Rectal bleeding refers to rectal hemorrhage (bleeding), and more generally the more or less abundant emission of blood through the anus. We also speak more rarely of hematochezia.

In medicine, we speak of rectorragia when the anus emits bright red blood. This is “undigested” blood, indicating hemorrhage from the lower digestive system. In the event of “upper” digestive bleeding, for example in the stomach, the blood in the stools is black (in this case we speak of melena or black stools).

Note that rectal bleeding is more frequent in the elderly, mainly men.

The rectal bleeding may occur after having a bowel movement, be recurrent or not. It can be more or less abundant, depending on the cause. When it is major (about 10% of cases), rectal bleeding can lead to blood loss requiring urgent care.

The rectal bleeding can also be minimal, invisible to the naked eye. These “occult bleeding” can be a sign of colon cancer, which is why they are systematically looked for from the age of 50, using a screening test.

It may be accompanied by other symptoms such as:

• anal pain;
• anal pruritus (itching)
• digestive pain;
• diarrhea or constipation;
• anemia, pallor;
• fever ;
• or a deterioration of the general condition.

In about 90% of cases, rectal bleeding is of colorectal or anal (proctological) origin. Many causes are possible, among others at the anorectal level. Let us quote for example:

• the presence of hemorrhoids: bleeding usually occurs after a bowel movement, and may be accompanied by discomfort or anal pain;
• anal trauma (and in particular the insertion of a thermometer, an enema, sexual practices, etc.);
• anal fissure, often associated with constipation;
• or even certain anal dermatoses (such as psoriasis, eczema, etc.).

When the bleeding involves the colonic or rectal area, the causes may be:

• diverticulosis (the presence of diverticula or abnormal cavities in the colon);
• a polyp or cancer of the anus, rectum or colon (in this case the bleeding is often minimal or even occult);
• or colitis (whatever the cause, inflammatory, infectious or ischemic), so certain inflammatory diseases such as ulcerative colitis or Crohn’s disease.

Finally, some treatments can be responsible for digestive bleeding, such as:

• radiotherapy;
• or taking blood thinners or nonsteroidal anti-inflammatory drugs.

Rectal bleeding is not a symptom to be taken lightly: even a small one, it can be a sign of potentially serious pathologies and lead to chronic anemia, or even be life-threatening.

It is therefore important to consult a doctor quickly to carry out the examinations necessary for the diagnosis.

The treatment of rectal bleeding obviously depends on the cause. The first step is therefore to locate the lesion. To do this, the doctor will perform various examinations, either proctological (examination of the anus and rectum) or imaging (colon endoscopy or colonoscopy, for example). A blood test will also assess the impact of bleeding on blood composition.

In the event of significant blood loss, intensive care will allow blood transfusions to be performed, if necessary.

In some cases, surgery will be necessary to treat the lesion in question and stop the bleeding (or prevent recurrence).