Rectal bleeding refers to appearance of fresh or altered blood in the stool. Although, this condition is less frequently reported in children, but can elicit a great deal of worry and concern among parents. The rectal bleeding in children may be apparent (i.e. seen on the toilet paper or toilet board after defecation) or can be somewhat concealed if it is mixed with the stool. The color of the blood may range from bright red to coffee brown or even black.

In most cases, appearance of blood in stool in the children is benign and localized that may not require any medical intervention. But in some cases, it may be a sign of a serious underlying pathological condition. Therefore proper assessment and diagnosis should be made for every case of rectal bleeding in children to minimize the risk of complications.

What Causes Rectal Bleeding in Children?

Some frequently reported causes of rectal bleeding in children are:

1.  Anal Fissures

Anal fissures refer to break or breech in the continuity of anal mucosa that may cause pain, discomfort and appearance of blood in stool in children. These fissures appear when a child passes a very hard or very large amount of stool. The hard stool stretches the rectal walls and lining of anal tract that may lead to tearing or fissure formation. With frequent passage of stool such as in diarrhea the anal lining can be irritated, resulting in worsening of the condition.

Symptoms: Itching, irritation and pain is usually felt during bowel movements.

Treatment: This condition is fairly common in children and can be completely resolved with basic care. It is imperative to keep in mind that the pace of healing decreases as the child grows older; therefore immediate interventions must be sought. Three F’s should be followed, these include Fiber, Fitness and Fluids. Application of some ointments can also help in relieving the pain and discomfort associated with anal fissures.

2.  Chronic Constipation

Passage of very hard stool or infrequent bowel movement can also lead to rectal bleeding in children without anal fissures. It is imperative to keep in mind that long standing and poorly managed constipation can lead to several other complications like rectal tear, anal fissures, hemorrhoids etc.

Symptoms: Infrequent bowel movements, straining on defecation

Treatment: Chronic constipation in children should be managed with fiber, fitness and fluids. Learn more about how to treat constipation in kids here.

3.  Inflammatory Bowel Disease

IBD is a chronic condition characterized by the inflammation of intestines. There are two primary clinical varieties of inflammatory bowel disease; these are Crohn’s disease and ulcerative colitis.

Symptoms: Classic symptoms are altered bowel movements, appearance of polyps, fissures, nutritional deficiencies and blood in stool in children. In severe cases of inflammatory bowel disease, anemia is a likely complication due to excessive blood loss over time.

Treatment: Speak to a pediatrician to learn more about dietary regulations and medical management that may help in controlling the symptom.

4.  Intestinal Infections

Different intestinal infections that may cause rectal bleeding in children are bacterial (salmonella, shigella, E.Coli), viruses (such as Dengue) and parasites.

Symptoms: Pain and varying degrees of fever is reported in infectious diarrhea caused by bacterial agents. Most cases of viral diarrhea are self-resolving.

Treatment: Depending upon the intensity of symptoms and infectious agent involved, treatment may be conservative or medical.

5.  Food Allergies

Some genetically susceptible children are more prone to develop severe food allergies or hypersensitive reaction in response to certain dietary agents. This may lead to an acute or chronic gut inflammatory response that may present as blood in stool in children.

Symptoms: Stomach ache, indigestion and rectal pain after bowel movement.

Treatment: Identification and removal of allergenic foods and ingredients from the diet.

6.  Soy Protein and Milk Intolerance

This condition is also referred to as protein induced proctocolitis, milk induced enterocolitis, and milk allergy syndrome. In this condition the infant is inherently allergic to cow’s milk and soy protein. If her mother has taken these products and is breastfeeding, the child may develop this intolerance.

Symptoms: Characteristic symptoms of milk and soy protein intolerance include bloody stools along with vomiting and diarrhea.

7.  Hemorrhoids

It is a condition characterized by the presence of varicose veins in the rectal region. This condition is not usually reported in very young children, but every case of rectal bleeding in children should be assessed for hemorrhoids.

Symptoms: Hemorrhoids can cause severe pain and irritation in the anal region during defecation (passage of stool). Additionally, irritation of hemorrhoids can also lead to rectal bleeding (usually bright red in color).

Treatment: Optimal management of constipation is the cornerstone in the management of hemorrhoids as constipation can deteriorate gut health.  

8.  Polyps

Polyp is the appearance of small outgrowths in the rectal lining. These polyps hinder the normal movement of fecal material across the gut and can cause bleeding due to irritation of polyp.

Symptoms: Polyps may be small (a few millimeters) in size to a few centimeters. Some polyps are visible while others are concealed and only appreciated during a rectal examination.

Treatment: The appearance of polyps and associated symptoms may help in differentiating a benign polyp from a cancerous growth. It is recommended to consult a health care provider for appropriate analysis and management of polyps.

9.  Bleeding Problems

Symptoms: Bleeding problems such as delayed clotting time makes a child prone to bleed through rectum after every bowel movement.

Treatment: Bleeding or clotting issues can identified via different tests such as prothrombin time (PT) and APTT (activated partial thromboplastin time). Treatment depends on the severity of issues and actual cause of bleeding.

10.  Colonic Obstruction

Hirschsprung's disease is characterized by onset of colonic obstruction (due to congenital defects of intestinal lining). 

Symptoms: The characteristic symptoms include bleeding, lethargy and developmental delays.

Treatment: Identification of colonic obstruction and emergent management is highly recommended to prevent life threatening consequences.

11.  Vascular Lesions

In this condition different small and large lesions appear on the vascular surface of rectum. This condition is extremely difficult to diagnose even with the use of modern techniques.

Vascular lesions include arteriovenous malformations and hemangiomas. Colonoscopy is generally recommended to localize the bleeding.

12.  Some Other Causes

Some of the rarely reported causes of rectal bleeding include,

  • Sexual abuse
  • Hemolytic uremic syndrome
  • Thrombocytopenia

How to Deal with Rectal Bleeding in Children

Although the specific management is dependent on the actual cause of rectal bleeding in children; some helpful tips are:

  • ŸKeeping the body physically active.
  • ŸIncreasing the hydration status in children.
  • ŸPrevent constipation in children by encouraging high fiber foods.
  • ŸIn case of serious fissures the doctor may perform a surgery to close the stretched area.

It is to be noted that chronic conditions such as inflammatory bowel diseases requires constant care on long term basis and appropriate management should be sought by health care practitioners.