Gastrointestinal bleeding, or GI bleeding, can occur anywhere along the digestive tract, from the oesophagus to the rectum. GI bleeding can be divided into two categories, each with different common causes:
- Upper GI bleeding: bleeding from the oesophagus, stomach, or small intestine. This is most often caused by a peptic ulcer or oesophagitis, but can mean cancer in the oesophagus or stomach.
- Lower GI bleeding: bleeding from the colon or rectum. This is most often caused by haemorrhoids and is trivial, but can be due to cancer or inflammatory bowel disease.
It is usually possible to identify the source area of the bleeding from the symptoms and the manner in which the blood is seen.
Symptoms of upper GI bleeding
Upper GI bleeding is usually seen as:
- Melaena: black tarry stools that have a distinctive smell
- 'Coffee ground' vomiting: where the vomit contains brown granular lumps of blood
- Haematemesis: bright red blood in the vomit.
Upper GI bleeding is always treated as a medical emergency, as it can quickly worsen and lead to serious complications and even death.
Symptoms of lower GI bleeding
Lower GI bleeding is usually seen as:
- Bloody stools: coated or mixed with fresh red blood
- Melaena: black or tarry stools
- Passing blood clots.
Spots of bright red blood on the toilet paper, or red blood coating otherwise normal stools usually suggests a cause from the anus or rectum (e.g. haemorrhoids). Dark blood mixed with the stools may suggest a more serious cause of bleeding, from further up in the colon (e.g. inflammatory bowel disease or colon cancer). Passing blood in the stool should always be checked out, as it may be a sign of an important problem in the colon.
Sudden acute GI bleeding
The sudden onset of a severe GI bleed is a serious condition and will often be accompanied by a range of other symptoms related to the blood loss, including:
- Dizziness or feeling faint
- Feeling short of breath
- Sudden weakness
- Stomach cramps
- Pale complexion.
If the blood loss is significant, a condition called hypovolemia, your blood pressure will drop and you may go into shock. Emergency hospital treatment should be sought immediately.
Symptoms of slow GI bleeding
In some cases, GI bleeding may be minimal or intermittent, and show no symptoms at all. This is called occult bleeding and may go unnoticed for months or even years, as the amount of blood in your stools is too small to notice. Over time, however, you may develop anaemia due to low iron levels and then begin to notice the symptoms, such as:
- A growing tiredness or lethargy
- Low fatigue threshold
- Shortness of breath during exertion
- Pale complexion
- Changes in bowel habits.
You can have a simple test to look for blood hidden in your stools, and a blood test will reveal if you have iron deficiency anaemia. However, the investigations to find the source of the bleeding are important and are likely to include a gastroscopy and colonoscopy.
When to get your symptoms checked
Most causes of GI bleeding, such as haemorrhoids and peptic ulcers, are not life threatening and are easily managed and treated – but only when they have been diagnosed. It is always best to have a thorough investigation, as GI bleeding can be a warning sign of many more serious conditions.
The Gastroenterology and Hepatology specialists at The Physicians' Clinic are extremely experienced in assessing, investigating, and treating patients with GI bleeding, and will be delighted to help.
Investigations that may be suggested include blood tests, scans, and colonoscopy. Endoscopic examination of the upper GI tract (such as OGD, aka a gastroscopy), and/or colonoscopy (an examination of the lower bowel using a flexible telescope) are safe and extremely accurate ways of investigating GI bleeding. They may also allow specific treatments to be given at the time to control bleeding.