What to do in case of anal bleeding?

“Anal bleeding is the discharge of blood from the anal canal, which is the final tract of the intestine, visually represented by a normally “funnel-shaped” structure surrounded by the muscle fibers of the anal sphincter,” Dr. Stuto explains.

Bleeding in this area, due to natural causes, may show up in different modalities, which need to be more thoroughly evaluated by the physician, such as:

• dripping, which goes into the toilet water;
• glazing in the outer contour of the feces;
• traces on the toilet paper (paper bleeding).

Anal bleeding vs occult blood

Anal bleeding is often mistakenly associated with occult blood testing. There is, in any case, a big difference between them:

• The occult blood test, as the word implies, is used to assess, through a stool sample, the presence of blood intermingled with stool that is not evident to the naked eye.
• Anal bleeding is an already obvious bleeding, so there is no need to search for it, nor should the occult blood test be performed in this circumstance, as the collected sample would be easily contaminated.

“The goal of the occult blood test is to assess, particularly in individuals over 45 or with a family history, the presence of intestinal polyps, which have a tendency to bleed. These are small growths present in the colon that, in any case, if neglected and not removed can lead to neoplasia,” Dr. Stuto concludes. 

For this reason, after the age of 45 or in the case of one or more family members with colon cancer, it is important to make frequent periodic examinations and endoscopies: the rule would be to perform checkups at least 10 years before the diagnosis in the diseased family member and, in the case of genetic-family-based polyposis, even earlier.

Anal discharge is an extremely common and, in most cases, benign phenomenon that, in any case, in addition to being annoying, may require specialized medical investigations. 

Some aspects, to which attention should be paid, in particular, may suggest to the person the need for a medical checkup with faster timelines. These include:

• Dark color of blood: 
  • or if the blood emitted is bright red this tends to indicate that its trigger is very close. In the absence of trauma and postoperative anal and perianal surgical procedures, it is frequently associated with hemorrhoids;
  • or dark and often foul-smelling blood, on the other hand, might suggest that the blood originated in an upper part of the body (mouth, esophagus-stomach, colon, etc.) and on the way down was partly digested and metabolized. In this case, therefore, even more investigation by the physician is required to identify the cause;
• frequent bleeding: that is, anal bleeding that is not occasional, occurring at least 10 times in a month (consecutive or not);
• blood loss not related to defecation;
• presence of pain, including abdominal pain and/or persistent cramping;
• association with persistent altered defecation (constipation or diarrhea);
• onset of an evening fever or a general feeling of malaise;
• sensation of a bulge protruding from the anus.

Then, based on the specific characteristics of the leaked blood (presence of clots, etc.), the specialist will be able to better understand its nature and origin or prescribe further investigations.

Anal bleeding is not a disease in itself, but the sign of an issue that causes it that in most cases is benign, but for which only the specialist can provide a specific diagnosis and appropriate therapy.

“Anal bleeding generally does not require going to the emergency room, UNLESS:

• there is an immediate post-surgical course;
• there is associated trauma;
• there is a risk of hemorrhage.

In most situations, also to avoid overburdening the emergency room, a medical examination with the trusted proctologist who will be able to give clear directions to the patient and possibly prescribe ad hoc tests and therapies is more indicated,” Dr. Stuto explains.

In the case of leakage of blood from the anal area, some self-medication methods generally have no beneficial effects, so they are ineffective. These include:

• application of ice; 
• taking medications such as anti-inflammatory drugs or local anesthetics/pain relievers.

Hemorrhoidal disease is the most common cause of anal bleeding and is generally characterized by the absence of pain. Hemorrhoids are, in fact, pads that serve to maintain anal continence and constantly swell and deflate. 

Because they are richly vascularized, a little friction is enough to injure them. In the case of liquid stools, however, it is their acidity that goes on to damage the surface state of the hemorrhoids causing them to bleed. Generally, the hemorrhoidal lesion repairs quickly and there is little or no pain.

In addition to hemorrhoids, other common causes that can result in anal bleeding are:

• fissures, which present as painful and bleeding in the early stage but much less so in the chronic stage;
• proctitis (inflammation of the rectum);
• inflammatory disease such as Crohn's disease and ulcerative colitis;
• anal fistulas.

“Contrary to common belief, it should be made clear that only very rarely anal bleeding is associated with cancer. Of course, the age of the patient should also be taken into consideration, but especially in the young and under 40, this is a very rare case history,” the doctor explains.  

Treatment for anal bleeding varies according to the underlying cause. Generally, these are drug and surgical therapies aimed at resolving the issue identified by the physician.