This is a condition that can scare the parents when they see the child passing blood in the stools. The age of the child can be a few months or the child may be 3 – 4 years old. The parents must be observant whenever they see blood in the stools of their child. Certain details are very important to the Pediatric Surgeon who can narrow down the differential diagnosis of the causes for the bleed. One should look for following parameters:
The color of the blood – bright red, dark red or blackish red;
The consistency of the stool – hard dry, soft and normal, or semi liquid with sticky mucus.
Does the child cry when passing stool, after the stool?
Is there any mass seen coming out of the rectum during or after the stool passage?
A rectal examination by the surgeon will help in ruling out certain possibilities. Very often, detailed history, proper rectal examination is enough to come to a diagnosis of the cause. If, however, these are inadequate to know the reason then other investigations like a Colonoscopy or a Barium Enema are required.

The commonest causes for a rectal bleed:

• Severe amebic dysentery: It presents with abdominal pain, blood & mucus mixed together in the stool.
• Fissure or crack at the anal margin: It presents as hard stool, crying when passing stool, blood streaking the stool on one side only and there may be a history of constipation.
• Bleeding within the intestines: It presents as painless dark blood in stools with large amount of clots. If, along with bleeding there is a mass that is seen by the parents, it cannot be Piles. Piles is unheard of in children so do not treat your child for piles. It could be either:
• Rectal Polyp: It is like a tumor in the rectum that comes out at times leading to fresh bright red blood after stools, which are normal in consistency and non-painful.

Figure 1: Rectal polyp

• Rectal prolapse: It is usually seen in a chronically constipated child who strains to pass hard stool. There may be associated blood and some mucus. Mass may go back inside after the passage of the stool.
• Intussusception: It occurs in an infants below 1 year and presents with severe abdominal pain, screaming, passage of only blood and mucus, distended abdomen and vomiting. The intestines are telescoped one over the other and are obstructed. If not treated early, it can lead to gangrene of the intestine requiring operative removal of a part of the intestine.

Thus, in short, Bleeding per rectum in a child below 1 year – run to a Pediatric Surgeon.
If the child is 2 – 3 years - walk to the Pediatric Surgeon and start specific therapy early.

The treatment may be medicines only, or medicines with exercises for a prolapse or medicines with surgery in polyp and intussusception.

Last updated on 01-04-2005