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Hematochezia

Definition

What is hematochezia? It is the passage of blood through the anus. It is commonly linked with lower gastrointestinal bleeding.


The exact cause of hematochezia has something to do with the lower gastrointestinal tract. In rare instances, too much bleeding from the upper part of the gastrointestinal tract can also lead to hematochezia. The difference with upper and lower GI tract bleeding is that the upper GI bleeding could result to black tarry stool or medically called melena. (1, 2)

note :

K92.1 is the ICD 10 Code for Hematochezia

Hematochezia Vs Melena

Hematochezia pertains to a bloody stool wherein the blood appears fresh and the color ranges from red to maroon. On the other hand, melena pertains to black, tarry stool indicating that the blood has degraded. (2)

An image detailing the stool described as hematochezia.photo

Photo 1: An image detailing the stool described as hematochezia.
Picture Source: image.slidesharecdn.com

A closer look at the lower gastrointestinal tract.photo

Image 2: A closer look at the lower gastrointestinal tract.
Photo Source: digestive.templehealth.org

Hematochezia Symptoms

  • Lower abdominal cramps
  • The lower abdomen is swollen, which is visible from the outside
  • Constipation/diarrhea
  • Fever
  • Body malaise
  • Dizziness (3)

Causes

There are various culprits for hematochezia. Some of the common causes of hematochezia in adults include the following:

  • Haemorrhoids
  • Diverticulosis (5)
  • Colorectal cancer
  • Ulcerative colitis
  • Inflammatory bowel disease
  • Crohn’s disease
  • Peptic ulcer
  • Gastric cancer
  • Esophageal varices (4)
  • Salmonellosis
  • Food poisoning
  • Eating red colored foods like beet and dragon fruit

Hematochezia in children/newborn/infants

Common causes of hematochezia in children are the following:

  • The infant swallow material blood at the time of delivery
  • Hematochezia in children can be a sign of necrotizing enterocolitis (common in premature infants)
  • Intussusception (hematochezia with abdominal pain) (5, 6)

How to diagnose hematochezia?

There are various diagnostic procedures and laboratory works used to correctly diagnose hematochezia. They are the following:

  1. CT scan
  2. Colonoscopy
  3. Wireless Capsule Endoscopy (WCE)
  4. Double-balloon Enteroscopy
  5. Esophagogastroduodenoscopy (EGD)
  6. Push Enteroscopy
  7. Radionuclide Scans
  8. Angiography
  9. Complete Blood Count
  10. Coagulation profile test (bleeding time test, prothrombin time (PT) test, aPPT or
  11. activated partial thromboplastin time, and manual platelet count test)
    Serum electrolytes level test (6, 7, 8)

Hematochezia Treatment

The treatment for hematochezia primarily depends on the factors that cause it. As for the health care professionals, problems in the gastrointestinal tract such as in hematochezia is handled by a gastroenterologist. Most of the time, the gastroenterologist needs to work hand in hand with a proctologist or a rectal surgeon, especially if the patient needs to undergo a surgical procedure. (8)

The main goal is for the symptomatic relief. The clinical manifestations should be addressed right away. Diagnostic procedures and laboratory work should be done to accurately determine the root cause of the problem. Treatment and management for hematochezia include the following:

  • IV fluids and Blood transfusion – Patients who have been suffering from hematochezia for several days are prone to anemia and low blood volume. Hence, the patient is hospitalized and given intravenous fluid and blood transfusion when deemed necessary. This is to bring the blood pressure to a normal range and prevent dizziness and shock. (9)
  • Colonoscopy – It is done to prevent bleeding, especially if the hematochezia is caused by polyps. However, colonoscopy alone is not that reliable in detecting the bleeding site. It can’t also stop recurrent bleeding. To accurately diagnose the condition of the patient, a visceral angiogram should be performed. The source of bleeding is stopped using angiographic catheter along with certain types of medications. (10)
  • Less invasive methods – mild cases of hematochezia can be treated using a less invasive or even non-invasive approach such as using hemorrhoidal creams, stool softener, or sitz baths. The less invasive treatment methods are recommended for patients with haemorrhoids. Patients are strongly advised to increase their fluid intake and consume foods rich in fiber so as to avoid constipation. Patients should refrain from sitting too long in the comfort room because doing so can add pressure to the bleeding site. (2, 10)
  • Drug therapy – If the cause of hematochezia is diverticulitis, the patient is put on a number of medications, especially drugs that can alleviate abdominal spasms. Examples are diclomine and hyoscyamine. The patient should be put on antibiotic therapy too. Examples are ciprofloxacin, cephalexin, and metronidazole. If the condition of the patient does not improve despite aggressive drug therapy, the next approach is to conduct surgery. The bleeding diverticula should be removed to stop and prevent further bleeding. (2, 3, 4)
  • Other treatment modalities – Hematochezia is possible in patients diagnosed with colorectal cancer. The treatment modalities primarily depends on the severity of cancer. A colorectal cancer in its early stage is easier to treat than a cancer in its advanced stage. A combination of various procedures is done to somehow improve the condition of the patients. This includes chemotherapy and surgery. Palliative care is also given to the patient. Lifestyle and diet modification should be given emphasis too. Patients should refrain from eating high caloric foods and meaty products. Vices should be stopped too, especially smoking and excessive alcohol drinking. (5)

Prevalence, prognosis, and prevention

Hematochezia can affect any age group including small children and geriatric population. Geriatric patients with hematochezia should be given the much needed care and attention because they are prone to hypotension, loss of consciousness, and confusion.

The prognosis is quite good as long as the root cause is determined at an early stage. If the condition is in its advanced stage and the patient belongs to the geriatric population, the prognosis is poor.

To prevent hematochezia, you should follow these tips:

  • Increase your intake of vitamin A and D.
  • Eat foods rich in fiber.
  • Keep your body hydrated by drinking plenty of fluids.
  • Take iron supplements to prevent anemia.
  • Avoid long sitting.

Hematochezia or blood in the stool shouldn’t be taken for granted. Any internal bleeding can be fatal. You should contact your health care provider the minute you notice a blood through your anus. By doing so, the root cause of the problem will be determined and proper treatment and management can be given to the patient. (4, 5, 7)

References:

  1. https://en.wikipedia.org
  2. www.ncbi.nlm.nih.gov
  3. www.webmd.com
  4. www.medicinenet.com
  5. www.healthhype.com
  6. www.verywell.com
  7. www.epainassist.com
  8. emedicine.medscape.com
  9. www.consumerhealthdigest.com
  10. Portable Signs and Symptoms By Lippincott Williams & Wilkins

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