What is Hematochezia?
Hematochezia refers to the passage of fresh blood through the anus, usually in or with stools. It is often a sign of bleeding in the lower gastrointestinal (GI) tract, which includes the colon, rectum, and anus. In pediatrics, hematochezia can be a concerning symptom for both parents and healthcare providers.
Anal fissures: Small tears in the lining of the anus, often caused by constipation and straining during bowel movements.
Infectious colitis: Inflammation of the colon due to bacterial, viral, or parasitic infections.
Inflammatory bowel disease (IBD): Conditions such as Crohn's disease and ulcerative colitis that cause chronic inflammation of the GI tract.
Juvenile polyps: Benign growths that can cause painless rectal bleeding.
Meckel's diverticulum: A congenital anomaly that can cause painless bleeding.
Allergic colitis: Inflammation due to an allergic reaction, often seen in infants with cow's milk protein intolerance.
How is Hematochezia Diagnosed?
Diagnosis typically involves a detailed medical history and physical examination. Additional diagnostic tests may include:
Stool tests: To check for infections, blood, or other abnormalities.
Blood tests: To evaluate for anemia or inflammatory markers.
Endoscopy: Procedures like colonoscopy or sigmoidoscopy to visualize the GI tract and identify the source of bleeding.
Imaging studies: Ultrasound, CT scan, or MRI to provide detailed images of the GI tract.
Anal fissures: Increased fiber intake, adequate hydration, stool softeners, and topical ointments can help.
Infectious colitis: Antibiotics or antiparasitic medications may be required, depending on the causative organism.
Inflammatory bowel disease (IBD): Medications such as anti-inflammatory drugs, immunosuppressants, or biologics, and sometimes surgery.
Juvenile polyps: Endoscopic removal of polyps.
Meckel's diverticulum: Surgical removal if symptomatic.
Allergic colitis: Dietary changes, such as eliminating cow's milk protein from the infant's or breastfeeding mother's diet.
Significant or persistent rectal bleeding.
Severe abdominal pain.
Signs of
anemia such as fatigue, pallor, or shortness of breath.
Unexplained weight loss or poor growth.
Any other concerning symptoms accompanying the bleeding.
Anemia: Due to significant or chronic blood loss.
Dehydration: Particularly in cases of infectious colitis with diarrhea.
Severe infections: If the underlying cause is an infection.
Growth and developmental delays: Especially in chronic conditions like IBD.
Conclusion
Hematochezia in pediatrics is a symptom that warrants careful evaluation to identify the underlying cause. Prompt diagnosis and appropriate treatment are essential to manage the condition effectively and prevent complications. Parents should be vigilant and seek medical attention if they observe any signs of rectal bleeding in their child.
