Which diseases are common in constipation with blood?
Department of Anorectal Surgery, Chaoyang Hospital, Capital Medical University Li Hengshuang
Patients with constipation often feel panic and afraid of coming to see a doctor because they find blood in their stools or dripping blood from the anus after stool. Common diseases that cause constipation with blood are:
(1) Bleeding from hemorrhoids Patients with hemorrhoids often suppress constipation due to pain in the anus during defecation, and gradually develop constipation, which aggravates hemorrhoids to a certain extent. When the hemorrhoids are large, the hemorrhoid mucosa tissue becomes thinner, and the dry fecal mass will easily scratch the hemorrhoid mucosa when defecation forcefully, causing blood in the stool. Its characteristic is that blood is discharged from the anus when defecation is forced, and the blood is often attached to the surface of the stool. After the stool, there may be blood dripping from the anus, or there may be blood on the toilet paper.
(2) Colonic diverticulum bleeding is manifested as a sudden heavy bleeding, bright red, with blood clots.
(3) Isolated rectal ulcer bleeding is blood on the surface of the stool and pain in the anal area.
(4) Anal fissure bleeding After constipation causes anal fissure, the constipation is further aggravated. When forced defecation, dry stool expands the anal canal, which can tear the small blood vessels of the anal canal and cause bleeding. It is characterized by less bleeding or the surface of stool With blood, or drips of blood during defecation, or stained toilet paper after defecation. Another feature is that patients with anal fissure often have severe tear-like anal pain. Therefore, when there is periodic severe anal pain accompanied by blood in the stool caused by defecation, anal fissure should be considered.
(5) Colorectal polyps, especially rectal polyps bleeding: Although most people have polyps formed in the intestinal mucosa, they have no symptoms, because small polyps are only raised nodules in the intestinal mucosa. Large polyps are often small tumors with a pedicle, which protrude into the intestinal cavity and can move up and down in the intestine. Due to fecal pressure and stimulation, the surface often has ulcers, erosions, and even bleeding. It can be seen that bright red blood covers the surface of the stool, and it can also be mixed with the stool, or mixed with mucus and purulent secretions. Rectal polyps often manifest as painless blood in the stool, usually with a small amount of bleeding. Large polyps in the colon can cause intussusception, lower abdominal cramps, worsening constipation, and blood in the stool.
(6) Colorectal cancer, including rectal cancer, sigmoid colon cancer, and colon cancer. The main symptom is blood in the stool. If the cancer is located on the right side of the colon, such as the ileocecal area, ascending colon, and liver flexure of the colon, it is generally not easy to see obvious bleeding, but the stool is positive for occult blood; if the cancer is located on the left side of the colon, the color of blood in the stool is mostly Bright red or dark red, attached to the surface of the stool, if the amount of bleeding is not much, and the intestinal cavity is retained for too long due to constipation, the blood will turn black and the blood will mix with the stool. Sigmoid colon cancer often manifests as constipation and diarrhea alternately, stool with blood, pus, and mucus; rectal cancer is stool with blood or pus or blood in the stool, or mucus and blood with bloody secretions in the stool.
In short, blood in the stool indicates that the bleeding site is in the digestive tract below the large intestine, especially the sigmoid colon, rectum, and anus on the left side of the colon. Hematochezia is an important symptom that cannot be ignored and should be diagnosed and treated promptly.