Anal Bleeding Bright Red

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Affiliation
1 Department of Surgery, University of Western Australia, Fremantle Hospital, Fremantle, Australia.
D Mehanna et al. ANZ J Surg. 2001 Dec.
Affiliation
1 Department of Surgery, University of Western Australia, Fremantle Hospital, Fremantle, Australia.
Background: Chronic, bright red, rectal bleeding is a common symptom in our community and the aetiology is frequently benign anal disease. The aim of the present study was to determine the efficacy of performing a flexible sigmoidoscopy on patients with chronic, bright red, rectal bleeding who are at low risk for colorectal neoplasia and who, on rigid sigmoidoscopy, are found to have an identifiable anal cause (e.g. haemorrhoids, fissure) for their bleeding.
Methods: A prospective study was conducted on patients presenting with chronic, bright red, rectal bleeding. Patients were considered at low risk for colorectal neoplasia if they fulfilled the following criteria: (i) less than 55 years of age; (ii) no past or family history of colorectal neoplasia or inflammatory bowel disease; (iii) no symptoms of altered bowel habit or abdominal pain; and (iv) a source of bleeding identified (e.g. haemorrhoids, fissure) on rigid sigmoidoscopy. All patients underwent a flexible sigmoidoscopy.
Results: Eighty-two patients were entered into the trial, mean age 39 +/- 9 years (range: 22-55 years), and the ratio of men:women was 1.8:1. The anal cause of bleeding was haemorrhoids in 96%, and anal fissure in 4%. At flexible sigmoidoscopy, five patients were found to have adenomatous polyps. Rigid sigmoidoscopy missed diminutive neoplastic lesions in 6% of patients.
Conclusions: Flexible sigmoidoscopy results in a low yield of colorectal neoplasia in patients presenting with chronic, bright red, rectal bleeding who are at low risk for colorectal neoplasia and who have an identifiable anal cause for their bleeding.
Macrae F. Macrae F. ANZ J Surg. 2001 Dec;71(12):699-700. doi: 10.1046/j.1445-1433.2001.test.2282.x. ANZ J Surg. 2001. PMID: 11906379 No abstract available.
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Olde Bekkink M, McCowan C, Falk GA, Teljeur C, Van de Laar FA, Fahey T. Olde Bekkink M, et al. Br J Cancer. 2010 Jan 5;102(1):48-58. doi: 10.1038/sj.bjc.6605426. Epub 2009 Nov 24. Br J Cancer. 2010. PMID: 19935790 Free PMC article. Review.
Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, Cocorullo G, Giordano P, Mistrangelo M, Trompetto M. Gallo G, et al. Tech Coloproctol. 2020 Feb;24(2):145-164. doi: 10.1007/s10151-020-02149-1. Epub 2020 Jan 28. Tech Coloproctol. 2020. PMID: 31993837 Free PMC article. Review.
Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Trompetto M, et al. Tech Coloproctol. 2015 Oct;19(10):567-75. doi: 10.1007/s10151-015-1371-9. Epub 2015 Sep 24. Tech Coloproctol. 2015. PMID: 26403234
Carlo P, Paolo RF, Carmelo B, Salvatore I, Giuseppe A, Giacomo B, Antonio R. Carlo P, et al. World J Gastroenterol. 2006 Dec 7;12(45):7304-8. doi: 10.3748/wjg.v12.i45.7304. World J Gastroenterol. 2006. PMID: 17143945 Free PMC article.

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Rectal bleeding can refer to any blood that passes from your anus, although rectal bleeding is usually assumed to refer to bleeding from your lower colon or rectum. Your rectum makes up the lower portion of your large intestine.
Rectal bleeding may show up as blood in your stool, on the toilet paper or in the toilet bowl. Blood that results from rectal bleeding is usually bright red in color, but occasionally can be dark maroon.
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Strate L. Etiology of lower gastrointestinal bleeding in adults. https://www.uptodate.com/contents/search. Accessed Jan. 16, 2020.
Gastrointestinal bleeding. National Institute for Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding. Accessed Jan. 16, 2020.
Understanding minor rectal bleeding. American Society for Gastrointestinal Endoscopy. https://www.asge.org/home/for-patients/patient-information/understanding-minor-rectal-bleeding. Accessed Jan. 16, 2020.
Innes JA, et al., eds. The gastrointestinal system. In: MacLeod's Clinical Examination. 14th ed. Elsevier. 2018. https://www.clinicalkey.com. Accessed Jan. 16, 2020.
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