Rectal Disease

Rectal conditions usually announce themselves with bleeding — bright red blood on the toilet paper or in the bowl — pain or burning with bowel movements, itching, swelling or a lump near the anus, mucus discharge, or a feeling of incomplete emptying. Because symptoms of minor conditions overlap with those of more serious ones, including rectal cancer, new or persistent symptoms should be evaluated rather than assumed to be hemorrhoids.

Evaluation typically includes a visual inspection and a gentle digital examination of the area. It may also include anoscopy, a brief office examination of the anal canal with a small instrument. Depending on your age, symptoms, and history, your gastroenterologist may recommend a flexible sigmoidoscopy or a colonoscopy to examine further inside and rule out other sources of bleeding.

Many rectal conditions improve with simple measures: more fiber and fluids to soften the stool, not straining or sitting on the toilet for long periods, warm sitz baths, and short courses of over-the-counter creams.

Hemorrhoids that keep bleeding can often be treated in the office with rubber band ligation, a quick procedure that cuts off the hemorrhoid's blood supply so it shrinks. Fissures are treated with stool softening and prescription ointments that relax the anal muscle so the tear can heal. Abscesses and fistulas usually require drainage or minor surgery.

Any rectal bleeding deserves an evaluation, even if you suspect hemorrhoids — especially if you are over forty-five, have a family history of colorectal cancer, or notice blood mixed into the stool. Also seek care for severe or worsening anal pain, a painful lump, fever with rectal pain, a change in bowel habits, or symptoms that persist despite a week or two of home care.