bleeding. It can be associated with any blood that passes from the anus (stomach, small intestine, large intestine, rectum, and anus). However, it is typically referred to bleeding from the lower colon or rectum. It can be seen in the stool, toilet bowl or toilet paper. The intensity depends on its site of origin, quantity of blood passed, among others.Its medical name is hematochezia.

Causes of Rectal Bleeding

Rectal bleeding is a fairly common occurrence. Bleeding typically comes from the gastrointestinal tract with the small intestine as the least likely culprit. It does not usually require medical treatment as most causes are treatable and not serious.

• Hemorrhoids (Piles): swollen blood vessels in the rectum
• Colon cancer and polyps
• Anal cancer
• Anal fissure: tear in anal skin
• Diverticulitis:formation of small bulges in the lining of the lower bowel
• Gastroenteritis: bacterial or viral infection of the stomach
• Inflammatory bowel disease, such as Crohn’s Disease
• Ulcer
• Diarrhea
• Constipation
• Rectal inflammation (proctitis)

Symptoms of Rectal Bleeding

Although often of no medical emergency, rectal bleeding is a symptom for many life-threatening diseases, such as colorectal cancer, therefore it is seek medical attention. Some of the symptoms of rectal bleeding include:

• The closer the bleeding site is to the anus, the brighter red the blood tends to be
  • Bright red blood coating the stool is associated to be from the sigmoid colon, rectum and anus. Hence, rectal bleeding is generally red or maroon in color.
  • Dark blood mixed with stool is associated to be from higher in the colon
  • Black, tarry (sticky) and foul stool smelling is associated to be from the stomach and duodenum (first part of small intestine). It is usually called melena.
  • Bright red blood in vomit
  • Slow, progressive bleeding
    • Shortness of breath
    • Gradual fatigue
    • Lethargy
    • Paleness of skin
    • Abrupt, heavy bleeding
      • Shortness of breath
      • Weakness
      • Dizziness
      • Fainting
      • Severe abdominal pain
      • Diarrhea
      • Pale, clammy skin

Treatment for Rectal Bleeding

                In order to determine the appropriate treatment for the rectal bleeding, the location and cause of rectal bleeding should be properly diagnosed. Tests, such as rectal examination and colonoscopy, are used to diagnose the source of rectal bleeding. The main purposes of treatment for rectal bleeding are to stop active bleeding and avoid recurrence of bleeding.

• For minor bleeding
  • Seek medical attention.
  • Place over-the-counter rectal ointments, though often obtained through prescription.
  • Avoid restraining bowel movements.
  • Apply ice packs on the affected area.
  • For major bleeding
    • Seek medical attention immediately.
    • Monitor symptoms.

To learn more about these kinds of emergencies and how to treat them, it is strongly advised to enroll in First Aid and CPR training located all throughout the country. These lessons do not only teach but include hands on training in cases of emergencies. These courses teach one to recognize and manage medical emergencies, such as in rectal bleeding.

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Clinical manifestations of underactive and depressed patients may often include apathy, sadness, feelings of unworthiness or worthlessness, suicidal thoughts, self blame, desire to escape, avoidance of simple problems, anorexia  and weight loss, decreased interest in sex, sleeplessness or insomnia and ceaseless activity or disinterest in activities of daily living. Moreover, the agitated depressed patient may also exhibit motor restlessness and severe anxiety.

Holistic approach in caring for underactive and depressed patients

The underactive and depressed patient can greatly benefit from ventilating personal feelings and therefore should be given every opportunity to express his or her feelings especially regarding his or her personal problems, disappointments and frustrations that incapacitates their effective coping mechanisms.

The emergency department staff should be calm and approachable and must elicit a desire to communicate with the depressed individual as properly manifested with the care provider’s choice of words and more importantly overt and covert actions so that the depressed individual can feel comfortable with the situation he/she is in. The health care provider should provide the patient with ample opportunity to converse and gather his/her thoughts in a calm and unhurried manner. Furthermore, it is vital that information on a perceived or real illness or sudden worsening of the depression is an important clue which can be effectively assessed upon an establishment of proper rapport between patient and health care provider.

Risk for suicide in underactive and depressed patients   

Underactive and depressed patients are at high risk of committing suicide. Attempts should be intensified in order to identify whether an individual has contemplated thoughts about attempting suicide as a remedy to his/her situation. Questions like “Have you ever thought of taking your own life?” may be an important assessment question to help start a conversation and open a line of communication in the discussion of such sensitive topic which the individual might be inhibited in initiating. Generally, with this approach the high risk individual is relieved to have been given an opportunity to discuss personal feelings. If the individual is seriously depressed, family members should be notified and must never be left alone since the act of suicide is normally done in solitude.

Advocating and supporting underactive and depressed patients       

The individual needs to understand that depression is treatable. Antidepressant and anti-anxiety medications can be prescribed by psychiatric physicians in order to correct the instability in neuron activities caused by the depression. Moreover, crisis and supportive services in the community including mental health centers, telephone counseling and referral, suicide prevention centers, group therapy, marriage and family counseling should be offered to the individual and family so that they will know that there are plenty of support care facilities other than the emergency department that can help the individual cope with his/her depressive episode. Usually, underactive and depressed patients are referred for psychiatric consultation and evaluation to a psychiatric facility for extreme cases of depression.

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In any emergency situation, the onset of shock should always be anticipated by comprehensively assessing and evaluating all injured victims as soon as possible. The underlying cause of shock (hypovolemic, cardiogenic, septic, neurogenic or anaphylactic) must be narrowed down as promptly as possible  in order to give the most appropriate definitive treatment for the specific cause of shock. Of the above mentioned classification of shock, hypovolemic shock is the most common one.

Common causes of Hypovolemia

The most common causes of hypovolemia include the following:

1. Excessive loss of blood (external or internal bleeding).
2. Excessive loss of plasma component of the blood (full-thickness burns).
3. Excessive loss of the body’s electrolytes (sodium and potassium) from excessive sweating, vomiting or diarrhea.
4. Vasodilatory nerve dysfunction due to trauma to the vasomotor center in the brain which causes disorganized inhibition and stimulation of the blood vessels.

Managing Hypovolemia

Emergency care for victims with hypovolemia is normally started by ensuring a patent air passageway and maintaining breathing if the victim is still not under the care of emergency medical services. Once emergency help arrives or the individual is rushed to the emergency department, additional ventilatory assistance is initiated and a quick but comprehensive physical assessment is done to determine the cause of shock.

Usually, the initial goal of the health team tending the individual for hypovolemia is restoring the adequate blood volume by rapidly infusing intravenous fluids, blood products or blood replacements based on the assessment findings, taking special precautions if the individual has preexisting cardiac and kidney dysfunctions. Blood component therapy or blood transfusion can significantly assist in optimizing cardiac preload, correcting hypotension and increasing tissue perfusion.

IV therapy

Until such time the prerequisite tests for  blood transfusion is carried out (blood typing and cross-matching)  and completed, IV fluids are infused at a rapid rate until systolic blood pressure increases above acceptable levels or until there is improvement in the individual’s current clinical condition. Infusion of IV fluids specifically Lactated Ringer’s solution is an effective initial treatment for hypovolemia since it approximates the remaining blood’s plasma electrolyte compositions and osmolality which consequently allows for the required blood tests to be completed. Moreover, the solution serves as an adjunct to blood transfusion therapy.

Blood Transfusion     

Blood transfusion or blood component therapy is almost always included as a definitive treatment for hypovolemic shock especially if blood loss has been severe or if the individual is currently hemorrhaging. Measures to control hemorrhage are instigated primarily because hemorrhage compounds the state of shock. When blood transfusion is initiated, the legs should be slightly elevated to promote venous return to the heart and to improve perfusion cerebral tissues. However, this is highly contraindicated for individuals with diagnosed and/or suspected head injuries since it can aggravate and further increase intracranial pressure.

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