passes through there and it is the only way we can see the lining of the rectum, which can be important.

Why? Because some causes of rectal bleeding are more sinister than fissures or hemorrhoids. Polyps in the colon, diverticulitis, infections, colitis and cancer are some of the real desperados of damage. If you are bleeding from one of these bad guys, you need to know. By looking inside we can inspect a little of the lining of the colon and that can be a clue. This is also the way we find internal hemorrhoids.

If we do all of the above and still can’t find a reason for your bleeding, we may refer you to a specialist. So if you are noticing blood where no blood should be, let us check it out.

Most often it is nothing dangerous, but that determination is best made by professionals. If you haven’t had rectal bleeding, and hope you never do, eat plenty of fiber, drink plenty of liquids and don’t spend too much time sitting, standing or straining.

Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.