Blood on your toilet paper? Know what’s causing it.

Ever noticed spots of blood on the toilet paper, your underpants, or how the water runs pink in the flush area?

These are often tell-tale signs of piles or an anal fissure, which refers to a small tear in the anus. The quantity of blood that is passed from person to person varies widely. Bleeding from the bottom or in medical terms ‘Rectal Bleeding’ is a common symptom among 15% of adults.

However, rectal bleeding should not be ignored. If the blood is darker, sticky or black it usually means that its origin is from the digestive tract and can also be the sign of a more serious health condition, including bowel cancer.

Hence it is important to seek medical advice about your symptoms. Dr. Jai Chaudhuri, a Laparoscopic and Gastrointestinal Surgeon of international repute, practicing in Narayana Multispeciality Hospital, Barasat answers some common queries and concerns that patients frequently ask.

1. I have experienced rectal bleeding. Do I have cancer?

Not necessarily. In fact, cancer is a relatively rare cause of rectal bleeding. The most common cause is Haemorrhoids or Piles. Other causes include anal fissure, anorectal fistula, colitis and non-cancerous (benign) polyps.

2. I have rectal bleeding associated with pain when I pass stool. Do I have piles?

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 of anal fissures, not piles.

3. What is a fissure?

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.

4. Do I need surgery for rectal bleeding?

Most of the conditions causing rectal bleeding such as haemorrhoids, anal fissures and colitis can be treated without surgery. However, in some cases, surgery might be necessary especially when initial non-surgical methods fail.

5. What are the investigations required to diagnose the source of my rectal bleeding?

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 – Proctoscopy, Flexible sigmoidoscopy, and Colonoscopy.

Proctoscopy involves inserting a very short tube through the anal opening and observing the lower end of the rectum. This can be easily done in the outpatient department and is very good for diagnosing piles.

Flexible sigmoidoscopy is a limited colonoscopy and involves looking at 70 cms of the large intestine from the anal opening. It is indicated for patients with isolated and fresh rectal bleeding.

Colonoscopy is indicated for people who display a 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.

6. What is Colonoscopy? I heard it can be quite painful.

Colonoscopy is performed under sedation and most find the examination tolerable. Doctors can inject a heavy sedative, with short general anesthetic, if the patient wishes to make it completely pain-free.

7. Is colonoscopy dangerous?

Performed with care and due caution, colonoscopy is an extremely safe procedure. Complications such as perforation and bleeding are extremely rare.

8. I have been diagnosed with piles. Do I need surgery?

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 require surgery.

9. Is surgery the only way to treat fissures?

No, not at all. Many fissures can be cured by medications. Some need surgery, especially for those where initial medical treatments fail.

10. What are polyps?

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.

11. Do I need open surgery for polyps?

Not necessarily. Most polyps can be removed through the colonoscope and there is no need for an open surgery. However, with bigger polyps, open surgery may be necessary.

12. What is a fistula?

Fistula is an abnormal connection between the inside of the rectum and skin. It produces recurrent infection and discharge.

13. What is the treatment for fistula?

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

14. Is colon cancer curable?

Colon cancers, if diagnosed at the initial stage, can be completely cured. Many of the early diagnosed colonic cancers are curable by surgery alone, but some may need chemotherapy post surgery. The survival rate is more than 90% for Stage A cancers, and is close to 75% for Stage B cancers. Even with Stage C cancers (i.e., involvement of regional lymph nodes), the five year survival rate is more than 50% with surgery and chemotherapy.

The sight of blood in the pan can be terrifying as the thought uppermost in their minds is that of the possibility of cancer. Simple tests and procedures can go a long way to reassure patients and ameliorate their fears.

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