Lower Gastrointestinal bleed – definition and its causes
Lower GI bleeding usually present with hematochezia (bloody stools) and usually signifies bleeding in the large intestine or in the rectum. Lower gastrointestinal bleed is not as common as your upper gastrointestinal bleed but it could still produce complications like your anemia and it could be the initial manifestation of a possible colon carcinoma. Patient’s with lower gastrointestinal bleeding should be stabilize first, like correcting the anemia and volume status, then proper diagnostics should be done (like colonoscopy, sigmoidoscopy, CT scan, etc) to properly pin point the site of bleeding and address it.
CAUSES OF LOWER GASTROINTESTINAL (GI) BLEEDING
Diverticulosis – this is the most common cause of lower GI bleeding. Diverticula is termed as herniations or outpouching of the colonic mucosa through the muscular layer. Although most of them are asymptomatic or don’t have complications, some diverticula would eventually have bleeding tendencies usually located at the base of the diverticula.
Colitis – colitis is defined as any inflammation in the colon (large intestine). Infectious colitis specially from shigella and salmonella infection could cause bleeding. Colitis from inflammatory bowel disease also cause lower gastrointestinal bleeding. Colitis secondary to ischemia to the colon could produce a painless lower GI bleed.
Colonic polyps and carcinoma – patients who have colonic polyps are prone to having lower gastrointestinal bleeding. Aside from polyps, colonoscopy could reveal a mass on patients presenting with lower gastrointestinal bleed. Patients with colonic carcinoma could also present with lower GI bleeding and usually needs surgical resection as part of the treatment plan.
Colonic Angioectasias – same with angioectasias in the upper GI tracts, angioectasias could also present with lower GI bleeding and since they are multiple blood vessels stopping the bleeding could be burdensome sometimes.
Internal Hemorrhoids – this cause of lower GI bleeding is located in the rectum. This is sometimes seen when after moving your bowels and cleaning with a tissue paper one can see blood. A rectal exam could palpate the haemorrhoid in the rectal vault, but sometimes a colonoscopy is still indicated to examined the whole colon.
Anal Fissures – this cause of bleeding is usually characterized by painful bowel movement. Bleeding from this cause is not usually massive.
Rectal Ulcers – ulcerations in the rectum could cause lower GI bleeding. This could be seen in old, critically ill patients presenting with painless lower GI bleeding. They could appear as a solitary lesion but sometimes they could be multiple ones.
If you see fresh blood in your stool, above is a short list of possible causes of lower gastrointestinal bleeding. Seek consult for proper identification and treatment.