Rectal bleeding in children

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.

When to worry about rectal bleeding

Most of the time, rectal bleeding is not caused by a serious condition but the only way to be sure is to see a health professional so that any cause of the rectal bleeding can be diagnosed and treated.

What causes 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

This occurs in babies and children of all ages and is usually caused by passing a large or hard stool. The blood in the stools 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. See also the separate leaflet called Anal fissure.

Cow's milk protein allergy

Cow's milk protein allergy can cause a wide variety of symptoms. Some babies get allergic colitis - inflammation of the colon - as a reaction to cow's milk proteins. This can cause blood and mucous in poo.

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). See also the separate leaflet called Intussusception and volvulus in children.

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

Bowel polyps 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)

Inflammatory bowel disease (IBD) is a term used for two long-term conditions that cause inflammation of the gut (digestive tract). See also the leaflets on Crohn's disease and Ulcerative colitis.

Gastroenteritis

Gastroenteritis is an infection of the gut (intestines) that can cause diarrhoea and vomiting, but may also cause other symptoms such as tummy pain or rectal bleeding.

Rarer causes of rectal bleeding

Necrotising enterocolitis

Necrotising enterocolitis 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 premature ones, at 3-10 days of age.

Sexual abuse

This can cause 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

Henoch-Schönlein purpura is a condition that causes the small blood vessels in the skin, joints, gut (intestines) and kidneys to become inflamed and bleed.

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)

Thrombocytopenia means you have a low blood platelet count. Platelets (thrombocytes) are cells in the blood that help the blood to clot by clumping and forming plugs in blood vessel injuries. Therefore a low platelet count may cause abnormal bleeding, such as rectal bleeding.

Cause of rectal bleeding in older children and teenagers

For teenagers, the possible causes are more similar to the causes of rectal bleeding in adults. Lower gastrointestinal bleeding is most often caused by:

• Anal fissures.

• Piles (haemorrhoids).

• Bowel polyps.

• Gastroenteritis.

• Crohn's disease.

• Ulcerative colitis.

Rectal bleeding in children symptoms

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 red 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.

Does rectal bleeding come and go?

Rectal bleeding can be very variable in severity and may be present all the time or may come and go. Even if the bleeding is just small amounts of blood and does come and go, it is still very important to see a health professional to get it checked out.

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.

Rectal bleeding in children treatment

The diagnosis and treatment will depend on the underlying cause and how much bleeding there is. For most children with minor 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.