Originally Posted by nikkilewis
What does a GP normally do when a patient comes in complaining of rectal bleeding? Do they just "look" without any sort of scope, or do they use a scope and if so, what does it feel like? Does it hurt? Do they do a "digital" exam? I just don't know what to expect, so any info would be appreciated. Never had this problem before. Thanks!
I can only speak from my own experience and that of other people I know who have consulted a GP for rectal bleeding but I believe the procedure is pretty standard with any serious family physician. As luck would have it my GP is my first cousin as well as a close friend so I was able to ask a lot of questions without feeling guilty of pestering him.
After being told by a patient that they have rectal bleeding the physician usually asks a few questions regarding accompanying symptoms such as cramps and other types of pain or discomfort experienced. My understanding is that this is done in order to help determine if a patient is suffering from anal fissure (torn rectum), a benign but painful condition that causes bright red bleeding and prevents digital rectal exam without local anesthesia. If this is the case the physician will only perform a visual exam of the rectal area and may refer the patient to a surgeon for further diagnosis and treatment.
If there is no fissure the GP will perform a digital rectal exam by inserting a gloved and lubricated finger into the rectum which is unpleasant but not painful. The purpose of this exam is threefold: confirm the presence of blood, feel for obvious conditions that cause bleeding (such as hemorrhoids) and determine the color of the blood. The darker red the blood is the farther up the intestinal tract it originates from. Dark red blood (which often contains clots) indicates the blood has been broken down by intestinal bacteria, or digested if you prefer. This means the blood has traveled through the digestive system for a period of time before being excreted, therefore it may originate from the upper colon, small intestine or even the stomach. However the GP is usually able to tell if the blood comes from the colon or upper intestinal tract by relying on secondary symptoms such as heartburn, which apparently tends not to occur with colon conditions.
Dark red blood is by no way indicative of a more serious condition than bright red (undigested) blood, it only helps to determine in which part of the colon the source of the bleeding is likely to be located which in turn helps to determine which type of endoscopy will need to be performed: sigmoidoscopy or full colonoscopy. Both procedures are performed by a gastroenterologist and require referral from a GP or ER physician and, of course, HMO approval for those who have that type of insurance. Sigmoidoscopy only examines the lower part of the colon, it doesn't take long and causes little discomfort and patients undergoing it are usually not sedated. If polyps or tumors are found during the procedure the specialist is likely to prescribe a full colonoscopy for further investigation and removal (of polyps).
A full colonoscopy is a more thorough and much more invasive procedure as it examines the whole colon. It takes longer and requires sedation or even general anesthesia in some cases. My GP told me however that general anesthesia is not the specialist's first choice because a colonoscopy is easier to perform if the patient is somewhat able to cooperate (move on his own) during the procedure.
There are many conditions that cause rectal bleeding, ranging from hard feces that tear the intestinal wall to chronic constipation to IBS to polyps to cancerous tumors to acute blood poisoning (a rare and immediately life-threatening condition). Some of these conditions are not serious and some are very concerning but one thing to remember is that, unless he finds an obvious cause such as fissures or faulty hemorrhoids, no GP can tell if rectal bleeding is caused by a serious condition or not
. Like CancerDad says if your GP blows you off without being able to tell you exactly what causes the bleeding then you should see a different GP, one who'll refer you to the appropriate specialist in a timely fashion.
In the past some doctors were pressured by insurance providers to limit the number of referrals for rectal bleeding, especially for patients under 40, because it often required costly exploratory surgery. Unfortunately this meant that a number of pre-cancerous conditions in younger patients went undetected. I guess the economics were sound because few people under 40 are at risk of developing colorectal cancer. But some do nonetheless and the advent of advanced colonoscopy removes any budgetary excuses and insurance providers prefer spending $1200 on the procedure than cover the costs of treating a cancer patient over the course of a lifetime. Unfortunately it seems that some GP's or even a number of specialists are still unaware of this.