The Gastrointestinal (GI) tract which extends from the mouth to the anus can bleed sometimes; the amount of which can range from nearly undetectable to acute, massive, and life-threatening. It is important to be aware of this, because it may point to many significant diseases and conditions.
Where Does It Bleed?
The bleeding may come from any side along the GI tract, but is often divided into upper GI (between the mouth and the upper part of the small intestine) bleeding and lower GI (between the upper part of the small intestine and the anus, including the small and large bowels) bleeding. You don’t have to be of a particular age for the bleeding to start – you are susceptible right from birth. GI bleeding can range from microscopic bleeding (the amount of blood is so small that it can only be detected by laboratory testing) to massive bleeding (pure blood is passed). Prolonged microscopic bleeding can lead to loss of iron, causing anaemia. Acute, massive bleeding can lead to hypovolemia (a blood disorder consisting of a decrease in the volume of circulating blood), shock, and even death.
Plethora of Causes
The following are only some possible causes of GI bleeding and one can only assess the gravity of the situation.
- Anal fissure: A crack or slit in the mucous membrane of the anus – very painful and difficult to heal.
- Aorto-enteric fistula: Development of an abnormal connection between the abdominal aorta or an abdominal aortic graft and a portion of the bowel.
- Arteriovenous malformations: Also called angiodysplasias, this refers to a small vascular malformation of the gut.
- Bleeding diverticulum, an outpouching of a hollow structure in the GI tract.
- Colon cancer: Also known as large bowel cancer, this includes cancerous growths in the colon, the rectum and the appendix.
- Cow milk allergy is the most common food allergy in young children, though most babies outgrow milk allergies by their second or third year.
- Crohn’s disease: A disease of the small intestine that often spreads to the colon which is a part of the large intestine. Crohn’s disease is characterised by diarrhoea, cramping, and loss of appetite and weight-loss, with local abscesses and scarring.
- Dieulafoy’s lesion: A large tortuous arteriole (minute branch of artery) in the stomach wall that erodes and bleeds.
- Duodenal ulcer: 90 per cent of ulcers in the duodenum (the 25 centimetres long region of the small intestine that occurs after the stomach) are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach.
- Dysentery: Infectious diarrhoea that causes bleeding.
- Oesophageal varices: Extremely dilated sub-mucosal veins in the lower oesophagus.
- Oesophagitis: Inflammation of the oesophagus, often caused by gastroesophageal reflux.
- Gastric (stomach) ulcer: An open sore in the stomach lining.
- Haemorrhoids: Swelling and inflammation of veins in the rectum and anus.
- Ischemic bowel: An insufficient blood supply to the bowel tissue caused by obstruction or disruption of the blood inflow (as in narrowing of arteries by spasm, disease, or injury).
- Intestinal polyps: A small vascular growth on the surface of the intestine.
- Intestinal obstruction, or twisted bowel as it is popularly known, is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.
- Intestinal vasculitis or the inflammation of a blood vessel in the intestine.
- Intussusception happens when the bowel telescopes on itself, folding in to form a pocket in the surface.
- Mallory-Weiss tear: A tear in the lower end of the oesophagus caused by severe vomiting.
- Meckel’s diverticulum: A birth defect in which a small sac forms in the ileum (lower end of the small intestine).
- Portal hypertensive gastropathy: Changes in the mucosa of the stomach in patients with portal hypertension
- Radiation injury to the bowel, caused primarily by cancer treatment.
- Ulcerative colitis: A serious chronic inflammatory disease of the large intestine and rectum characterised by recurrent episodes of abdominal pain, fever, chills and profuse diarrhoea.
Blood on the Floor
With so many reasons to have a GI bleed, it would be good to check if:
- You have black, tarry stools (this may be a sign of upper GI bleeding).
- You have blood in your stool.
- You vomit blood or material that looks like coffee grounds.
Tests & Exams
GI bleeding can be an emergency condition requiring immediate medical attention. Treatment may involve blood transfusions, fluids and medicines injected through a vein or gastric lavage, depending on the severity. Once the condition is stable, a physical examination, including a detailed abdominal examination, will be performed. These tests may be required:
- Complete blood count, clotting tests, platelet count, and other laboratory tests
- Abdominal X-ray
- Upper GI Endoscopy
- Sigmoidoscopy: Intestinal examination from anal insertion with a sigmoidoscope.
- Colonoscopy: Visual examination of the colon with a colonoscope.
- Capsule endoscopy: A camera pill that is swallowed to look at the small intestine.
- Abdominal CT scan
- Abdominal MRI scan
- Bleeding scan: A nuclear medicine imaging test where tagged red blood cells are scanned.
- Angiography: Radiography of vessels after the injection of a radio-opaque contrast material.
One of the more common and simple-to-treat causes is haemorrhoids which are swollen veins in the lower portion of the rectum or anus. This condition is very common, especially during pregnancy and after childbirth. Internal haemorrhoids occur just inside the anus, at the beginning of the rectum. External haemorrhoids occur at the anal opening and may hang outside the anus.
Haemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are sitting. These are the common causes:
- Straining during bowel movements.
- Sitting for long periods of time.
- Anal infections.
- In some cases they may be caused by other diseases, such as liver cirrhosis.
- Over-the-counter Corticosteroid creams can reduce pain and swelling.
- Haemorrhoid creams with Lidocaine can reduce pain.
- Wearing cotton undergarments can reduce itching.
- Avoid toilet tissue with perfumes or colours.
- Try not to scratch the area.
- Sitz baths, where you sit in warm water for 10 to 15 minutes, can help you to feel better.
- Stool softeners help reduce straining and constipation.
- Book an appointment if your symptoms do not improve with home treatment, and especially if you have rectal bleeding. If it’s the first time you are bleeding, it is always advisable to let your doctor rule out other more serious causes. These are the options your surgeon would consider:
- Infrared coagulation: Heat treatment to shrink internal hemorrhoids.
- Sclerotherapy involves making the body react to a mildly irritating injected substance.
- Laser Haemorrhoidectomy, as the name suggests, uses laser to remove the haemorrhoid.
- Stapled haemorrhoidectomy is a minimally invasive procedure that can be performed as a day care surgery. It is the latest and the most effective technique for treatment for haemorrhoids.
Most treatments are effective, but to prevent the haemorrhoids from relapsing, you will need to maintain a high-fibre diet and drink plenty of fluids.
Prevention is Better
GI bleed is much more than a pain in the nether region. Avoid straining during bowel movements. You can help prevent haemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fibre diet of fruit, vegetables, whole grains. Consider fibre supplements