Rectal Bleeding (Rectorrhagia)

CLINICAL DIAGNOSTIC MANUAL

Rectal bleeding, or rectorrhagia, refers to the passage of bright red blood through the rectum, typically mixed with stool, and is a symptom indicating bleeding in the lower gastrointestinal tract, specifically the colon, rectum, or anus.

This condition can vary in severity from mild blood spotting on toilet paper to massive haemorrhage, which can be life-threatening. Identifying the underlying cause of rectorrhagia is crucial for determining the appropriate treatment and preventing serious complications.

Condition	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Haemorrhoids	Inflamed and dilated veins in the rectum or anus, itching, pain, and bright red bleeding	Medical history and physical examination	Anoscopy or sigmoidoscopy
Anal fissure	Tears or cracks in the anus, severe pain during defecation, bleeding	Medical history and physical examination	Anoscopy
Diverticulitis	Abdominal pain, fever, rectal bleeding	Medical history and physical examination	Abdominal CT scan, colonoscopy
Rectal carcinoma	Changes in bowel habits, blood in stool, abdominal pain, weight loss	Medical history, physical examination	Colonoscopy with biopsy
Colon carcinoma	Blood in stool, persistent changes in bowel habits, abdominal pain, fatigue	Medical history, physical examination	Colonoscopy with biopsy
Ulcerative colitis	Bloody diarrhoea with mucus, abdominal pain, urgency to defecate	Medical history, physical examination	Colonoscopy with biopsy
Massive upper gastrointestinal bleeding	Vomiting blood (haematemesis), black tarry stools (melaena), hypotension, shock	Medical history, physical examination	Upper endoscopy
Crohn’s disease	Chronic diarrhoea, abdominal pain, weight loss, occasionally rectal bleeding	Medical history, physical examination	Colonoscopy with biopsy, CT or MRI
Meckel’s diverticulum	Painless rectal bleeding, intestinal obstruction	Medical history, physical examination	Technetium-99m pertechnetate scan (Meckel scan)
Trauma	Physical injuries to the rectal or anal area, bleeding	Medical history, physical examination	Anoscopy, sigmoidoscopy, CT depending on the type and extent of trauma
Intussusception	Severe abdominal pain, obstruction, rectal bleeding	Medical history, physical examination, abdominal ultrasound	Abdominal CT scan, colonoscopy
Other causes	Vary depending on the aetiology, including infections, ischaemic colitis, prior radiation therapy, angiodysplasia	Medical history, physical examination, specific analysis based on suspicion	Specific tests based on suspected cause (e.g., colonoscopy, angiography)