The rectum is the last portion of the large bowel that ends just before the anus. Bleeding from this area can be mild, serious, or even life-threatening. It is very common once in a while in babies and adults. The reason for rectal bleeding can be very mild like a skin aberration in the rectum or serious like carcinoma. It can be fresh blood known as splash in the toilet or blood mixed with feces.
In any situation, bleeding per rectum is a medical emergency. You need to get immediate medical care in that condition. Proper diagnosis and treatment are very much essential.
SIGNS AND SYMPTOMS
- maroon-colored stools,
- bright red blood on or in the stool,
- blood on the toilet paper, or
- blood staining the toilet bowl water red.
- abdominal and /or rectal pain,
- dizziness,
- fainting,
- low blood pressure,
- vomiting,
- rapid heartbeat, and
- confusion.
CAUSES
- haemorrhoids
- anal fissures
- diverticula (diverticulitis)
- infections (bacterial and other pathogens)
- inflammatory bowel diseases
- angiodysplasia
- tumors
- polyps
- bowel trauma.
- Upper GI tract problems like ulcers and Mallory-Weiss tears in the esophagus
- a dilated vein or varix.
PATHOPHYSIOLOGY
Pathophysiology of rectal bleeding varies according to the cause. Blood never gets mixed with food or stool anywhere in any normal pathway of digestion. Bleeding per rectum means somewhere the capillaries are broken and bleeding happened. Any pathology in the GI Tract leading to bleeding produce rectal bleeding. Bright red blood usually means bleeding that’s low in the colon or rectum. Dark red or maroon blood can mean the bleeding higher in the colon or in the small bowel. Melena (dark and tar-like stool) often points to bleeding in the stomach, such as bleeding from ulcers.
DIAGNOSIS
physical exam
blood tests,
endoscopy
proctoscopy
CT scans
angiography
nuclear medicine studies.
TREATMENTS
It depends upon the cause.
Stabilizing the patient by blood replenishment and fluid maintenance.
PROGNOSIS
The prognosis of rectal bleeding depends on the cause and the person’s response to treatment. In general, those people who lose a small amount of blood do better than those who lose large amounts of blood and prognosis is better when not associated with other severe diseases.
COMPLICATIONS
The majority of complications like weakness, dizziness, or fainting occur from rectal bleeding when large amounts of blood have been lost.
DISEASE AND AYURVEDA
Gudaja-raktasrava
NIDANA
Causative factors for the vitiation of PITT-rakta, especially
Poisons
Kshata in koshtha or gudavali
Food which is not habitual or suitable to body
Alcohol intake
Haemorrhoids
Faulty routine during ghee intake (as a treatment)
Intestinal parasites
Suppression of natural urges
PURVARUPA
Not mentioned
SAMPRAPTI
Due to the causative factors, Pitta dosha vitiates along with rasa-raktadhatus. When these dosha-dooshyas get lodged inside koshtha & guda, raktavahini siras & dhamanis are broken and bleeding happens. It is then expelled through anus.
LAKSHANA
Passing of stools with blood
Pain & burning sensation of rectum & anus
Divisions
Not mentioned
Prognosis
Kricchrasadhya in healthy individuals without any complications & dhatudushti.
Asaadhya in children, old persons and with complications.
Chikithsa
Ayurveda treatment for gudaja raktasrava includes avoiding the causative factors. Treatment depends upon the disease or condition that is causing the disease. For example, if arsas is causing gudaja raktasrava, treatment for arsas should be done and the bleeding will reduce. Mild fasting is advised if indigestion is present in adults. It cannot be done in small babies & weak people. Management of aggravated Pitta and bringing back the normalcy of Rasa-raktadhatus are the treatment methods.
Samana
Internal medicines with tiktarasa and rookshaguna
Stambhana if the bleeding is heavy
Seethaguna externally and internally
Sodhana
No sodhana is done in children unless fatal & emergency condition.
Therapies done in adults for sodhana include:
Vamana
Virechana
Snehavasti
Kashayavasti-Picchavasti
Commonly used medicines
Vilwadi gulika
Pippallyasavam
Dadimashtakachoornam
Vasaguluchyadi Kashayam
Pushyanuga Churna
Bola Parpati
Annabhedi Sindhooram
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Home remedies
Rectal bleeding is a medical emergency. Better to seek medical help than relying on home remedies.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
carbonated drinks – makes the stomach more acidic and disturbed digestion
refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
curd – causes vidaaha and thereby many other diseases
- To be added
Drink only boiled water
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Better to avoid extreme hot climate
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid sitting continuously for a long time and avoid squatting.
Avoid holding or forcing natural urges like cough, sneezing, urine, faeces etc.
Yoga
Yoga is not advised in people with severe rectal bleeding. Complete bedrest is advised for even an adult patient with loose stools. After regaining normal health, following a daily exercise routine will help the person to improve digestion & health.
Stretching exercises and specific yoga asanas like pavanamuktasana, vajrasana, bhujangasana etc are recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Pavanamuktasana
Vajrasana
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
RESEARCH ARTICLES
DOI: 10.1053/j.gastro.2019.10.035
In patients with moderately to severely active ulcerative colitis, etrasimod 2 mg was more effective than placebo in producing clinical and endoscopic improvements.
DOI: 10.1002/hep.30794
In patients with advanced cirrhosis with coagulopathy and nonvariceal upper GI bleeding, TEG-guided transfusion strategy leads to a significantly lower use of blood components, without an increase in failure to control bleed, failure to prevent rebleed, and mortality in a randomized controlled trial.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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