by Dr. Iain Corness
Is rectal bleeding just a passing thing?
Rectal bleeding is something most people don’t discuss at
parties. This may be a bad plan, actually, because you should not ignore rectal
bleeding. You see, not every case of rectal bleeding is from a pile (hemorrhoid)
that will settle.
A friend had some rectal bleeding recently, and did not ignore it. Fortunately
the cause was found with a colonoscopy (the black snake), and the condition was
amenable to surgery and he is now over it. But it could have been the other way
round. Never ignore rectal bleeding.
The rectum is the last portion of the large bowel that ends just before the
anus. Bleeding from this area can be a herald sign of a mild or life-threatening
importance, which is why all episodes of rectal bleeding must be investigated.
Depending upon the cause of the bleeding, and how high up in the
gastro-intestinal tract, it may be seen as black, tarry stools, maroon stools;
bright red blood on or in the stool, blood on the toilet tissue, or blood
staining the water in the toilet bowl bright red. Treatment can range from
relief of symptoms and let Mother Nature do the rest, to antibiotics, blood
transfusion, or even surgery. It all depends on the cause.
There are many potential causes, including hemorrhoids (piles) which are swollen
rectal veins in the anal and rectal area. They can cause burning, painful
discomfort, as well as bleeding. External hemorrhoids are small swellings that
are easy to see and quite painful, however internal hemorrhoids are usually
painless. A feeling of incomplete emptying may be noted with bowel movements.
Treatment focuses on relieving these symptoms with the use of stool bulking
agents and softeners, and if necessary, removal of the bleeding piles.
Rectal fissure is another. This is a tear in the lining of the rectum caused by
the passage of hard stools, which can lead to mild rectal bleeding of bright red
blood. Exposed nerves and vessels result in moderate to severe pain.
Diverticulosis, those little pockets on the bowel wall, can also bleed. The
stools are dark red or maroon. Pain is usually absent but surgery is required in
up to 25 percent of these patients.
Bloody diarrhea is often seen in bacterial dysentery, which we have all had to a
greater or lesser degree. Responsible organisms include Campylobacter jejuni,
Salmonella, Shigella, Escherichia coli, and Clostridium difficile. A most
unsavory bunch of bugs! The treatment depends upon the organism, but generally
intravenous fluid and electrolyte replacement and an anti-spasmodic and broad
spectrum antibiotic will bring this under control.
Another common cause of rectal bleeding is Inflammatory Bowel Disease especially
in young adults - typically those younger than 50 years of age. Bleeding occurs
in small to moderate amounts of bright red blood in the rectum, usually mixed in
with stool and mucus. Associated symptoms include fever and abdominal cramps.
This condition generally settles with steroids.
Of course, the one that everyone worries about is bowel cancer. We lump these
together under the general heading of Tumors and Polyps. Polyps bulge out from
the lining of the colon. Bleeding occurs when large polyps develop. They can be
hereditary, and are usually harmless, but some types can be pre-cancerous.
Both benign and malignant tumors are frequently found in the colon and rectum.
Those people older than 50 years are most affected; however, tumors can be found
in younger people. It should also be noted that less than 20 percent of people
with tumor or polyps will have rectal bleeding. However, when bleeding does
occur, it is usually slow, chronic, and minimal. Diagnosis requires careful
evaluation with colonoscopy.
Rectal bleeding from a traumatic cause is always a critical concern. Rectal
damage from a gunshot wound or foreign body insertion can result in extensive
infection or rapid and fatal blood loss.
And yes, there’s more! A common source of bleeding is hemorrhage from the
stomach or duodenum. This can occur after someone has swallowed a foreign body
that causes injury to the stomach lining or bleeding stomach ulcers.
The list does go on, but these conditions are rare; however, the message is that
rectal bleeding must always be investigated. Never ignore rectal bleeding!
Digital Lifestyle makes for worry lines?
Botox may be the answer?
Some interesting information coming out
of the UK, where it is claimed that Botox use has increased in an
increasingly younger age group. No longer is Botox the province of the
middle-aged matrons, it is claimed. And the reason is put down to squinting
at computer and other LCD screens.
Medical experts at Court House Clinics in the UK believe the number of women
in their 20’s seeking Botox treatments is in part due to the rise of daily
computer use and smart phone technology.
They base some of this on the sales of smart phones. They state the
analytics company IDC has reported smart phone shipments of 144.9 million in
Q1 of 2012 compared to 101.7 million units in Q1 in 2011. These figures,
they say, along with societal pressure to look eternally young has led to a
massive increase in the number of young women seeking Botox treatment. The
increase being touted is 410 percent!
Dr Patrick Bowler - Medical Director Court House Clinics, says, “We have to
accept that our lifestyles are changing as fast as the technology boom is
altering our lives. Look around and we see people immersed in their mobiles.
Also most people now work with computer screens.
When you look at people using these devices they are concentrating hard. The
natural reaction of the face when concentrating is the “frown” or screwing
up of the eyes. If you over use any part of your face lines will develop.
This can be seen with, for example, smokers where the lip area becomes more
lined and creased. The new generation of young women are spending more time
on these devices with the resultant consequences. Women are now more aware
that they can help prevent these lines deepening with the use of treatments
like Botox. It’s not about age, it’s about treating the individual and what
is happening to their face and there has been a noted increase in younger
women troubled by static frown lines in the last five years.” Constantly
peering down at a small screen such as the ones found on an iPhone,
Blackberry or other handheld device has caused more facial wrinkles to
appear in young women, he says.
Dr Bowler’s theory is one supported by Dr Sebagh of the US who amongst other
things has been responsible for treating celebrities like Cindy Crawford for
wrinkles. “The phenomenon of increased facial wrinkles can be seen on anyone
who has and regularly checks a Blackberry or iPhone,” said Dr Sebagh last
So what exactly is Botox? It is a prescription-only medical product that
contains tiny amounts of highly purified botulinum toxin protein refined
from the bacterium, Clostridium botulinum. Botox has a unique, protected
molecular structure that stabilizes the core toxin from degradation. When
injected at FDA-approved and labeled doses into a specific muscle or gland,
the Botox neurotoxin diffuses locally to produce a safe and effective result
by producing a localized and temporary reduction in the overacting muscle or
gland, usually lasting up to approximately three to ten months depending on
the indication and on the individual patient.
However, it should not be thought that Botox is purely for people with
wrinkles. According to the manufacturer Allergan, “Patients should receive
their treatments in an appropriate medical setting from people who are well
trained. We heavily discourage - we even mandate - that our sales people
don’t go to places like spas. We will supply to anyone who can establish
their credentials as a medical professional. If it’s someone new, we make
sure they have a valid license through a state medical society.”
Non-cosmetic use of Botox includes bladder treatment, for example.
Researchers at the University of Pittsburgh have found that injections of
the Botulinum toxin can help treat people who suffer from an overactive
bladder. The patients suffered from a variety of conditions, including
multiple sclerosis, spinal cord injury and stroke. Professor Michael
Chancellor, an expert in urology and gynecology at the University of
Pittsburgh, said, “Bladder dysfunction affects a staggering number of people
worldwide. The use of Botox injections can offer many of these patients a
safe, but temporary, solution to this embarrassing problem.”