Rectal bleeding is one of the commonest problems that brings a patient to a medical practitioner. The site of blood in the pan is terrifying for the patient and many seek help early. The thought uppermost in their minds is that of the possibility of cancer and reassurance goes a long way to ameliorate their fears. Here is a list of some of the questions that these patients frequently ask and their possible answers:
- I have got rectal bleeding. Have I got cancer?
Ans: Not necessarily. In fact cancer is a relatively rare cause for rectal bleeding. The commonest cause ishaemorrhoids or piles. Other causes include anal fissure, anorectal fistula, colitis and non-cancerous (benign) polyps, etc
- I have got fresh rectal bleeding associated with pain when I pass stool. Have I got piles?
Ans: Pain is an extremely rare symptom of piles (haemorrhoids). Typically haemorrhoids cause painless fresh rectal bleeding . However haemorrhoids may become painful if a blood clot develops inside an external pile (the so-called ‘thrombosed’ pile). Rectal bleeding associated with pain is typical for anal fissures, not piles
- What is a fissure?
Ans: A fissure is a tear in the skin covering the anal canal. It most commonly follows a bout of constipation and can be extremely painful. Pain is sometimes associated with bleeding but not always
- Do I need surgery for rectal bleeding?
Ans: Most of the conditions causing rectal bleeding such as haemorrhoids, anal fissures and colitis can be treated without surgery. However, in some cases surgery may be necessary especially when initial non-surgical methods fail
- What investigations do I need for diagnosing the source of bleeding?
Ans: The best way to demonstrate the source of bleeding is to introduce a scope through the bottom (lower gastrointestinal endoscopy) and have a look inside the bowel. There are three types of lower GI endoscopy: a) proctoscopy, b) flexible sigmoidoscopy and c) colonoscopy
Proctoscopy involves inserting a very short tube through the anal opening and looking at the lower end of the rectum. This can be easily done in the outpatients department and is very good in diagnosing piles
Flexible sigmoidoscopy is a limited colonoscopy and involves looking at about 70 cm of large intestine from the anal opening. It is indicated for patients who present with isolated fresh rectal bleeding
Colonoscopy is indicated for people who have change in bowel habits (loose motions or recent constipation) with or without rectal bleeding. It aims to look at the whole length of the colon and sometimes the last portion of the small intestine
- Colonoscopy? I have heard it is quite painful.
Ans: Colonoscopy is performed under sedation and most find the examination tolerable. We, however, can do it under a heavy sedation (short general anaesthetic) if someone so wishes and make it completely pain-free for the patient
- Is colonoscopy dangerous?
Ans: Performed with care and due caution, colonoscopy is an extremely safe procedure. Complications, such as perforation and bleeding are extremely rare
- I have been diagnosed with piles. Do I need surgery?
Ans: Most piles don’t need surgery. The decision depends a bit on how big the piles are and whether they are dropping out of the anal opening. Most haemorrhoids can be treated through non-surgical methods. Large haemorrhoids may need surgery
- Is surgery the only way to treat fissures?
Ans: No not at all. Many fissures can be cured by medications. Some need surgery, especially those where initial medical treatments fail
- What are polyps?
Ans: It is a wart-like swelling projecting from the internal lining (mucous membrane) of the intestine. This may be a cause for bleeding through the rectum
- Do I need open surgery for polyps?
Ans: Not necessarily. Most polyps can be removed through the colonoscope and there is no need for open surgery. However, with bigger polyps open surgery may be necessary
- What is a fistula?
Ans: Fistula is an abnormal connection between the inside of the rectum and skin. It produces recurrent infection and discharge
- What is the treatment for fistula?
Ans: Most can be treated with simple surgery which requires only an overnight stay at the hospital. However, some of the more complex fistulas may need more extensive surgery
- Is colon cancer curable?
Ans: Colon cancers if caught early are completely curable. Many of the early colonic cancers are curable by surgery alone but some may need chemotherapy after surgery. The survival rate (expressed as five year survival rate) is more than 90% for Stage A cancers and is close to 75% for Stage B cancers. Even with Stage C cancers (ie, involvement of regional lymph nodes) the five year survival is more than 50% following surgery and chemotherapy.
Dr Jai Choudhuri,
Consultant, General Surgery