In the case of proctorrhagia, the blood loss comes from the anal canal, while in rectorrhagia, the blood comes from the sigmoid or rectum.
The leakage of blood from the anus is a fairly frequent symptom that can occur in various conditions: hemorrhoidal disease, fissures, colitis on an infectious basis, colorectal polyps, sudden rectal lesions or trauma from foreign bodies are just some of the possible causes. usually, bleeding in the form of proctorrhagia or rectorrhagia occurs during defecation and / or at the end of it, in the toilet bowl or directly on the toilet paper.
Proctorrhagia and rectorrhagia are not a clinical sign to be underestimated and the etiology of these conditions should be properly investigated by a physician to establish the correct therapeutic procedure.
) in the faeces allows to exclude, instead, another type of gastrointestinal haemorrhage - the melaena - characterized by the emission of faeces containing digested blood, which gives the faeces a blackish color and a sticky appearance.
To learn more about hematochezia and melena, you can consult the dedicated articles:
- Hematochezia
- Melena
Rectorrhagia and proctorrhagia: differences with hematochezia
Rectorrhagia and proctorrhagia indicate a loss of bright red blood from the anus during, after or independently of defecation. However, these conditions are not easily distinguishable from hematochezia and the elements of divergence reside in the quantity of blood in the stool, which is greater in rectorrhagia and in proctorrhagia, and in the possible independence of the latter from defecation. Furthermore, rectorrhagia can also depend on bleeding that drains into the rectum, but which does not originate from it.
they can be complicated by blood loss or real anorectal haemorrhages. In most cases, bleeding originates from the lower digestive tract consisting of the descending colon, rectum and anus, although it can arise from anywhere in the digestive tract. As a rule, the darker the color of the blood, the greater the likelihood that the bleeding will originate from the higher portions of the gastrointestinal tract, ie farther from the anus. With respect to the mode of onset, blood loss can be acute or chronic, evident or hidden.
In adults, the most common causes of proctorrhagia and rectorrhagia are hemorrhoids and fissures:
- Blood stains in toilet paper or dripping bleeding after defecation are a typical sign of hemorrhoids.
- Blood streaks in toilet paper associated with intense anal pain during defecation are a typical sign of anal fissures.
Proctorrhagia and Rectorrhagia: what are the possible causes?
Proctorrhagia and rectorrhagia can be caused by pathologies of an inflammatory nature or resulting from mechanical phenomena (sudden rectal lesions or trauma from foreign bodies) involving the last enteric tract.
When the blood is mixed with the stool, it means that it has time to mix with it during part of the intestinal journey. This symptom can therefore signal the presence of pathologies localized in the left colon or in the sigma, such as diverticula and chronic inflammatory diseases of the intestine (including ulcerative colitis and Crohn's disease). of benign or malignant neoplasms located in the lower part of the colon and rectum (colorectal cancer, intestinal polyps, etc.).
The presence of blood that wets the surface of the stool is an expression, instead, of processes that affect the last part of the rectum and / or the anal canal. In this case, the haemorrhoidal pathology is the most frequent reason.
This type of bleeding can also occur in the case of:
- Anal fissures;
- Ischemic colitis;
- Neoplastic pathologies;
- Infections (amoebiasis, salmonellosis, shigellosis).
Isolated dripping from defecation or the appearance of minimal amounts of blood from the anus following hygiene practices may result from:
- Hemorrhoids;
- Fissures;
- Anal fistulas;
- Colon angiodysplasia;
- Neoplasms of the anal canal.
Blood clotting disorders can also cause proctorrhagia, as a predisposition to blood loss in other areas. From an etiological point of view, rectorrhagia can also be due to:
- Vascular malformations of the gastrointestinal tract;
- Ischemic colitis, intestinal infarction;
- Abdominal trauma;
- Taking certain drugs (eg treatment with anticoagulants);
- Complications of endoscopic interventions or invasive diagnostic investigations.
and, as such, they must be evaluated as soon as possible by the doctor. The differential diagnosis is generally made with a proctological visit supported by an endoscopic examination and / or a colonoscopy.
Patient assessment should be directed at:
- Confirm the presence of anal and / or rectal bleeding;
- Estimate the amount and speed of bleeding;
- Identify the source of the blood loss and potential specific causes;
- Consider the concomitant presence of serious illness or contributing factors, which could adversely affect the management of proctorrhagia.
The medical history and the visit with rectal exploration are the first step to take and allow to identify the anal causes of bleeding or suggest, by exclusion, to extend the research to other sites. As soon as the patient's clinical conditions allow it, an endoscopic examination complementary to the rectal exploration is performed (eg esophagogastroduodenoscopy, anoscopy, rectosigmoidoscopy, colonoscopy, etc.); this allows direct vision of the bleeding site and planning a correct therapeutic strategy When the site of proctorrhagia and rectorrhagia is not identified, special methods such as scintigraphy or angiography are performed.
The emission of small quantities of chronic and occult blood can only be evidenced by laboratory investigations on a stool sample (search for occult blood in the faeces).
On the other hand, blood tests allow to find a "progressive or acute anemia. In addition to the blood count, the determination of prothrombin time (PT), partial thromboplastin time (PTT), electrolytes and creatininemia may be indicated."
Other investigations that may be indicated in case of suspected massive blood loss are blood gas analysis and electrocardiogram (to highlight changes in the heart rhythm and any fatigue of the heart pump).
