Rectal Bleeding in Children
Rectal bleeding means bleeding from the back passage. Rectal bleeding in children can cause a great deal of anxiety but most children with rectal bleeding do not have any serious underlying problem.
How common is rectal bleeding in children?
Rectal bleeding in children is not very common and is less common than in adults. It is not known exactly how common it is.
What are the causes of rectal bleeding in children?
The likely causes in children vary with age. The most common causes are not very serious (for example, anal fissure). But rectal bleeding can sometimes be caused by serious conditions.
The possible causes include:
- Anal fissure: occurs in babies and children of all ages. The blood is bright red and the fissure is usually painful. The fissure can be seen and no tests are usually needed. Most fissures get better with no treatment or by just keeping the stools soft.
- Twisting of the gut (volvulus). A volvulus occurs when a loop of bowel twists around itself. This can interfere with the blood supply to the bowel and cause a blockage in the bowel. This can occur in babies and infants. As well as rectal bleeding, there may be sickness (vomiting) and swelling of the tummy (abdomen).
- Part of the gut folds over itself (this is called intussusception). This occurs most often in infants aged between 5 and 7 months. There are frequent episodes of tummy pain with vomiting and swelling of the tummy.
- Bowel polyps. These usually cause painless repeated bleeding.
- Meckel's diverticulitis. A Meckel's diverticulum is a bulge in the wall of the gut that is present at birth. it is the most common congenital abnormality of the bowel. Inflammation of the diverticulum (diverticulitis) may cause rectal bleeding. This is more common in children aged younger than 2 years. It is more common in boys.
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis).
- Necrotising enterocolitis - this is a very serious condition in which some of the tissue in the gut becomes inflamed and dies. This is very rare but occurs in newborn babies, usually at 3-10 days of age.
- Sexual abuse - may present with rectal bleeding.
- Hirschsprung's enterocolitis - Hirschsprung's disease is a rare condition which affects the nerve cells of the gut. This causes a blockage in the gut. Enterocolitis means an infection of the large bowel (colon) and this can be a serious complication of Hirschsprung's disease.
- Rectal ulcer - this means an ulcer in the lining of the rectum at the lower end of the bowel.
- Abnormalities of the blood vessels in the gut - these include a range of lesions called haemangiomas, arteriovenous malformations and angiodysplasias. These can be difficult to diagnose even with newer investigation methods.
- Henoch-Schönlein purpura.
- Haemolytic uraemic syndrome (HUS) - this is a condition caused by the abnormal breakdown of red blood cells. HUS is a serious condition that can cause abnormal bleeding (including rectal bleeding) as well as life-threatening kidney failure.
- Low blood platelets (thrombocytopenia).
Older children and teenagers
For teenagers, the possible causes are more similar to the causes for adults. Lower gastrointestinal bleeding is most often caused by:
What are the symptoms of rectal bleeding in children?
Bright red blood means that the bleeding is in the lower part of the gut (bowel). Blood from higher up in the bowel gets partly broken down to make the stools very dark or black (this is called melaena). Bleeding from the stomach may cause bringing up (vomiting) of blood (haematemesis).
The age of your child and other symptoms (such as tummy pain, swelling of the tummy, constipation or diarrhoea) will help your doctor to find the cause of the rectal bleeding.
What tests can be done?
Most children with rectal bleeding don't need any tests. If needed, the initial tests will include blood tests and also a stool test. X-rays and scans - ultrasound, computerised tomography (CT) or magnetic resonance imaging (MRI) - may be needed and your child may need a colonoscopy in hospital under general anaesthetic.
What is the treatment for rectal bleeding in children?
The treatment will depend on the underlying cause and how much bleeding there is. For most children with rectal bleeding, the cause is harmless and the bleeding stops without any treatment.
If the cause of the bleeding is not obvious and may be serious then your child will usually be referred to a children's specialist (paediatrician) or a bowel specialist. Occasionally the bleeding is severe and needs emergency hospital treatment.
What is the outlook?
The outlook (prognosis) depends on the underlying cause of the rectal bleeding. Most cases of rectal bleeding in children are not serious and get better without any treatment.
Further reading & references
- Balachandran B, Singhi S; Emergency management of lower gastrointestinal bleed in children. Indian J Pediatr. 2013 Mar;80(3):219-25. doi: 10.1007/s12098-012-0955-x. Epub 2013 Jan 25.
- Jiang J, Jiang B, Parashar U, et al; Childhood intussusception: a literature review. PLoS One. 2013 Jul 22;8(7):e68482. doi: 10.1371/journal.pone.0068482. Print 2013.
- Sagar J, Kumar V, Shah DK; Meckel's diverticulum: a systematic review. J R Soc Med. 2006 Oct;99(10):501-5.
- Kessmann J; Hirschsprung's disease: diagnosis and management. Am Fam Physician. 2006 Oct 15;74(8):1319-22.
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Dr Colin Tidy
Dr Anjum Gandhi