Definition

The digestive tract can be divided into two main parts: the upper gastrointestinal (GI) tract and the lower gastrointestinal tract. The upper GI tract includes the mouth, esophagus, stomach, and small intestine, while the lower GI tract includes the large intestine to the anus.

Lower GI bleeding is characterized by the presence of blood in the stool. Although it may appear alarming, blood in the stool does not always indicate a life-threatening condition. There are various diseases that can cause lower GI bleeding. The appearance of blood in the stool can provide important clues about the underlying cause of the bleeding. For instance, fresh red blood may suggest bleeding from the lower part of the digestive tract, while blood mixed with stool can cause the stool to appear dark.

Causes

Some diseases or conditions that can cause lower gastrointestinal bleeding include:

• Hemorrhoids: Swelling of blood vessels around the anus.
• Anal fissure: A small tear in the anal wall that can cause sharp pain during bowel movements.
• Intestinal infections: Certain bacteria and parasites can infect the intestine and lead to bleeding, as seen in symptoms of lower gastrointestinal bleeding caused by bacteria like Shigella dysenteriae.
• Ulcerative colitis: A chronic inflammation of the colon that can result in wounds and bleeding in the lower gastrointestinal tract. Symptoms often include abdominal pain or cramps, frequent small amounts of bloody stools, fever, and weight loss.
• Intestinal polyps: Growth of abnormal tissue with branches on the colon wall. Polyps can sometimes enlarge and cause symptoms such as abdominal pain, constipation or diarrhea lasting more than a week, and visible lower gastrointestinal bleeding during bowel movements. Blood may be bright red or mixed with stool, leading to dark-colored stools.
• Colon cancer: Colon cancer can also lead to lower GI bleeding. The blood may be mixed with stool or appear fresh, as well as brown-blackish in color. In addition to bleeding, cancer is often accompanied by drastic weight loss and changes in bowel movement patterns.
• Other diseases such as diverticulitis, disorders of the colon's blood vessels, and Crohn's disease.

Risk factor

Risk factors that can increase the risk of lower GI bleeding include:

• Age: Gastrointestinal bleeding is more common in adults over the age of 60.
• Gender: Males are more likely to experience gastrointestinal disorders than females.
• Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Long-term use of NSAIDs, such as Ibuprofen, Piroxicam, and Mefenamic Acid, increases the risk of bleeding.
• Use of blood thinners (antiplatelets): The use of these drugs doubles the risk of bleeding.
• Alcohol consumption
• Smoking
• Diabetes

Symptoms

The symptoms of lower GI bleeding include:

• Bloody stools
• Black-colored stools
• Abdominal cramps or pain
• Dizziness
• Unexplained fatigue or weakness
• Appearance of paleness
• Shortness of breath
• Fainting
• Shock: In severe cases of gastrointestinal bleeding, patients may experience shock. Signs of shock include a drastic drop in blood pressure, decreased urination, rapid heartbeat or pulse, cold extremities, and unconsciousness. If experiencing shock, it is crucial to seek immediate medical attention at the nearest healthcare facility for prompt and proper treatment.

Diagnosis

Diagnosis of lower gastrointestinal bleeding involves:

• Medical interview: The doctor conducts an interview to gather information about the symptoms experienced, medications currently being used, and the patient's and family's medical history.
• Physical examination: The doctor performs a physical examination to assess vital signs such as blood pressure, pulse rate, and skin color (paleness), which can help determine the level of blood loss. Other aspects of the physical examination include:
• Examination with a nasogastric tube to determine if the bleeding is from the upper or lower digestive tract. Fluid in the lower digestive tract usually is not mixed with blood.
• Weight measurement, as massive weight loss in a short period can be related to malignancy or cancer.
• Thorough abdominal examination to assess abdominal pain, suspicion of liver failure, or suspicion of organ enlargement in the abdomen. Palpable lumps (masses) in the abdomen can also support the presence of malignant diseases.
• Examination of the anal area.
• Diagnostic tests: Diagnostic tests that can be performed in cases of suspected lower GI bleeding include:
• Stool examination: This helps determine the cause of the bleeding.
• Blood tests: A complete blood count is performed to assess how quickly the blood clots, platelet count, and liver function.
• Gastrointestinal tract examination with a camera tube, such as endoscopy and colonoscopy.

Management

The principles of treatment for lower GI bleeding include:

• Fluid replacement through intravenous (IV) infusion to maintain hydration.
• Transfusion of blood if hemoglobin levels are low, especially if they are <7 g/dL, as determined by the doctor.
• Medications for stomach-related conditions.

The specific treatment approach depends on the underlying cause of the lower GI bleeding:

• Hemorrhoids and anal fissures: These conditions often resolve on their own but can be managed with home treatments such as:
• High-fiber diet
• Adequate fluid intake to prevent constipation
• Avoiding straining during bowel movements
• Using hemorrhoid creams
• Taking warm baths
• Use toilet paper or a towel to wipe the wet area after urinating to prevent irritation
• Colitis and infections: Treatment depends on the cause. Antibiotics may be prescribed if there is an infection. Other therapies may include:
• Anti-inflammatory drugs such as steroids
• Immunosuppressant drugs
• Surgery if necessary
• Polyps and intestinal cancer: Surgery is the primary treatment. In cases of cancer, chemotherapy and radiotherapy may be recommended before and after surgery, depending on the stage and severity of the cancer.

Complications

Lower GI bleeding is a serious condition that requires prompt and appropriate treatment, as it can be life-threatening. Complications that may arise due to lower GI bleeding include:

• Anemia
• Respiratory failure
• Heart failure/heart attack
• Infection
• Shock
• Death

Prevention

To prevent lower GI bleeding, consider these measures:

• Adopt a healthy and clean lifestyle.
• Consume a diet rich in healthy, high-fiber foods.
• Ensure adequate fluid intake, aiming for at least 8 glasses of water daily.
• Engage in regular exercise to promote digestive health.
• Avoid straining during bowel movements.
• Refrain from smoking.
• Limit alcohol consumption.

Additionally, it's advisable to inspect your stool after bowel movements for any signs of bleeding or changes in color. Healthy stool typically ranges from yellowish-brown to dark brown.

When to see a doctor?

Seek prompt medical attention if you experience bleeding while passing stool, whether the blood is visible or if the stool appears darker than usual. Early detection allows for timely intervention and reduces the risk of complications.

Looking for more information about other diseases? Click here!