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Bleeding PR

 

Bleeding PR (per rectum) refers to the passage of blood through the rectum. It can range from visible blood in the stool to occult (hidden) blood detected through tests. The causes can vary widely, from benign conditions to serious medical issues. Here’s a detailed overview:

Common Causes:

  1. Hemorrhoids:

    • Swollen veins in the lower rectum and anus, often causing bright red blood on the toilet paper or in the toilet bowl.

  2. Anal Fissures:

    • Small tears in the lining of the anus, typically causing pain and bright red bleeding during or after bowel movements.

  3. Diverticular Disease:

    • Small pouches (diverticula) in the colon wall can become inflamed or bleed.

  4. Colorectal Polyps:

    • Growths on the inner lining of the colon or rectum, which can bleed. Some polyps can develop into cancer.

  5. Colorectal Cancer:

    • Malignant tumors in the colon or rectum, often causing blood in the stool, changes in bowel habits, and abdominal pain.

  6. Inflammatory Bowel Disease (IBD):

    • Includes Crohn’s disease and ulcerative colitis, causing inflammation, ulcers, and bleeding in the digestive tract.

  7. Gastrointestinal Infections:

    • Bacterial, viral, or parasitic infections can cause diarrhea and bleeding.

  8. Angiodysplasia:

    • Abnormal, fragile blood vessels in the gastrointestinal tract can bleed.

  9. Peptic Ulcers:

    • Sores in the lining of the stomach or duodenum can cause upper gastrointestinal bleeding, which may be seen as dark or tarry stools.

  10. Proctitis:

  • Inflammation of the lining of the rectum, which can cause rectal bleeding and pain.

Symptoms to Watch For:

  • Visible Blood: Bright red blood in the stool, on the toilet paper, or in the toilet bowl.
  • Melena: Black, tarry stools indicating upper gastrointestinal bleeding.
  • Changes in Bowel Habits: Diarrhea, constipation, or changes in stool caliber.
  • Abdominal Pain: Pain or cramping associated with bleeding.
  • Weight Loss: Unexplained weight loss.
  • Fatigue: Due to anemia from chronic blood loss.

Diagnosis:

  • Physical Examination:

    • Includes a digital rectal exam to check for hemorrhoids, fissures, or masses.

  • Stool Tests:

    • To detect hidden (occult) blood.

  • Blood Tests:

    • To check for anemia and signs of infection or inflammation.

  • Colonoscopy:

    • A flexible tube with a camera is used to view the entire colon and rectum.

  • Flexible Sigmoidoscopy:

    • Similar to a colonoscopy but only examines the rectum and lower colon.

  • Upper Endoscopy:

    • To examine the upper digestive tract if upper gastrointestinal bleeding is suspected.

  • Imaging Studies:

    • CT scans, MRI, or angiography to locate sources of bleeding.

Treatment:

  • Hemorrhoids and Anal Fissures:

    • Topical treatments, sitz baths, dietary changes to prevent constipation.

  • Diverticular Disease:

    • Dietary modifications, antibiotics, or surgery if complications arise.

  • Polyps and Cancer:

    • Removal during colonoscopy, surgery, chemotherapy, or radiation therapy.

  • Inflammatory Bowel Disease:

    • Medications to reduce inflammation, immune-suppressants, or surgery.

  • Infections:

    • Antibiotics or antiparasitic medications.

  • Angiodysplasia:

    • Endoscopic treatments like cauterization or medications to control bleeding.

  • Peptic Ulcers:

    • Medications to reduce stomach acid, antibiotics for H. pylori infection, or surgery if necessary.

When to Seek Medical Attention:

  • Significant or persistent rectal bleeding.
  • Associated symptoms like severe abdominal pain, dizziness, or fainting.
  • Unexplained weight loss or changes in bowel habits.
  • If over-the-counter treatments for hemorrhoids or fissures do not resolve the issue.

Prompt medical evaluation is crucial to determine the underlying cause and appropriate treatment for bleeding PR.

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