By Douglas Yoder, MD
Surgical Associates of Northwest Ohio
Health care providers frequently see patients who have noticed they have passed blood into the toilet. It can be surprising and distressing, but many people are not concerned and blame the bleeding on hemorrhoids.

Hemorrhoids are clusters of veins that are normal and present in the lowest part of the intestinal tract where stool exits the body. They function to serve as a shock absorber so that bowel movements can leave the body easily. Occasionally, they enlarge and bleed. Situations where this happen are when people frequently strain due to constipation or heavy lifting.

Pregnancy also causes hemorrhoids to enlarge, and for many women, may be the time in their lives when hemorrhoids begin. Frequently, swollen hemorrhoids can be felt when cleaning after a bowel movement. In many situations, there may not be a cause that can be identified.

If there is swelling but not pain or bleeding after a bowel movement, no treatment may be needed. Increasing the fluids and/or raw fruits and vegetables in your diet can often improve the quality of your bowel movement and allow for the swelling or pain to improve. Swelling and pain can occur from time to time, but if symptoms persist, they are signs that you should speak with your physician.  

If you notice bleeding in a bowel movement, on the toilet tissue or in the toilet bowl, this may be more significant. It may be a hemorrhoid but can also be a sign of something far more important. People may pass a large amount of blood or even clots, and this can be sudden and surprising. This can be associated with abdominal cramping. If this occurs, especially if is associated with dizziness, it is important to see your physician right away or go to the emergency room.  

A small amount of blood occasionally is not an emergency, but it is still important. If the bleeding persists, it is important to speak with your physician. An examination of the area may simply reveal hemorrhoids, fissures (cuts in the lining of the anus) or a fistula (abnormal channel connected to the anus). Treatment for these conditions can be provided by your physician and involves increasing fluid and fiber intake, possibly utilizing stool softener or hemorrhoid cream, minimizing straining, and warm bath tub soaks. Rarely do hemorrhoids require surgery.  

If bleeding continues despite easy treatment, further evaluation is needed. Inflammation of the intestines and polyps or tumors of the intestines are important, potentially life-threatening problems that can be identified with additional testing, such as a colonoscopy. While some of these conditions occur in older patients, even teenagers can show signs of bleeding as a result of inflammation.

Fortunately, life-threatening problems are not commonly a cause for rectal bleeding, but it is important to tell you physician if it occurs. Your physician can perform a quick and easy examination to determine the cause of the bleeding. If the cause appears to be hemorrhoids, treatment can be started. If hemorrhoids are not the problem, your physician can refer you to a specialist who can help identify the cause of bleeding. Not all rectal bleeding results from hemorrhoids, but most of the time it does. If not, it is important to figure why you are bleeding. It could save your life.