‘10% rectal bleeding patients need surgery’
In an interview with The Tribune, Dr SPS Grover, a general physician, sheds light on the causes of rectal bleeding and the importance of early diagnosis and treatment
Dr SPS Grover, a general physician at New Ruby Multi-Specialty Hospital in Jalandhar, shares insights on managing rectal bleeding in diabetic patients.
What happens in the condition of rectal bleeding?
Rectal bleeding, also known as Hematochezia, refers to the passage of blood per rectum. This can range from a small streak of blood on stool or toilet paper to a large volume of blood. Abdominal pain may accompany rectal bleeding and this condition can affect any patient, whether or not they have been diagnosed with diabetes prior to the bleeding episode.
What are the chances of a diabetic patient suffering from rectal bleeding?
Diabetic patients may experience abdominal pain and rectal bleeding due to issues in the lower gastrointestinal tract. While rectal bleeding can occur in any patient, the incidence is around 33-87 per 100,000 patients, regardless of whether they have diabetes.
How does a doctor diagnose this condition?
Diagnosis involves taking a detailed clinical history, performing a physical examination, and conducting hematological and biochemical investigations. Endoscopies and radiographic imaging are also crucial. Rectal bleeding can originate anywhere in the intestine, from the ligament of treitz to the anus.
What are the causes of rectal bleeding?
Rectal bleeding can be caused by a variety of conditions, including anal fissures, scarring carcinoma of the colon and rectum, inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis, bacillary dysentery and conditions like intussusception or mesenteric infarction in the small intestine.
What is the common age group for this condition?
Rectal bleeding is common in individuals under 40 years of age, particularly children. A common trigger is constipation. Mesenteric infarction, however, typically affects the elderly, especially those with a history of metabolic syndrome, diabetes or heart disease.
Why does rectal bleeding cause trauma for the patient?
Patients often experience significant trauma due to the pain associated with defecation, which can persist for minutes to hours. This pain may make the patient fearful of using the bathroom. Blood may appear on toilet paper or as streaks on the stool. In severe cases, patients may draw up their legs, scream in pain, or even collapse due to the severity of the bleeding.
What treatments are available for rectal bleeding?
In diabetic patients, it is crucial to address rectal bleeding and abdominal pain promptly, as their slow healing and reduced immunity can complicate recovery. Conditions like ulcerative colitis and Crohn’s disease require long-term treatment with medication. Around 90% of patients recover with medical treatment, while about 10% may need surgery, such as colectomy for ulcerative colitis or fistulectomy for Crohn’s disease. Polyps in the large intestine can often be removed endoscopically. Ischemic colitis requires urgent medical intervention and large gut cancer may require surgical resection, sometimes followed by radiation therapy. Diverticular disease usually responds to medical management but may occasionally require surgery. Advanced diagnostic tools like double balloon enteroscopy, spiral enteroscopy, capsule endoscopy, CT angiography and catheter angiography can help detect lesions. Biopsy samples may be needed for further analysis. In cases of significant blood loss, especially in anaemic patients, immediate care is crucial.
How can rectal bleeding be prevented?
Preventing rectal bleeding depends on its underlying cause. For example, piles-related bleeding can be minimized by avoiding constipation, reducing spicy foods, and cutting back on junk food. A high-fibre diet is beneficial for preventing abdominal issues. In diabetic patients, a thorough medical history, physical examination and relevant tests are necessary to confirm the diagnosis and provide the appropriate treatment to improve the patient’s chances of recovery and save their life.
Punjab