Krwawienie z odbytu to symptom, którego nie powinniśmy bagatelizować, ponieważ może świadczyć nie tylko o hemoroidach, ale również o raku jelita grubego, który dzięki wykryciu we wczesnym etapie, jest chorobą uleczalną.
Do najczęstszych przyczyn krwawienia z odbytu zalicza się chorobę hemoroidalną (9—12%), szczelinę odbytu (1—3%), polipy i rak jelita grubego (3—11%), zmiany zapalne (3—29%), krwawienie z uchyłków (5—42%) oraz zmiany naczyniowe (angiodysplazja) (1—3%).
Krwawienie może objawiać się obecnością świeżej krwi na papierze toaletowym, w wodzie obok stolca, powlekającej grudę kałową, skrzepów krwi w stolcu czy krwi przemieszanej z masami kałowymi. Informacje te będą przydatne w ocenie źródła krwawienia, czy doszło do niego w odbycie czy świetle jelita, o czym świadczyć będą skrzepy.
Jakie badanie należy wykonać u pacjenta z krwawieniem z odbytu?
Podstawowym badaniem w diagnostyce krwawienia z odbytu jest badanie jelita grubego, tzw. badanie per rectum, czyli bezpośrednia ocena palcem przez odbyt. Może być również uzupełniona aparatem wziernikowym, krótszym anoskopem bądź dłuższym rektoskopem. Co istotne, u osób do 40 r. ż. u których diagnostyka wykazała chorobę hemoroidalną nie ma bezwzględnej konieczności przeprowadzania dalszej diagnostyki.
Krwawienie u osób, u których nie stwierdzono zarówno zmian w odbycie, jak i hemoroidów będzie świadczyło o konieczności przeprowadzenia kolonoskopii. Wskazaniem do tego badania endoskopowego będzie również wiek powyżej 40 r. ż., obciążenie w rodzinie rakiem jelita grubego bądź wystąpienie innych objawów, takich jak utrata wagi czy niedokrwistość.
Jakie leczenie należy zastosować przy krwawieniu z odbytu?
W leczeniu choroby hemoroidalnej zazwyczaj stosuje się środki miejscowe. Leczenia operacyjnego będą natomiast wymagały bardziej zaawansowane zmiany.
Z uwagi na jedynie okresowe krwawienie z uchyłków, nie wymaga leczenia. Operacja konieczna jest jedynie w sporadycznych przypadkach. Leczenia farmakologicznego natomiast wymagają choroby zapalne. Do leczenia endoskopem mogą zostać zakwalifikowane takie zmiany jak polipy, najczęściej gruczolaki, a do leczenia chirurgicznego zmiany występujące przy raku jelita grubego.
Wpływ na krwawienie z odbytu będzie miało również stosowanie leków, które zaburzają krzepnięcie oraz mogą mieć wpływ na intensywność krwawienia. Wśród nich wymienia się kwas acetylosalicylowy oraz antywitaminy K. Dlatego do momentu ustabilizowania krwawienia, zaleca się modyfikację leczenia.
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