Minor rectal bleeding (MRB) is when a few drops of bright red or fresh blood pass from the rectum into stools, toilet paper and/or a toilet bowl. Most of the causes of MRB are benign, not life threatening and easily treatable. There are, however, instances where rectal bleeding is a symptom of colon cancer, which can be cured if it is detected early enough. The key takeaway is that patients who experience MRB should be evaluated by a gastroenterologist.

MRB can be caused by:

• Anal fissures
• Proctitis (inflammation of the rectum)
• Hemorrhoids
• Rectal ulcers
• Colon or rectal polyps
• Colon or anal cancer

How Gastroenterologists Evaluate MRB

There are several techniques that gastroenterologists use to examine patients for MRB. This includes looking for anal fissures, cancer or external hemorrhoids and using a lubricated and gloved finger to feel for abnormalities in the lower rectum and anal canal. The doctor may also perform a sigmoidoscopy or a colonoscopy, which both involve inserting a flexible tube that contains a small camera through the anus to examine a part of or the entire colon. Patients are typically sedated before these procedures to ensure they are comfortable. Gastroenterologists sometimes perform a flexible sigmoidoscopy — which uses a shorter tube — to examine the lower colon and rectum. And in examinations that are limited to the lower rectum and anal canal, a three- to four-inch anoscope examination may be performed; this is applicable and especially useful when the doctor suspects the bleeding is related to hemorrhoids, anal cancer or anal fissures.

Anal Fissures

CAUSES
Anal fissures are tears that occur in the lining of the anus. These are usually caused by constipation and passing hard stools, although they can also be the result of diarrhea or inflammation of the anus. In addition to bleeding from the rectum, anal fissures may cause significant pain and a sensation of tearing, ripping or burning during and immediately after bowel movements.

TREATMENTS
Most anal fissures can be treated with simple remedies like fiber supplements, stool softeners and laxatives
(if the cause is constipation) and Sitz baths. The gastroenterologist may also prescribe a cream to soothe the inflamed area and an ointment to help heal the fissure. Fissures that don’t heal with the use of medication may require a botulinum toxin injection, and surgery may be necessary in more severe cases.

Proctitis

CAUSES
Proctitis is the inflammation of the lining of the rectum. It can be caused by radiation therapy for various cancers, medications, infections or a form of inflammatory bowel disease (IBD). Proctitis can cause the sensation of not having completely empty bowels after a bowel movement or the frequent urge to have a bowel movement. Other symptoms include passing mucus through the rectum, rectal bleeding and pain.

TREATMENTS
Gastroenterologists treat proctitis in a variety of ways, depending on the root cause.

Hemorrhoids

CAUSES
Hemorrhoids or piles are blood vessels in the anus and rectum that become swollen or engorged due to increased pressure — in much the same way varicose veins form in the legs. Hemorrhoids can either be internal (inside the anus) or external (under the skin around the anus). They are the most common cause of MRB. Hemorrhoids typically aren’t painful unless they result in a blood clot or a thrombosed hemorrhoid. They may also cause anal itching, bulging around the anus or fecal soiling (i.e., the passing of stool into clothing). Hemorrhoids are caused by constipation, diarrhea, sitting or standing for long periods, obesity, heavy lifting, straining and pregnancy. Hemorrhoids are common, especially as we age. The good news is that hemorrhoids do not lead to cancer.

TREATMENTS
The first step gastroenterologists normally take to treat hemorrhoids is to treat the patient’s underlying constipation. This includes increasing the amount of fiber in the diet or taking a fiber supplement to soften the stool. Stool softeners or laxatives are a good next step. In addition, soaking the rectal area in warm water for 10 to 15 minutes two to three times a day can relax the muscle around the anus to alleviate pain. This can be done in a bathtub or by using a Sitz bath, which is available in most drugstores. There are also over-the-counter creams and suppositories that can help relieve the
symptoms. Gastroenterologists sometimes use other methods to reduce the size of or eliminate hemorrhoids and each one differs when it comes to the success rate, risks and recovery time.

These include:

• Rubber band ligation, which is the most common outpatient procedure to treat hemorrhoids in the U.S. This involves placing rubber bands around the base of an internal hemorrhoid to cut off its blood supply, which causes it to shrink. In a few days, the hemorrhoid and rubber band fall off during a bowel movement. Possible complications include pain, bleeding and infection. Patients who have this procedure often get prescriptions for pain medication and stool softeners. Patients who experience pain, fever or rectal bleeding following this procedure should contact their gastroenterologist immediately.
• Office-based laser or infrared coagulation and sclerotherapy, which involves injecting medicine into the hemorrhoids.
• Surgery to remove the hemorrhoids if the symptoms persist despite the use of rubber band ligation, coagulation or sclerotherapy.

Rectal Ulcers

CAUSES
Solitary rectal ulcer syndrome is an uncommon condition that can affect men and women, and it may be associated with long-standing constipation and prolonged straining during bowel movements — although the cause is not always clear. This condition can cause bleeding from the rectum, rectal pain and the passage of mucus.

TREATMENTS
Treatment normally involves fiber supplements and laxatives to relieve constipation, although surgery may be required if the symptoms are significant.

Colon and Rectal Polyps

CAUSES
Polyps are benign growths that can develop in the lining of the large bowel. While most are harmless, polyps that develop in the lower colon and rectum can cause minor bleeding.

TREATMENTS
Gastroenterologists use colonoscopy to detect and remove colon polyps, action that’s crucial because these polyps can turn into colon cancer.

Colon ancer

CAUSES
Most colon cancers are the result of polyps that have gone untreated for several years. Colon cancer can
affect men and women of every ethnicity, and it is the second most common cause of cancer deaths in the
U.S. Colon cancer may cause rectal bleeding, and it is often diagnosed in people who’ve had longstanding bouts of rectal bleeding that were presumed to be related to hemorrhoids. It is a generally slow-growing cancer that can be cured if it is detected early enough, which is why patients who experience MRB should see a gastroenterologist as soon as symptoms appear.

TREATMENTS
A colonoscopy, which could lead to the removal of any polyps, is the best way to reduce the risk of
colon cancer. It is also worth noting that while less common, anal cancer is also curable when it’s diagnosed early enough.

About the American Society for Gastrointestinal Endoscopy (ASGE)

Since its founding in 1941, the ASGE has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal (GI) endoscopy. ASGE physicians have highly specialized training in endoscopic procedures of the digestive tract, including upper GI endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).

Visit ASGE.org for details on ASGE’s Understanding Minor Rectal Bleeding

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.