Rectal Bleeding in Children
Rectal bleeding is common in childhood and can be frightening for families. However, cracks in the anus, called anal fissures, often caused by constipation, cause bleeding and are not a serious condition. In order to stop bleeding and treat anal fissure, it is necessary to eliminate constipation first.
The presence of blood in the stool may appear as a symptom of some diseases and the source should be investigated by the doctor and the necessary treatment should be applied.
Rectal Bleeding in Children Reasons
Hardened poop due to constipation causes superficial cracks, which we call anal fissure, around the anus due to strain. This situation is mostly seen in the age of game childhood, when junk food is started to be eaten.
The child, who is hurting while trying to poop because of the anal fissure, starts to hold his poop. The longer you wait, the harder the poop becomes, causing more cracks, and the child thus enters a vicious circle. There are various methods to prevent this, but basically it is necessary to change the child’s diet and lifestyle.
In addition, hemorrhoids caused by constipation and strain can cause bleeding when they reach an advanced level.
To a lesser extent, polyps, intestinal obstruction, Meckel’s diverticulum, Crohn’s disease and ulcerative colitis, intestinal infections and parasites can cause diarrhea and bleeding. Certain foods and medications can also cause stools to appear bloody.
Rectal Bleeding in Children Symptoms
It is not always possible to know the source or type of rectal bleeding based on the appearance of stool alone. As rectal bleeding can be caused by constipation or sometimes it can be the cause of various intestinal disorders, it is necessary to consult a doctor and have the necessary tests done.
The presence of blood in the stool may indicate bleeding in the upper digestive tract (stomach and small intestine) or lower digestive tract (colon, rectum and anus).
Bleeding in the stomach and small intestine often causes black, very dark stools. In many cases, the child also vomits red or black that looks like coffee grounds.
Bleeding in the lower digestive tract is often seen with bright red blood in the stool.
Anal Fissure
It is the first among the causes of bleeding during defecation in childhood. Although it can be seen at any age, it is more common in the transition period from infancy to childhood. During this period, when feeding with solid foods is started, the child’s stool gradually begins to solidify. This period, which is a problem-free period for many, is in the form of more solid and bulky stools for some. As a result, tears (cracks) occur at the edge of the anus.
This extremely painful injury results in further delay of stool. Harder and more bulky stools enter a vicious circle that leads to progressively deeper fissure opening.
Anal Fissure Symptoms
Light red blood in the form of small spots on diapers or underwear
Line tear in the anus, usually on the posterior wall
streak-shaped blood in stool
Pain while using the toilet in older children
More solid and bulky stools due to constipation, blood seen
Skin fold at the tip of the fissure
Rectal Polyp
A polyp is a type of tumor that is attached to a location in the intestine either at the end of a stalk or without a stem. It is one of the most common causes of bleeding in childhood. It occurs between the ages of 5-15 years. Their size can be up to 2-20 mm. Although there is only one polyp in half of the cases, their number can reach up to 10.
Polyps are usually attached to the intestinal wall by a stalk. It bleeds easily from the surface with fecal frictions. It is reported that 70% are located in the hindgut (rectum) and 15% in the lower intestine (sigmoid). Although almost all of them are benign tumors, pathological examination is essential.
The first symptom is blood in the stool. It can be seen as a line smeared on the stool or as a few drops immediately after the stool. In 10% of cases, the first symptom is prolapse of the polyp from the anus during defecation. Cramp-like abdominal pain and mild diarrhea may also be among the complaints. There is more bleeding after spontaneous rupture.
Rectal Polyp Symptoms
Blood in stool
Polyp prolapse from the anus during defecation
Cramp-like abdominal pain and
Mild diarrhea
More bleeding after spontaneous rupture.
Intestinal Occlusion (Invagination)
Although it is most common in infants aged 4-12 months, it can be seen at all ages. It is accompanied by occasional abdominal pain in the form of bleeding and cramps in the form of abundant strawberry jelly. The child does not poop, or when he does, he makes it bright red and bloody.
Constipation or frequent diarrhea may also occur. Among the pains, the child is initially calm. However, if not noticed early, vomiting and abdominal swelling; gradually fire and fondness are added to the table.
The patient is extremely weak due to dehydration. It can be described as the entry of the intestines into each other like a glove finger or binoculars. The cause is often unclear. In older children, small intestinal tumors (polyps), masses and some congenital structures (such as diverticula) can cause this condition.
Invagination Symptoms
Strawberry jelly bleeding
Abdominal pain from time to time in the form of cramps
Weakness
Inability to go to the toilet
Bright red or runny bloody stools
Meckel’s diverticulum
Meckel’s diverticulum is the protrusion of all or part of the deaf wall towards the end of the small intestine. It usually occurs in children before the age of 2 years. Its incidence is 2 percent.
Many adults with Meckel’s diverticulum have no symptoms at all. It is only noticed during surgery or during tests for another condition. In this case, Meckel’s diverticulum usually does not need to be treated.
Meckel’s Diverticulum Symptoms
Mild or severe pain in the abdomen
Blood in stool
Sudden onset, painless, multiple and spontaneous bleeding
Pale color of the child due to excessive bleeding
Nausea and vomiting
Tenderness around the belly button
Congestion in the intestines: It can cause pain, bloating, diarrhoea, constipation and vomiting due to slowing of bowel movements (Seen in older children and adults)
Diverticulitis (inflammatory swelling of the intestinal wall)
Diagnostic Methods
In children, a simple physical examination with a finger is required to detect cracks in the anal regions and a stool sample is requested to learn the blood content. In addition, physical examination is important in problems such as detection of polyps. Infections caused by bacteria, viruses or parasites are tested in the stool sample.
When the cause of the bleeding cannot be determined in this way, medicated large intestine film, endoscopy and colonoscopy examination can be performed.
Anus Fissure (Anal fissure)
It is typical to see streaky blood on the stool. It is told that pooping is painful and that the child does not want to poop. Blood is almost always associated with hard and solid stools. Although the anal examination is painful, it usually allows to see the fissure. At the outer end of the fissure there is usually a skin fold (the sentinel urve). Many parents go to the doctor because of this fold.
Rectal Polyp (Juvenile Polyp)
Diagnosis is mostly made by examination. In suspicious cases, medicated large intestine film or endoscopic examination should be performed.
Intestinal Occlusion (Invagination)
Diagnosis can be made with blood tests and imaging methods. Especially your abdominal ultrasound is very important in diagnosing this disease. X-rays are also performed by introducing a catheter or barium into the intestines.
Meckel’s diverticulum
This disease causes bleeding, intestinal obstruction and inflammation. Various diagnostic tests are performed when symptoms of bleeding and abdominal pain are observed in children. First, abdominal ultrasonography and Meckel scintigraphy are applied. MRI, tomography and diagnostic laparoscopy can be used for further investigations.
Treatment Methods
Anus Fissure (Anal fissure)
It is necessary to begin treatment with the elimination of existing constipation. Constipation can be eliminated in the long term by softening the stool consistency and increasing the frequency of going to the toilet. In the same period, the fissure should be healed with warm sitting baths and pain relief creams.
Starting to make stools with a painless and soft consistency is the most important step in the treatment. However, it should not be forgotten that it can easily recur, and the family should be warned about toilet and eating habits. In chronic cases, surgery may be required. Surgery is rarely used in children.
Rectal Polyp (Juvenile Polyp)
Diagnosis is mostly made by examination. In suspicious cases, medicated large intestine film or endoscopic examination should be performed. The treatment is surgical removal. Anal intervention is performed under general anesthesia. It can be done as day surgery.
Intestinal Occlusion (Invagination)
First of all, the general condition of the patient should be corrected, and fluid and electrolyte losses should be replaced. The treatment is in three stages. It starts with the first stage and if the patient cannot be treated at this stage, the second stage should be started, and if it is not sufficient, the third stage should be started.
First Stage (Non-Surgical-Nonoperative Treatment)
It includes the procedures for rescuing the nested intestine from this situation. First of all, it is tried to remove the liquid or air to be given through the anal route with the pressure provided, under the guidance of various imaging methods of the inner intestine.
The most commonly applied method is to give serum from the anus while being monitored by ultrasonography. 85-90% of patients who come in the early period (first 24-48 hours) can be treated with this method. If treatment cannot be provided and the patient’s condition is suitable, it can be tried again. If this method is not successful, the patient should be operated.
Second Stage (Surgery)
In case of failure of non-surgical treatment or if it has been a long time since the onset of symptoms, direct surgery is performed. In the surgery, the intestines are corrected manually.
Third Stage (Surgery)
If the manual correction attempt fails in the surgery, the affected intestine is removed and the intestines are sutured end to end. This occurs more frequently in delayed patients.
Meckel’s diverticulum
When the diagnosis is finalized, the treatment method is surgery. The diverticula and surrounding small intestine are removed and the ends of the remaining intestines are stitched together. Your doctor will recommend the best approach based on your child’s symptoms, age, and general health.
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