Daily Dhaka Times: Blood in stools is an extremely common aliment and can be seen among people of all ages. On one hand it can occur in large amounts and thus appear very alarming to the patient while on the other hand it can occur in small amounts and thus be ignored by the person. But one thing is very certain are that none should be ignored.
The most common cause of blood in stools is piles. In most cases this is painless and bright red in color and is very alarming to the patient. It can also occur because of fissures, in which case, the person also has severe pain during passage of stools. The other less common reasons for blood in stools are cancer of the large bowel and colitis.
A person who has blood in stool should always report to a surgeon. An internal examination of the area is always required. This will reveal the presence of any piles or fissure. Also revealed will be the presence of any anal cancer or tumor.
Since piles and fissure are extremely common, their presence does not in anyway rule out the presence of any other problems in the large bowel. Hence for all such problems the patient also needs to undergo an investigation known as a colonoscopy.
In this procedure the patients’ needs to undergo cleaning of the bowel, followed by insertion of a tube like instrument to visualize the large bowel. Many cases of piles and fissure can be treated by medicines, but those that are advanced or not responding to medicines will require surgery.
Surgery for these ailments is not a major one and can be performed as an out patient procedure or with a few days admission in the hospital. There is a lot fear among patients that surgery for these ailments is difficult, painful and requires long periods of leave from work. However, currently this is not so.
Surgery for fissures is a very simple procedure and does not require hospital stay. The patient can coming in the mornings, get operated and go home the same day after a few hours. The pain is relived almost instantaneously and the patients can join back to work the very next day. In other words only one day off from work is required.
Similarly for surgery for piles is currently performed by stapler gun. The advantage of this method as compared to the previous conventional method is that pain is much less. Whereas in the convention type of surgery there was significant pain and patients could join back to work only after 2 to 3 weeks.
with the current stapler treatment of piles, patients can join back to work on an average in about five days time. Similarly with regards to hospital stay, most patients are discharge on the same day of surgery. For patients with colitis or to be more precise ulcerative colitis, again the treatment is with medicines.
Surgery is required only in certain specific situations where the bleed is excessive or not responding to medicines. Cancer of the colon and rectum is one of the most worrisome causes of blood in stool. For cancer of the rectum or colon treatment is essentially surgery and should be preformed after the requisite work up.
Many patients may require radiotherapy and chemotherapy before or after operation depending on the position and stage of the cancer that will be decided by the treating surgeon.
A very common misconception among most people is that surgical treatment of cancer of the rectum results in permanent removal of the natural passage of stools (anal canal) and creation of a permanent stoma with stool being collected in a bag. In reality only a minority of patients would require such a device.
But many patients during the course of their treatment may require a temporary stoma in which the stool is collected in a ‘bag’. This stoma in due course is closed and subsequently stool passes normally through the natural orifice (anal canal).
Another misconception among the lay public is that, when large bowel cancer which has spread to other organs like the liver, it is the end of the road for that person. But in reality though it is a matter of grave concern, many of these patients unlike other cancers of the gastrointestinal tract can still be treated with a combination of chemotherapy and surgery with a good outcome.
One should always remember that not all cancers will present with blood in stool and not all patients of bleeding will have cancers. In conclusion though blood in stool is not always ominous it should prompt a visit to the doctor and should be investigated as deemed necessary.
Dr. Sanjoy Mandal
MBBS (AIIMS), MS (AIIMS), DNB, MRCS(Ed), MCh
Consultant GI Surgeon
(Advanced laparoscopic Surgery and Oncosurgery)
Director, Department of GI Surgery
Medica Superspecialty Hospital, Kolkata