Bleeding from Rectum

Vivek M. Rege
Bleeding From Rectum - Introduction
This is a frightening symptom with which the parents rush to the doctor. They have noticed that their child passes blood from the anus and an associated mass comes out when the child goes to pass stool. The blood scares them and the mass confuses them, and very often they feel that these are piles. Piles rarely if ever, occur in a child hence that possibility should not be entertained. There are 3 possible conditions that could present with bleeding and mass coming out of the rectum - a rectal polyp, rectal prolapse and lastly but least commonly is an intussusception.

The only therapy possible is surgical. The child is taken under general anesthesia, and through the rectum speculum is inserted and the polyp is visualized. Gentle traction on the polyp will help to deliver it out of the anal opening and the base and the stalk are identified. A clamp is then applied to the base and the polyp and the stalk is excised. There is usually a blood vessel supplying the polyp and this is then tied off with a suture. The child can go home the same day and need not stay in the hospital. The polyp that has been removed, must be sent to the laboratory for a histological examination to know what type it is, chances of recurrence, more than one being present higher up etc.

In this condition, the cause is important in deciding the treatment. Chronic constipation if present needs to be corrected by proper diet, a laxative and proper stool training. If it has occurred after a bout of recurrent diarrhea then controlling the loose stools and then giving a good nutritious diet to improve the weight and the para rectal fat support of the rectum is very important. Active therapy of the prolapse is again non surgical as far as possible ? this is done by asking the parents to give strapping by bringing the 2 buttocks together to close the anal opening and giving external support with sticking plaster all day except when the child passes stool. This is continued for a few weeks. Along with this the child is referred to a good physiotherapist who is asked to teach the child sphincter exercises to increase the tone of the anal sphincter and prevent prolapse. Also Faradic stimulation a type of electrical stimulation of the sphincters is done to increase the tone and power which can be given for 6 weeks. In almost 90% children this is all adequate to stop the prolapse and nothing more is required. In those where the prolapse persists or is of a long standing duration when the child is brought to us, or there is a failure of the above mentioned methods to treat the prolapse, then surgery is undertaken which may be a simple suture to narrow the sphincter and prevent the prolapse, or more extensive surgery where the rectum is attached to the sacrum and sutured to avoid the recurrence. This is done either with open surgeryor through the laparoscope.

Since this is a telescoping of the intestine over the immediate adjacent one, intervention is must and that too urgently. Today, with good image intensifiers, it is possible to reduce the telescoping and send the child home within 1 day. This is possible by using either the Barium solution with an enema can to allow the barium to flow under hydrostatic pressure into the bowel. This pressure reduces the intussusception gradually till the entire intestine is restored to normal. I have done many of these with great success, at times with a good sonologist, this same procedure can be carried out with Ultrasound monitoring and using Saline. The advantage is that this does not expose the child to radiation of x ray machine. If this is not possible - then the option is only open surgery to look for the segment of intestine affected and then manually reduce the intussusception and then send the child home after a few days.

Bleeding from Rectum Bleeding from Rectum 01/18/2001
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