CHANGE IN BOWEL HABIT AND CAUSES OF RECTAL BLEEDING

Blood Supply to the Gastrointestinal Tract

The blood supply to the gastrointestinal (GI) tract is a complex system involving both arterial and venous components, which ensure that the various organs receive adequate oxygen and nutrients while also facilitating the removal of waste products. The vascular anatomy can be divided into two main parts: the arterial supply and the venous drainage.

Arterial Supply

The arterial supply to the GI tract primarily originates from branches of the abdominal aorta. The major arteries involved include:

1. Celiac Trunk: This artery arises from the abdominal aorta at approximately the level of T12/L1 vertebrae and supplies blood to the foregut structures. The celiac trunk further divides into three main branches:
   • Left Gastric Artery: Supplies the lesser curvature of the stomach.
   • Splenic Artery: Supplies the spleen and parts of the stomach and pancreas.
   • Common Hepatic Artery: Supplies the liver, gallbladder, stomach, and duodenum.
2. Superior Mesenteric Artery (SMA): Located just below the celiac trunk at L1, this artery supplies blood to midgut structures, which include:
   • The distal part of the duodenum
   • Jejunum
   • Ileum
   • Cecum
   • Appendix
   • Ascending colon
   • Two-thirds of the transverse colon
3. Inferior Mesenteric Artery (IMA): This artery arises at about L3 and supplies blood to hindgut structures, including:
   • The distal third of the transverse colon
   • Descending colon
   • Sigmoid colon
   • Rectum

These arteries form anastomotic connections that provide collateral circulation between different regions of the GI tract, ensuring that if one pathway is obstructed, others can compensate.

Venous Drainage

The venous drainage of the GI tract is primarily through a system known as the hepatic portal system. Blood from most abdominal organs drains into this system before returning to systemic circulation via the inferior vena cava. Key components include:

1. Hepatic Portal Vein: Formed by the convergence of several veins:
   • Superior mesenteric vein (draining blood from areas supplied by SMA)
   • Splenic vein (draining blood from areas supplied by celiac trunk)
2. Portal Circulation: Blood collected in these veins carries nutrients absorbed from digestion directly to the liver for processing before it enters systemic circulation.
3. Hepatic Veins: After processing in the liver, blood drains into hepatic veins that empty into the inferior vena cava.

This dual supply system—arterial for oxygenation and nutrient delivery, and venous for nutrient processing—ensures efficient functioning of digestive processes.

In summary, understanding this vascular anatomy is crucial for diagnosing and managing various gastrointestinal diseases where blood supply may be compromised or altered.

Potential Causes of Change in Bowel Habit

Changes in bowel habits can be indicative of various underlying health conditions or lifestyle factors. Understanding these potential causes is crucial for identifying when to seek medical advice. Below are some of the most common causes:

1. Dietary Factors

Diet plays a significant role in bowel habits. A diet low in fiber can lead to constipation, while a sudden increase in fiber intake can cause diarrhea as the digestive system adjusts. Foods that are high in fat or sugar may also contribute to irregular bowel movements.

2. Hydration Levels

Inadequate fluid intake can result in hard, dry stools and constipation. Conversely, excessive fluid consumption, particularly from caffeinated beverages, can lead to increased bowel frequency and diarrhea.

3. Physical Activity

Regular exercise promotes healthy digestion and regular bowel movements. A sedentary lifestyle can lead to constipation due to slower intestinal transit times. Sudden increases in physical activity may also disrupt normal bowel patterns temporarily.

4. Stress and Mental Health

Stress and anxiety can significantly affect gut health, leading to conditions such as irritable bowel syndrome (IBS). Emotional distress may cause either diarrhea or constipation, depending on the individual’s response.

5. Medications

Many medications have side effects that impact bowel habits. Common culprits include:

• Opioids: Often cause constipation.
• Antibiotics: Can disrupt gut flora, leading to diarrhea.
• Antacids containing aluminum: May cause constipation.

6. Gastrointestinal Disorders

Several chronic gastrointestinal conditions can lead to changes in bowel habits:

• Irritable Bowel Syndrome (IBS): Characterized by abdominal pain and altered bowel habits (diarrhea or constipation).
• Inflammatory Bowel Disease (IBD): Includes Crohn’s disease and ulcerative colitis, both of which can cause persistent diarrhea, abdominal pain, and blood in stools.
• Celiac Disease: An autoimmune disorder triggered by gluten that leads to various digestive symptoms including diarrhea and bloating.

7. Hormonal Changes

Hormonal fluctuations, particularly during menstruation or pregnancy, can affect bowel habits. For example, many women experience changes such as increased constipation or diarrhea due to hormonal shifts.

8. Age-related Changes

As people age, their digestive systems may slow down, leading to an increased likelihood of constipation or fecal incontinence due to weakened pelvic muscles.

9. Cancer

Bowel cancer or other malignancies affecting the gastrointestinal tract can lead to significant changes in bowel habits such as persistent diarrhea or constipation, blood in stools, unexplained weight loss, and abdominal pain.

10. Infections

Gastrointestinal infections caused by bacteria (e.g., Salmonella), viruses (e.g., Norovirus), or parasites can result in acute changes like diarrhea or vomiting.

In conclusion, while many changes in bowel habits are benign and related to diet or lifestyle adjustments, persistent alterations warrant consultation with a healthcare provider for proper diagnosis and treatment.

Potential Causes of Rectal Bleeding

Rectal bleeding, also known as hematochezia, can arise from a variety of conditions affecting the gastrointestinal (GI) tract. Understanding the potential causes is crucial for determining the appropriate course of action and treatment. Below are some common and less common causes of rectal bleeding.

1. Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum or anus that can cause discomfort and bleeding. They may result from increased pressure due to straining during bowel movements, pregnancy, or prolonged sitting. Bleeding from hemorrhoids typically presents as bright red blood on toilet paper or in the toilet bowl after a bowel movement.

2. Anal Fissures

An anal fissure is a small tear in the lining of the anus, often caused by passing hard or large stools. This condition can lead to sharp pain during bowel movements and may result in bright red blood on the stool or toilet paper.

3. Constipation

Chronic constipation can lead to straining during bowel movements, which may cause both hemorrhoids and anal fissures. The presence of hard stools can irritate the anal area and lead to bleeding.

4. Colorectal Polyps

Polyps are growths on the inner lining of the colon that can be benign but have the potential to develop into colorectal cancer over time. Some polyps may bleed, resulting in blood mixed with stool or visible blood during bowel movements.

5. Inflammatory Bowel Disease (IBD)

Conditions such as Crohn’s disease and ulcerative colitis fall under IBD, which involves chronic inflammation of the GI tract. These conditions can cause symptoms like abdominal pain, diarrhea, and rectal bleeding, often presenting as bloody diarrhea.

6. Gastrointestinal Infections

Infections caused by bacteria (such as Salmonella or E. coli), viruses, or parasites can lead to inflammation of the intestines and result in rectal bleeding along with other symptoms like diarrhea and abdominal cramps.

7. Diverticular Disease

Diverticulosis occurs when small pouches form in the walls of the colon due to increased pressure within the intestine. If these pouches become inflamed (diverticulitis), they can bleed, leading to rectal bleeding that may be accompanied by abdominal pain.

8. Peptic Ulcers

Ulcers in the stomach or duodenum (the first part of the small intestine) can cause upper GI bleeding that may present as dark, tarry stools due to digestion processes before reaching the anus.

9. Colorectal Cancer

Colorectal cancer is a serious condition that can manifest with symptoms including changes in bowel habits, unexplained weight loss, abdominal discomfort, and rectal bleeding—often presenting as dark red blood mixed with stool.

10. Sexually Transmitted Infections (STIs)

Certain STIs such as gonorrhea or chlamydia can cause inflammation in the rectal area leading to bleeding.

11. Rectal Trauma

Injuries to the rectum from accidents or sexual activity can result in significant bleeding requiring immediate medical attention.

12. Endometriosis

In women and individuals assigned female at birth (AFAB), endometriosis may cause tissue similar to uterine lining to grow outside of it, potentially affecting nearby organs including those in the pelvic region leading to rectal bleeding during menstruation.

Each potential cause varies significantly regarding severity and required treatment; therefore, it is essential for individuals experiencing rectal bleeding to consult a healthcare provider for proper diagnosis and management.

Aetiopathology of Common Causes of Change in Bowel Habit

Change in bowel habit can manifest as diarrhea, constipation, or alternating patterns and can be indicative of various underlying conditions. Below is a detailed discussion of the aetiopathology associated with several common causes of altered bowel habits.

(a) Irritable Bowel Syndrome (IBS)

IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits without any identifiable structural abnormalities. The exact aetiology remains unclear, but several factors contribute to its pathogenesis:

1. Gut-Brain Axis Dysfunction: There is evidence suggesting that IBS involves dysregulation in the gut-brain axis, leading to abnormal visceral sensitivity.
2. Psychosocial Factors: Stress, anxiety, and depression are prevalent among IBS patients and may exacerbate symptoms.
3. Altered Gut Microbiota: Dysbiosis or imbalance in gut microbiota has been implicated in IBS, potentially affecting gut motility and immune responses.
4. Intestinal Motility Disorders: Abnormalities in colonic motility can lead to symptoms such as diarrhea or constipation.

(b) Coeliac Disease

Coeliac disease is an autoimmune disorder triggered by the ingestion of gluten in genetically predisposed individuals. The aetiopathology includes:

1. Genetic Predisposition: Most patients carry HLA-DQ2 or HLA-DQ8 haplotypes.
2. Immune Response to Gluten: Ingestion of gluten leads to an inappropriate immune response that damages the intestinal mucosa, particularly the villi, resulting in malabsorption.
3. Environmental Triggers: Factors such as infections or changes in diet during infancy may trigger the onset of coeliac disease.

(c) Colorectal Cancer (CRC)

Colorectal cancer often presents with changes in bowel habits due to tumor growth affecting bowel function. The aetiopathological factors include:

1. Genetic Mutations: Mutations in oncogenes (e.g., KRAS) and tumor suppressor genes (e.g., APC, p53) play critical roles in colorectal carcinogenesis.
2. Lifestyle Factors: Diets high in red and processed meats and low in fiber are associated with increased CRC risk.
3. Inflammation and Polyps: Chronic inflammation from conditions like inflammatory bowel disease can lead to dysplastic changes and polyp formation, which may progress to cancer.

(d) Inflammatory Bowel Disease (IBD)

IBD encompasses Crohn’s disease and ulcerative colitis, both characterized by chronic inflammation of the gastrointestinal tract. The aetiopathology involves:

1. Immune Dysregulation: An inappropriate immune response against intestinal microbiota leads to inflammation.
2. Genetic Factors: Certain genetic markers (e.g., NOD2 for Crohn’s disease) have been identified that increase susceptibility.
3. Environmental Triggers: Factors such as smoking (in Crohn’s), diet, and infections may influence disease onset and exacerbation.

(e) Thyroid Disease

Thyroid dysfunction can significantly affect bowel habits; hypothyroidism typically causes constipation while hyperthyroidism may lead to diarrhea:

1. Hormonal Influence on Gut Motility: Thyroid hormones regulate metabolic processes including gastrointestinal motility; low levels slow down motility while high levels speed it up.
2. Autoimmune Mechanisms: Conditions like Hashimoto’s thyroiditis involve autoimmune processes that can also affect gut health indirectly through systemic effects.

(f) Diverticular Disease

Diverticular disease includes diverticulosis and diverticulitis, which can alter bowel habits primarily through mechanical obstruction or inflammation:

1. Increased Intracolonic Pressure: Low-fiber diets contribute to increased pressure within the colon leading to diverticula formation.
2. Inflammation/Infection of Diverticula (Diverticulitis): When diverticula become inflamed or infected, they can cause localized pain and changes in bowel habits.

(g) Bowel Obstruction

Bowel obstruction can be caused by various factors including adhesions from previous surgeries, tumors, hernias, or strictures:

1. Mechanical Blockage: Physical obstruction prevents normal passage of contents through the intestines leading to symptoms such as abdominal pain, vomiting, constipation or diarrhea depending on the location and severity of the blockage.
2. Distension Effects: Increased pressure from accumulated intestinal contents can lead to further complications like ischemia if not resolved promptly.

In summary, changes in bowel habit can arise from a variety of complex interactions involving genetic predispositions, environmental factors, immune responses, hormonal influences, dietary habits, and structural abnormalities within the gastrointestinal tract.

Aetiopathology of Common Causes of Rectal Bleeding

Rectal bleeding can arise from various gastrointestinal conditions, each with distinct aetiopathological mechanisms. The common causes include colorectal cancer, diverticular disease, hemorrhoids, anal fissures, and inflammatory bowel disease (IBD). Below is a detailed examination of the aetiopathology associated with each condition.

(a) Colorectal Cancer

Colorectal cancer (CRC) is characterized by the malignant transformation of colonic or rectal mucosa. The aetiology involves multiple factors:

1. Genetic Factors: Certain inherited syndromes such as familial adenomatous polyposis (FAP) and Lynch syndrome significantly increase the risk of developing CRC due to mutations in specific genes involved in DNA repair and cell cycle regulation.
2. Environmental Factors: Diets high in red and processed meats, low in fiber, sedentary lifestyle, obesity, smoking, and heavy alcohol consumption are linked to increased CRC risk.
3. Pathophysiological Mechanisms: The progression from adenomatous polyps to carcinoma follows the adenoma-carcinoma sequence, where genetic mutations accumulate over time leading to dysplasia and eventual malignancy. Tumors may invade local tissues and metastasize to distant organs.
4. Clinical Presentation: Rectal bleeding in CRC often presents as bright red blood per rectum or mixed with stool, indicating potential tumor involvement or ulceration.

(b) Diverticular Disease

Diverticular disease encompasses diverticulosis and diverticulitis:

1. Formation of Diverticula: Diverticula are small pouches that form in the colonic wall due to increased intraluminal pressure, often exacerbated by low dietary fiber intake leading to constipation.
2. Inflammation and Complications: When these pouches become inflamed (diverticulitis), they can cause localized pain and complications such as abscesses or perforation.
3. Bleeding Mechanism: Diverticular bleeding occurs when small blood vessels within the diverticulum rupture. This typically results in painless rectal bleeding that can be significant but usually self-limiting.
4. Clinical Presentation: Patients may present with bright red blood per rectum without accompanying pain unless diverticulitis is present.

(c) Hemorrhoids

Hemorrhoids are engorged vascular structures located in the anal canal:

1. Aetiology: Increased pressure on pelvic veins due to factors like straining during bowel movements, prolonged sitting, pregnancy, or obesity leads to venous dilation and subsequent hemorrhoid formation.
2. Types of Hemorrhoids: They can be classified into internal (above the dentate line) or external (below the dentate line), with internal hemorrhoids more commonly causing painless rectal bleeding while external ones may be painful if thrombosed.
3. Bleeding Mechanism: Bleeding occurs when these engorged vessels rupture during defecation or due to irritation from stool passage.
4. Clinical Presentation: Patients typically report bright red blood on toilet paper or in the toilet bowl after bowel movements.

(d) Anal Fissures

Anal fissures are tears in the anal mucosa:

1. Causes: They often result from trauma due to passing hard stools or excessive stretching during childbirth or anal intercourse.
2. Pathophysiology: The fissure leads to spasm of the internal anal sphincter which exacerbates pain and prevents healing; this creates a cycle of pain and further tearing.
3. Bleeding Mechanism: Bleeding occurs primarily from superficial vessels at the fissure site during bowel movements.
4. Clinical Presentation: Patients experience sharp pain during defecation accompanied by bright red blood on stool or toilet paper.

(e) Inflammatory Bowel Disease (IBD)

IBD includes Crohn’s disease and ulcerative colitis:

1. Aetiology: The exact cause remains unclear but involves an inappropriate immune response against intestinal microbiota in genetically susceptible individuals leading to chronic inflammation.
2. Pathophysiological Differences:
   • In Crohn’s disease, inflammation can occur anywhere along the gastrointestinal tract but is most common in the ileum; it can lead to transmural lesions.
   • In ulcerative colitis, inflammation is limited to the colon and rectum affecting only the mucosal layer.
3. Bleeding Mechanism: Ulcerations caused by chronic inflammation lead to vascular erosion resulting in rectal bleeding which may be mixed with mucus or pus depending on severity.
4. Clinical Presentation: Patients may experience bloody diarrhea along with abdominal pain and systemic symptoms like weight loss and fever depending on disease activity.

In summary, rectal bleeding has diverse aetiologies ranging from benign conditions like hemorrhoids to serious diseases like colorectal cancer requiring careful evaluation for appropriate management strategies based on underlying pathology.

Common Causes of Diarrhea and Constipation

(a) Diarrhea Causes

Diarrhea is characterized by loose, watery stools and can be caused by various factors. Here are some common causes:

1. Infections:
   • Viral Infections: Viruses such as norovirus and rotavirus are leading causes of acute diarrhea, often resulting from contaminated food or water.
   • Bacterial Infections: Bacteria like Escherichia coli (E. coli), Salmonella, and Campylobacter can cause diarrhea through contaminated food or water.
   • Parasitic Infections: Parasites such as Giardia lamblia can lead to gastrointestinal disturbances and diarrhea.
2. Medications:
   • Certain medications, particularly antibiotics, can disrupt the natural balance of bacteria in the gut, leading to diarrhea. Other medications that may cause diarrhea include antacids containing magnesium and some chemotherapy drugs.
3. Food Intolerances and Allergies:
   • Lactose intolerance (inability to digest lactose found in dairy products) and fructose intolerance (difficulty digesting fructose found in fruits) can result in diarrhea after consuming these substances.
4. Digestive Disorders:
   • Conditions like irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, celiac disease, and microscopic colitis can cause chronic diarrhea due to inflammation or abnormal functioning of the digestive tract.
5. Surgery:
   • Surgical procedures involving the gastrointestinal tract may lead to temporary or permanent changes in bowel habits, including diarrhea.
6. Artificial Sweeteners:
   • Some sugar substitutes like sorbitol and mannitol can have a laxative effect when consumed in large amounts, leading to diarrhea.
7. Other Factors:
   • Stress and anxiety can also trigger episodes of diarrhea in some individuals due to their impact on gut motility.

(b) Constipation Causes

Constipation is defined as infrequent or difficult bowel movements and can arise from several factors:

1. Poor Diet:
   • A diet low in fiber—found in fruits, vegetables, and whole grains—can lead to hard stools that are difficult to pass.
2. Inadequate Fluid Intake:
   • Not drinking enough fluids can result in dehydration, causing the stool to become hard and dry.
3. Lack of Physical Activity:
   • Sedentary lifestyles contribute significantly to constipation since physical activity helps stimulate intestinal function.
4. Medications:
   • Various medications are known to cause constipation as a side effect, including narcotics for pain relief, certain antidepressants, antacids containing aluminum or calcium, iron supplements, and some antihypertensives.
5. Irritable Bowel Syndrome (IBS):
   • IBS with constipation (IBS-C) is a common condition where individuals experience abdominal discomfort along with infrequent bowel movements.
6. Pelvic Floor Dysfunction:
   • This occurs when the muscles responsible for bowel movements do not relax properly during defecation, leading to difficulty passing stool.
7. Ignoring the Urge to Defecate:
   • Habitually ignoring the urge to have a bowel movement can disrupt normal bowel function over time.
8. Medical Conditions:
   • Certain medical conditions such as hypothyroidism, diabetes mellitus, Parkinson’s disease, multiple sclerosis, and spinal cord injuries may increase the risk of constipation due to their effects on nerve function or hormone levels.
9. Aging:
   • Older adults often experience constipation due to slower metabolism and decreased physical activity levels combined with dietary changes.
10. Pregnancy:
    • Hormonal changes during pregnancy can slow down intestinal motility leading to constipation; additionally, pressure from the growing uterus on the intestines may contribute further.

By understanding these causes of both diarrhea and constipation, individuals can better identify potential triggers for their symptoms and seek appropriate treatment or lifestyle modifications when necessary.

Signs and Symptoms of Colorectal Cancer and Its Pathological Development

Colorectal cancer (CRC) is a type of cancer that originates in the colon or rectum, often beginning as small growths called polyps. These polyps can develop into cancer over time, making early detection crucial for effective treatment. Understanding the signs and symptoms associated with colorectal cancer is essential for timely diagnosis and intervention.

Pathological Development of Colorectal Cancer

1. Initial Formation of Polyps: The pathological development of colorectal cancer typically starts with the formation of adenomatous polyps in the lining of the colon or rectum. These are benign growths that can vary in size and number.
2. Progression to Dysplasia: Over time, some polyps may undergo dysplastic changes, where cells begin to show abnormal characteristics. This stage indicates a higher risk for progression to cancer.
3. Invasive Cancer Development: If left untreated, dysplastic polyps can evolve into invasive colorectal cancer, penetrating deeper layers of the bowel wall and potentially spreading to nearby lymph nodes or distant organs.
4. Metastasis: In advanced stages, colorectal cancer can metastasize, meaning it spreads to other parts of the body such as the liver or lungs, leading to further complications and symptoms.

Signs and Symptoms of Colorectal Cancer

Colorectal cancer may not present noticeable symptoms in its early stages; however, as it progresses, various signs may emerge:

1. Changes in Bowel Habits:
   • Persistent diarrhea or constipation lasting more than a few days.
   • A change in stool consistency or shape (e.g., narrower stools).
2. Rectal Bleeding:
   • Bright red blood on toilet paper or mixed with stool.
   • Dark brown or black stools indicating potential bleeding higher up in the digestive tract.
3. Abdominal Discomfort:
   • Cramping or persistent abdominal pain.
   • Bloating or a feeling of fullness.
4. Unexplained Weight Loss:
   • Significant weight loss without dieting or increased physical activity.
5. Fatigue and Weakness:
   • Excessive fatigue that does not improve with rest.
   • Weakness due to anemia from chronic blood loss.
6. Other Symptoms:
   • A feeling that you need to have a bowel movement that is not relieved by doing so.
   • Changes in appetite without an obvious cause.
7. Signs of Advanced Disease:
   • If colorectal cancer has spread, symptoms may include jaundice (yellowing skin), difficulty breathing if it has spread to the lungs, or palpable masses in areas like the liver during physical examination.

It is important to note that these symptoms can be caused by conditions other than colorectal cancer; however, if any unexplained changes persist for more than two weeks, it is crucial to consult a healthcare provider for evaluation and possible screening tests.

In summary, recognizing these signs and understanding how colorectal cancer develops pathologically can lead to earlier diagnosis and improved outcomes for patients.

Management of Rectal Bleeding

The management of rectal bleeding involves a systematic approach that includes assessment, investigations, treatment options, and indications for surgical intervention. The process can be broken down into several key steps:

1. Initial Assessment

The first step in managing rectal bleeding is to perform a thorough clinical assessment. This includes:

• History Taking: Gather information about the nature of the bleeding (duration, frequency, color), associated symptoms (such as pain or weight loss), and any relevant family history of gastrointestinal diseases.
• Physical Examination: Conduct an abdominal examination to check for tenderness or masses and perform a digital rectal examination (DRE) to assess for any rectal masses or ongoing bleeding.

2. Risk Stratification

Patients presenting with rectal bleeding should be stratified based on their hemodynamic stability. The Oakland Score can be utilized to determine if outpatient management is feasible. Factors considered include age, sex, previous admissions for lower gastrointestinal bleeding, physical examination findings (e.g., PR findings), heart rate, and systolic blood pressure.

3. Investigations

Depending on the initial assessment and risk stratification, various investigations may be warranted:

• Laboratory Tests: Complete blood count (CBC) to assess for anemia; coagulation profile if anticoagulant use is suspected.
• Endoscopic Evaluation:
  • Colonoscopy: This is the gold standard for evaluating lower gastrointestinal bleeding and allows direct visualization of the colon and potential therapeutic interventions.
  • Flexible Sigmoidoscopy: May be considered in younger, low-risk patients with rectal bleeding.
• Imaging Studies: In cases where endoscopy is not immediately available or feasible, imaging studies such as CT scans may be used to identify sources of bleeding.

4. Treatment Options

Management strategies depend on the underlying cause identified through investigations:

• Conservative Management: For benign causes like hemorrhoids or minor diverticular disease, conservative measures such as dietary modifications, increased fluid intake, and topical treatments may suffice.
• Medical Management: Conditions like inflammatory bowel disease (IBD) may require specific medical therapies including corticosteroids or immunosuppressants.

5. Indications for Surgical Intervention

Surgical intervention may be necessary in certain scenarios:

• Persistent Bleeding: If a patient continues to experience significant rectal bleeding despite conservative management or medical therapy.
• Malignancy: If colorectal cancer is diagnosed during evaluation; surgical resection may be indicated based on staging and location of the tumor.
• Severe Diverticulitis or Complications: Patients with diverticular disease who develop complications such as abscesses or perforation may require surgical intervention.

In summary, the management of rectal bleeding requires careful assessment and investigation to determine the underlying cause. Treatment options vary widely from conservative measures to surgical interventions depending on the severity and etiology of the condition.