Bleeding, from any part of the body, is abnormal and demands attention (unless it is from an expected menstrual period).  I am always amazed when I receive a call from a patient who has been bleeding for “awhile”.  The call usually occurs after hours or on weekends.  “Doc, I’m bleeding rectally.  It looks like a lot!  It started last week.”

I don’t know about you but I hate the sight of my own blood pouring out of my body.  The instinct for survival should cause an individual who is bleeding to seek help immediately.  What is amazing is the number of excuses my patients have for ignoring their blood loss.

“I have hemorrhoids.”  “I drank too much alcohol last weekend.”  “I thought it was because I fell down two flights of stairs last week.”  “I have a family history of a bleeding disorder.”  “I have irregular periods and didn’t think much about it.”

Bleeding is abnormal and “I think” is not a good enough answer.  Bleeding demands a definite answer (why) and treatment plan.  In my experience, hemorrhoidal bleeding is the most common cause of bleeding.   Bleeding hemorrhoids rarely cause significant blood loss.  The harm lies in the fact that patients who have hemorrhoids learn to ignore the bleeding.  Patients self treat by using suppositories and over the counter remedies and fail to ever mention their hemorrhoids to their doctors.  No one wants a rectal exam.  While the patient ignores his/her rectal bleeding, the unseen tumor that lies above the hemorrhoid grows silently.  It is a mistake to assume your rectal bleeding is simply a hemorrhoid.  Hemorrhoids are curses that demand yearly follow-up visits and, sometimes, more definitive treatments.

“I drank too much.”  If you are bleeding from the effects of alcohol, you are in big trouble.  Varicose veins of the esophagus from chronic alcohol abuse, tears in the esophagus from retching, and ulcers are all potentially life threatening causes of bleeding.  Please don’t ignore bleeding.

“I fell last week.”  If you fell and injured yourself causing internal bleeding, don’t call me; call 911.  If you cut your hand with a knife, pressure on the wound should stem the flow of blood long enough to get help.  There is no way to put pressure on a bleeding organ.  If you fell and subsequently have bleeding from your stomach or bowel, call 911!

If you have a family history of bleeding problems, seek help before you are bleeding.  There are tests that can help diagnose familial bleeding problems; and, then treatments and precautions can be taken.  Again, do not ignore bleeding.

“My periods are heavier than usual.”  Most women are familiar with their “normal” menstrual flow.  If your bleeding pattern changes and you are suddenly using an excessive number of pads, see your doctor.  Women with heavy “normal” menses may lose enough blood to become anemic.  Treatment may include iron supplements and hormonal manipulation.

Signs of anemia vary.  Often fatigue is the first symptom.  As anemia worsens, pallor (pasty yellow or white skin), shortness of breath, and even chest pain may occur.  Bleeding from the stomach often causes nausea, loss of appetite, and black tarry stools.  A gush of bright red blood rectally should be followed by a call to 911.  Bright red blood on the toilet paper demands a visit to your doctor’s office.

Err on the safe side.  If you are bleeding, see a doc.  If you are bleeding bad, see an emergency room doc.  If your friends are telling you look bad (pale), believe them!  Remember, the life you save may be your own.

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