Does blood in stool mean cancer?

Usually not. In one large community survey, only 1 in 709 people with rectal bleeding was diagnosed with colorectal cancer. But because cancer is one of the possible causes, and studies disagree on exactly how common it is, any new painless bleeding is worth having checked.

Is bright red blood in stool bad?

Bright red blood usually comes from the lower colon or rectum and is most often linked to hemorrhoids, diverticulosis, or a rectal ulcer rather than an emergency. Still, studies show it can occasionally signal something more serious, so it shouldn't be ignored, especially if it continues or is heavy.

What does it mean if my poop is lined with blood (just a little)?

Small streaks of blood on the outside of stool are most often described with hemorrhoids or minor irritation near the anus in the studies reviewed here. A doctor can usually tell this apart from bleeding coming from higher up in the bowel with a simple exam.

What causes bright red blood when you poop?

In the largest study looking at this, the most common findings were diverticulosis (small pouches in the colon wall), rectal ulcers, hemorrhoids, and abnormal blood vessels in the bowel lining. Less often, case reports describe rarer causes such as polyps, tumors, or inflammatory conditions.

Should I just wait and see if it stops on its own?

No — waiting isn't supported by this evidence. Because studies show painless bleeding can occasionally come from a rectal ulcer, bowel tissue damage, a medication reaction, or cancer, the safer step is to see a doctor for an exam, and a colonoscopy if recommended, rather than watching and waiting.

If something could be seriously wrong, what should I do instead of waiting?

See a doctor or go to urgent care to get examined rather than watching and waiting, since painless blood in the stool can come from very different sources — from hemorrhoids to rectal ulcers to, less often, polyps or cancer — and you can't tell which from symptoms alone. In one large study of adults hospitalized with this type of bleeding, colonoscopy found a specific cause in about 95% of cases, so a direct look is what actually answers the question. If bleeding is heavy, recurs, or comes with weakness or dizziness, treat it as an emergency and seek care right away rather than trying to manage it at home.

Why am I pooping blood with no pain?

Name: Why am I pooping blood with no pain?
Published: 2026-10-13
Keywords: why am i pooping blood no pain, why am i bleeding when i poop but no pain, what does it mean if my poop is lined with blood little, is bright red blood in stool bad, what causes bright red blood when you poop, does blood in stool mean cancer, why am i pooping blood no pain male, what happens if there is blood in your poop

In adults presenting with painless rectal bleeding or blood-streaked/bloody stool, what are the most common underlying causes, and how often does this symptom indicate colorectal cancer or another serious condition?

How people search for this, in their own words

“why am i pooping blood no pain”
“why am i bleeding when i poop but no pain”
“what does it mean if my poop is lined with blood little”
“is bright red blood in stool bad”
“what causes bright red blood when you poop”
“does blood in stool mean cancer”
“why am i pooping blood no pain male”
“what happens if there is blood in your poop”

Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

Painless blood in your stool is usually caused by a common, treatable problem like hemorrhoids, diverticulosis (small pouches in the colon), or a rectal ulcer — but in a small number of people it turns out to be cancer or another serious condition, and the studies available cannot tell you which one applies to you without an exam.

A large community survey found that only 1 in 709 people who reported rectal bleeding was later diagnosed with colorectal cancer. A separate, larger study of people sick enough to be hospitalized for bleeding found a cause on colonoscopy in nearly 95% of cases — most often diverticulosis, rectal ulcers, hemorrhoids, or abnormal blood vessels. These two studies looked at different groups of people and don't agree on how worrying the symptom usually is, which is why the certainty here is low. Case reports also describe rare but serious causes — including cancer, bowel tissue death, and damage from certain medications — found when painless bleeding was investigated.

How certain

Very low

Only observational evidence addresses this question (4 studies). The studies disagree with one another, so the overall certainty is lower than any single one of them.

What it shows

Signal of harm

7 studies reported harm or tissue damage, including laboratory evidence.

studies found: 104studies found
randomised trials: 4randomised trials
people studied: 21,122people studied
review of trials: 1review of trials
years covered: 1976–2026years covered

Read this first

In a small case series of three high-risk elderly patients with significant other health problems, routine anorectal procedures (glycerin enemas or anorectal pressure testing) were followed by sudden, massive, painless bleeding severe enough to need emergency treatment. It is not known how often this happens or whether the risk is similar in people without serious underlying illness.
A bleeding rectal ulcer found during investigation can be serious in frail patients: in one case report, bleeding continued despite treatment and the patient later died of organ failure.
Common painkillers (NSAIDs) and a phosphate-binding drug used in kidney disease (sevelamer) have each been linked, in case reports, to ulcers that damaged the bowel lining and caused painless bleeding.
Rectal cancer causing painless bleeding has, in a rare case report, been linked to a severe clotting complication that proved fatal.
Bowel tissue death from a blocked blood supply is a rare but life-threatening cause of painless bleeding described in one case report; it was only diagnosed after the patient died.
Surgery for hemorrhoids (a stapling procedure) caused bleeding during the operation in nearly half of patients in one study, and about 1 in 4 needed to be readmitted to hospital for bleeding afterward.

What the research shows

Proportion found to have colorectal cancer or advanced neoplasia
In a large community survey, only 1 in 709 people with rectal bleeding was diagnosed with colorectal cancer. No large study has reported this figure specifically for painless bleeding in a hospital or high-risk setting, so this number may not apply to everyone.[1]
Insufficient evidence
Proportion found to have no identifiable cause
In one large hospital study, colonoscopy found a cause in 94.9% of adults with rectal bleeding, meaning roughly 1 in 20 had no cause identified. A smaller pediatric study found a handful of children with mild painless bleeding stayed undiagnosed.[1,2]
Insufficient evidence
Need for colonoscopy based on age and risk factors
No study has directly tested or compared different age- or risk-based thresholds for ordering a colonoscopy after painless rectal bleeding. One review states that people with risk factors for colorectal cancer, such as adults over 50, should have a colonoscopy to rule out cancer even if hemorrhoids are seen on exam, but this is a general recommendation rather than a result from a comparative study of thresholds.[1]
Not studied
Rate of missed cancer diagnosis without workup
No study measured how often a serious cause is missed in people whose painless bleeding is never investigated.
Not studied

What it may help with

When painless rectal bleeding is investigated with colonoscopy, doctors find a specific, explainable cause in the large majority of cases — most often diverticulosis, a rectal ulcer, hemorrhoids, or abnormal blood vessels.[1]
In a large community survey, most people who reported rectal bleeding did not turn out to have colorectal cancer.[1]
Hemorrhoids, a very common and usually treatable cause of bright red painless bleeding, often improve with simple measures like fiber, stool softeners, or minor procedures.[1,2,3]

Important limitations

Almost all of the detailed evidence on specific causes — tumors, hemangiomas, Meckel's diverticulum, endometriosis, and more — comes from single-patient case reports, which cannot show how common any one of these causes actually is.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]
The two largest studies on this question looked at different groups — one surveyed anyone in the community who noticed bleeding, the other studied people sick enough to be hospitalized for it — so their findings can't be combined into one answer.[1,2]
No randomized trial has tested how painless rectal bleeding should be worked up; every study here is observational, so other unmeasured differences between patients could affect the results.[1,2]

What the studies found

Found a benefit35 · 34%
Found no clear effect3 · 3%
Mixed or unclear59 · 57%
Found possible harm7 · 7%

What kind of studies

Case series79 · 76%
Narrative review13 · 13%
Retrospective4 · 4%
Randomised trial4 · 4%
Prospective cohort3 · 3%
Systematic review1 · 1%

The studies that decided it

Nagata et al. 2021
Identifying Bleeding Etiologies by Endoscopy Affected Outcomes in 10,342 Cases With Hematochezia: CODE BLUE-J Study
Painless bleeding often from ulcers, hemorrhoids, vessels, diverticula.RetrospectiveModerate quality
10,342 people2021
Painless bleeding was especially linked to rectal ulcers, hemorrhoids, abnormal blood vessels, radiation colitis, and diverticulosis, while colonoscopy found a cause in 94.9% of cases, most often diverticular bleeding.
Who was studied
adults hospitalized for sudden rectal bleeding (hematochezia)
What they received
colonoscopy to find the source of bleeding
Compared with
no control group; observational comparison across different bleeding causes
Main outcome
finding the cause of bleeding and outcomes like rebleeding, death, need for treatment
Quality
Large multi-hospital study, but it only looked back at past cases rather than following patients forward in a controlled way.
Limitations
Retrospective design across many hospitals, so data quality and management may have varied; abstract does not mention blinding or adjustment for confounders.
Taken word for word from the abstract
- n analyzed 10,342 patients admitted for outpatient-onset acute hematochezia
- population patients admitted for outpatient-onset acute hematochezia
- intervention Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding.
- comparator multicenter retrospective cohort study conducted at 49 hospitals across Japan analyzed 10,342 patients admitted for outpatient-onset acute hematochezia
- primaryOutcome Diagnostic yield of colonoscopy reached 94.9%, most frequently diverticular bleeding.
- result Higher rates of painless hematochezia at presentation were significantly associated with multiple diseases, such as rectal ulcer, hemorrhoids, angioectasia, radiation colitis, and diverticulosis.
Am J Gastroenterol · PMID 34388140 · Read it on PubMed ↗
Sugawa et al. 2020
Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA: A case series
Painless bleeding from a rectal ulcer in frail elderly patientsCase seriesVery low quality
11 peoplewithin a month
All 11 needed blood transfusions; 7 improved with transfusion alone, 4 needed endoscopic treatment to stop bleeding; 3 died within a month from other illnesses, not bleeding; the 8 survivors had no further bleeding
Who was studied
elderly, bedridden hospital patients with major underlying illnesses and sudden painless rectal bleeding
What they received
endoscopic diagnosis and treatment of acute hemorrhagic rectal ulcer
Compared with
none
Main outcome
control of bleeding and survival after diagnosis of acute hemorrhagic rectal ulcer
Quality
This is a small descriptive case series of only 11 patients from one hospital with no comparison group, so it cannot show whether treatments worked better than no treatment.
Limitations
Small sample size from a single center; no control group; descriptive case series design.
Taken word for word from the abstract
- n Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU.
- population AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases.
- intervention The other 4 patients required endoscopic hemostasis.
- comparator Seven patients responded to blood, plasma, and platelet transfusions.
- primaryOutcome Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding.
- result All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.
Medicine (Baltimore) · PMID 32358354 · Read it on PubMed ↗
Fox et al. 2014
Anorectal conditions: hemorrhoids
Hemorrhoids often cause painless bleeding.Narrative reviewLow quality
size not given2014
hemorrhoids are the most common cause of bright red, painless rectal bleeding during bowel movements, but colon cancer must be ruled out with colonoscopy in those at risk
Who was studied
people with hemorrhoids, especially adults over 50
Main outcome
cause of painless rectal bleeding
Quality
this is a general review article summarizing known facts, not a study testing a treatment or measuring outcomes.
Limitations
no original data, numbers, or control group; it is a descriptive overview rather than a research study.
Taken word for word from the abstract
- population Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids.
- result Bright red, painless rectal bleeding during defecation is the most common presentation.
- result Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer (eg, adults older than 50 years) should still undergo colonoscopy to exclude cancer as the etiology.
- primaryOutcome Bright red, painless rectal bleeding during defecation is the most common presentation.
FP Essent · PMID 24742083 · Read it on PubMed ↗
Sierra-Montenegro et al. 2013
[Rectal cancer and Trousseau syndrome. Case report]
Painless bleeding was from rectal cancer.Case seriesVery low quality
1 people2013
painless bleeding was caused by a rectal tumor (adenocarcinoma); patient later developed Trousseau syndrome with blood clots and died from multi-organ failure after surgery
Who was studied
40-year-old woman with painless rectal bleeding
What they received
none (observational case report)
Main outcome
diagnosis and clinical course after rectal cancer surgery
Quality
this is a single patient case report, so it cannot show what usually causes painless bleeding or how treatment works.
Limitations
only one patient described; no comparison group; outcome reflects a rare and severe complication (Trousseau syndrome), not the usual course of rectal cancer.
Taken word for word from the abstract
- population Female 40 years old, went to the Coloproctology Service for painless bleeding.
- intervention Ultra-low anterior resection with colonic reservoir and loop ileostomy surgery was performed.
- primaryOutcome A computed tomography report showed a tumor of 5 by 6 cm up 5 cm from the anal margin.
- result The pathology report showed a semidiferenciate adenocarcinoma of the rectum
- result she died within 5 days because of multiorgan failure
- n Female 40 years old
Cir Cir · PMID 23769256 · Read it on PubMed ↗
Mitchell et al. 2010
Adult ischemic necrotizing enterocolitis
Bowel tissue death from blocked blood flow.Case seriesVery low quality
1 people5 days
bowel tissue death from blocked blood vessels, found after death, causing bowel perforation; patient died 5 days after admission
Who was studied
a 66-year-old man with a heart attack and painless rectal bleeding
What they received
none (observation of the natural course of illness)
Main outcome
cause of the rectal bleeding and outcome
Quality
this is a single patient's case, so it cannot show how common this cause is or how it usually turns out.
Limitations
only one patient described; diagnosis made only after death; extensive tests during life did not find the cause.
Taken word for word from the abstract
- n A 66-year-old male presented with posterior myocardial infarction and painless rectal bleeding.
- population A 66-year-old male presented with posterior myocardial infarction and painless rectal bleeding.
- primaryOutcome despite extensive investigations the cause of his lower gastrointestinal bleeding remained elusive
- intervention He was treated for acute coronary event but despite extensive investigations the cause of his lower gastrointestinal bleeding remained elusive.
- result Postmortem examination showed evidence of severe atherosclerosis and thrombosis in branches of abdominal aorta leading to bowel ischemia with multiple perforations and necrosis.
- followUp Patient died 5 days after admission.
J Coll Physicians Surg Pak · PMID 20642975 · Read it on PubMed ↗
Thompson et al. 2000
Rectal bleeding in general and hospital practice; 'the tip of the iceberg'
Painless bleeding rarely means cancer.Prospective cohortLow quality
4,006 people5 years
only 1 in 709 people with rectal bleeding was later diagnosed with colorectal cancer
Who was studied
adults over 16 in general practice who reported rectal bleeding
What they received
none (observational survey of symptoms)
Main outcome
how often rectal bleeding is linked to colorectal cancer
Quality
this was a one-time mailed questionnaire with recall bias, no control group, and only one cancer case found, so it can't say much about any individual's cause.
Limitations
Relies on self-reported symptoms via postal survey; only 1:4 who saw a GP were referred to hospital, so most cases were never medically confirmed.
Taken word for word from the abstract
- n Six thousand questionnaires were sent and 4006 (67%) were returned.
- population 6000 subjects, over the age of 16 years, randomly selected from the three General Practices
- intervention The study was based on a postal questionnaire
- primaryOutcome The prevalence of colorectal cancer was determined in subjects reporting rectal bleeding in the 5-year period after the postal survey.
- result Rectal cancer was diagnosed in only one patient 4 years after the first episode of rectal bleeding, giving a predictive value of rectal bleeding for colorectal cancer in the community of 1:709.
- followUp the 5-year period after the postal survey
Colorectal Dis · PMID 23578119 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 104 studiesEvery study that answered the question, with its design, size and result.

The other 98 studiesEverything else the search returned, including anything retracted.

Alswiket et al. 2026
An 18-Year-Old Man with Bleeding From a Meckel's Diverticulum of the Terminal Ileum Diagnosed by 99mTc-Pertechnetate Scintigraphy (Meckel's Scan)
Rare bowel pouch caused bleeding.Case seriesVery low quality
1 people2026
the Meckel's scan found a Meckel's diverticulum after other tests missed it, and surgery removed it successfully
Who was studied
18-year-old man with sudden painless rectal bleeding
What they received
99mTc-pertechnetate scintigraphy (Meckel's scan) for diagnosis, followed by surgical removal
Compared with
other diagnostic tests (CT scan, colonoscopy, endoscopy, capsule endoscopy) that failed to find the cause
Main outcome
finding the source of the bleeding
Quality
this is a single patient case report, so it cannot show how often this explains painless bleeding or how reliable the scan is in general.
Limitations
only one patient; no comparison group; cannot say how common this cause is
Taken word for word from the abstract
- n the case of an 18-year-old male patient
- population 18-year-old male patient who presented to the emergency department with a 24-hour history of 4 episodes of fresh rectal bleeding
- intervention A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum on day 4 of admission, followed by a successful laparoscopic segmental resection on day 10 of admission.
- comparator computed tomography scan, sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy, and capsule endoscopy, none of which revealed any abnormalities
- primaryOutcome A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum
- result A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum on day 4 of admission, followed by a successful laparoscopic segmental resection on day 10 of admission.
Am J Case Rep · PMID 42430297 · Read it on PubMed ↗
Suleman et al. 2026
Schistosomal Colitis as an Uncommon Cause of Hematochezia in a School-Aged Boy: A Case Report
Painless bleeding from parasite infection, treated successfully.Case seriesVery low quality
1 people2026
the boy's bleeding improved after treatment with praziquantel
Who was studied
a 9-year-old boy living in a region where schistosomiasis is common
What they received
oral Praziquantel (40 mg/kg)
Compared with
none
Main outcome
resolution of painless rectal bleeding
Quality
this is a single patient case report, so it cannot show whether this treatment works in general.
Limitations
only one patient was described, with no comparison group, so results may not apply to others.
Taken word for word from the abstract
- n We report a case of a 9-year-old boy
- population a 9-year-old boy presenting with painless hematochezia and a history of residence in a schistosomiasis-endemic region
- intervention treatment with oral Praziquantel (40 mg/kg)
- comparator The patient responded well to treatment with oral Praziquantel (40 mg/kg).
- primaryOutcome presenting with painless hematochezia
- result The patient responded well to treatment with oral Praziquantel (40 mg/kg).
Clin Med Insights Pediatr · PMID 42290952 · Read it on PubMed ↗
Yin et al. 2026
Life-threatening lower gastrointestinal bleeding after routine anorectal procedures: a case series and management implications
Enemas caused severe rectal bleeding.Case seriesVery low quality
3 people2026
all three patients had sudden, painless, massive rectal bleeding with major blood loss and instability, found to be caused by injury from the procedure in the distal rectum
Who was studied
elderly patients with health problems who had routine anorectal procedures
What they received
glycerin enemas or anorectal manometry (catheter/instrument procedures)
Compared with
none
Main outcome
severe rectal bleeding after the procedure
Quality
This is only three patient cases, so it cannot show how common this is or prove it applies broadly.
Limitations
Very small case series of only 3 patients with no comparison group, so causality and frequency cannot be established.
Taken word for word from the abstract
- n We analyzed three cases of high-risk elderly patients
- population high-risk elderly patients who experienced acute, massive hemorrhage following routine anorectal procedures, specifically glycerin enemas and anorectal manometry
- intervention routine anorectal procedures, specifically glycerin enemas and anorectal manometry
- comparator Standard anoscopy failed to localize the bleeding source
- primaryOutcome sudden, painless, massive hematochezia following routine anorectal procedures
- result All three elderly patients with significant comorbidities experienced sudden, painless, massive hematochezia following routine anorectal procedures.
BMC Gastroenterol · PMID 41904412 · Read it on PubMed ↗
Motoyoshi et al. 2026
Acute hemorrhagic rectal ulcer after cardiac surgery: a case report
Rare bleeding ulcer after heart surgery.Case seriesVery low qualityRelated question
2 peoplewithin 1 week postoperatively
both patients had painless bloody stools and shock from rectal ulcers, and recovered after repeated endoscopic treatment
Who was studied
men recovering from cardiac surgery with diabetes and kidney dialysis
What they received
endoscopic treatment with heat cautery and clipping for bleeding rectal ulcers
Main outcome
stopping the bleeding and recovery
Quality
this is just two patients described after the fact, so it cannot tell you how common this is or what causes it in general
Limitations
only two patients, both with major underlying illness and recent major surgery, so unlikely to reflect a general case of painless rectal bleeding
Taken word for word from the abstract
- population The first patient, a 64-year-old man on chronic hemodialysis for diabetic nephropathy, and the second, a 71-year-old man with similar comorbidities
- intervention Hemostasis was achieved with heat probe cautery and clipping
- primaryOutcome both patients required repeated endoscopic interventions but ultimately recovered and were discharged
- result both developed sudden, painless hematochezia and hemorrhagic shock within 1 week postoperatively
- n We report two cases of AHRU occurring in the intensive care unit after cardiac surgery.
- followUp within 1 week postoperatively
Int J Surg Case Rep · PMID 41837035 · Read it on PubMed ↗
Hu 2026
Exsanguinating jejunal Dieulafoy's hemorrhage: how failed embolization guided life-saving resection - a case report
Surgery stopped life-threatening bleeding lesion.Case seriesVery low quality
1 people2026
Embolization failed to stop the bleeding, but surgical removal of the lesion stopped it and the patient recovered and went home 5 days later
Who was studied
31-year-old woman with sudden severe rectal bleeding and shock, no prior health problems
What they received
Surgery to remove the bleeding part of the small intestine (jejunum), after embolization failed
Compared with
Attempted artery embolization (blocking the bleeding vessel) before surgery
Main outcome
Stopping the bleeding and patient recovery
Quality
This is a single patient case report, so it cannot show how often this treatment works for others.
Limitations
Only one patient described, no comparison group, so findings may not generalize.
Taken word for word from the abstract
- population A 31-year-old female without significant medical comorbidities acutely developed recurrent, high-volume hematochezia and hypotensive shock.
- intervention exploratory laparotomy with segmental jejunal resection of the Dieulafoy's lesion was performed
- comparator Selective arterial embolization was implemented but failed to achieve hemostasis.
- primaryOutcome The patient demonstrated satisfactory recovery and was discharged on the fifth postoperative day.
- result Selective arterial embolization was implemented but failed to achieve hemostasis. Consequently, exploratory laparotomy with segmental jejunal resection of the Dieulafoy's lesion was performed. The patient demonstrated satisfactory recovery and was discharged on the fifth postoperative day.
- n A 31-year-old female
Int J Surg Case Rep · PMID 41837015 · Read it on PubMed ↗
Han et al. 2025
Utilizing the EyeMax direct visualization system for the treatment of colonic diverticular bleeding: A case report
Bleeding pouch found and stopped.Case seriesVery low quality
1 people2025
the bleeding diverticulum was located and bleeding stopped, patient discharged a week later
Who was studied
70-year-old man with sudden painless rectal bleeding
What they received
colonoscopy using the EyeMax direct visualization system to find and treat the bleeding
Compared with
none
Main outcome
whether the bleeding source was found and stopped
Quality
this is a single patient case report, so it cannot show whether this approach generally works better than standard care.
Limitations
only one patient described; no comparison group
Taken word for word from the abstract
- population a 70-year-old male with acute painless hematochezia
- intervention the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding
- comparator Colonoscopy showed active bleeding originating from a diverticulum, and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.
- primaryOutcome No further evidence of bleeding was observed at the end of the procedure.
- result No further evidence of bleeding was observed at the end of the procedure. The patient was discharged from hospital on the seventh day.
- n a 70-year-old male
World J Gastroenterol · PMID 41358171 · Read it on PubMed ↗
Mureb et al. 2025
Rectal Arteriovenous Malformations: A case report of a rare cause of Lower Gastrointestinal Bleeding
Rare vessel defect caused painless bleeding.Case seriesVery low quality
1 people2025
repeated angioembolization did not stop the bleeding, and surgery was ultimately needed
Who was studied
a 37-year-old man with blood in urine and recurring rectal bleeding
What they received
angioembolization procedures followed by surgery (laparoscopic low anterior resection with diverting ileostomy)
Compared with
no comparator, single patient followed over time
Main outcome
control of rectal bleeding and resolution of anemia
Quality
this is a single patient case report, so it cannot show whether treatments generally work.
Limitations
only one patient described, no control group, and no standardized treatment guideline exists for this condition
Taken word for word from the abstract
- n a 37-year-old male with hematuria and recurrent rectal bleeding
- population a 37-year-old male with hematuria and recurrent rectal bleeding, diagnosed through a series of imaging studies, including CT scan and pelvic MRI
- intervention Despite undergoing multiple angioembolization procedures, the patient's symptoms persisted, leading to significant anemia and frequent emergency interventions. The decision was made to proceed with a laparoscopic low anterior resection with diverting ileostomy
- comparator We present a case of a 37-year-old male
- primaryOutcome leading to significant anemia and frequent emergency interventions
- result Despite undergoing multiple angioembolization procedures, the patient's symptoms persisted, leading to significant anemia and frequent emergency interventions. The decision was made to proceed with a laparoscopic low anterior resection with diverting ileostomy after a thorough discussion of the risk and benefits.
- primaryOutcome symptoms often include painless rectal bleeding
Int J Surg Case Rep · PMID 41332049 · Read it on PubMed ↗
Brown et al. 2025
An incidental finding of mesenteric hematoma in a patient with a new diagnosis of inflammatory bowel disease
Rare bleeding disorder found with colitis.Case seriesVery low quality
1 people2025
the painless rectal bleeding was found to be due to an incidental mesenteric hematoma, occurring alongside a new diagnosis of ulcerative colitis, thought to result from inflammation causing microvascular bleeding or clotting
Who was studied
a 10-year-old patient with painless rectal bleeding, newly diagnosed with ulcerative colitis
What they received
not applicable (case report describing diagnostic workup including exploratory surgery, CT angiography, and colonoscopy with biopsy)
Main outcome
cause of painless rectal bleeding
Quality
this is a single case report, so it cannot show how common this cause is or how it applies to other people.
Limitations
only one patient described; management and outcome over time are not well established in the literature.
Taken word for word from the abstract
- population We report a case of a MH which was incidentally found in a 10-year-old patient with a new diagnosis of ulcerative colitis (UC).
- intervention underwent an exploratory laparotomy when a mesenteric hematoma was incidentally found
- primaryOutcome The patient presented with painless hematochezia with unknown etiology
- result We propose that the MH was a result of inflammation which caused microvascular bleeding/thrombotic events.
- result colonoscopy with biopsy confirmed a diagnosis of UC
- n a 10-year-old patient
- limitations Management strategies including follow-up of resolution is not well delineated in the literature.
JPGN Rep · PMID 41245020 · Read it on PubMed ↗
Jha et al. 2025
Unveiling the hidden cause behind painless lower gastrointestinal bleeding in an adult - Meckel's Diverticulum: A case report
Rare bowel pouch caused bleeding.Case seriesVery low quality
1 people2025
CT scan found a Meckel's Diverticulum as the cause, and wedge resection was performed
Who was studied
30-year-old man with painless rectal bleeding for 2 weeks, with similar episodes over 3 years
What they received
surgical removal of Meckel's Diverticulum (wedge resection)
Compared with
no comparator (single case)
Main outcome
identification of the cause of painless rectal bleeding and resolution after treatment
Quality
This is a single patient case report, so it cannot show how common this cause is or whether treatment works in general.
Limitations
Only one patient is described; no control group or long-term outcome data after surgery is given.
Taken word for word from the abstract
- population A 30-year-old male presented with painless per rectal bleeding for 2 weeks.
- intervention for which wedge resection was done
- comparator CASE PRESENTATION
- primaryOutcome Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis confirmed the diagnosis of Meckel's Diverticulum
- result Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis confirmed the diagnosis of Meckel's Diverticulum, for which wedge resection was done.
- n A 30-year-old male presented with painless per rectal bleeding for 2 weeks.
Int J Surg Case Rep · PMID 40627878 · Read it on PubMed ↗
Merchan et al. 2025
Cavernous Hemangioma of the Anal Canal Mimicking a Neoplasm: A Rare Cause of Lower Gastrointestinal Bleeding Successfully Treated With Transanal Excision
Rare blood vessel growth, cured by surgery.Case seriesVery low quality
1 peoplethree-month follow-up
symptoms completely resolved with no recurrence after three months
Who was studied
a 75-year-old woman with a year of painless rectal bleeding
What they received
surgical removal of the lesion through the anus
Compared with
none
Main outcome
resolution of bleeding and recurrence of the lesion
Quality
this is a single patient case report, so it cannot show how common this cause is or how reliable the treatment is in general
Limitations
only one patient was described, with a short three-month follow-up
Taken word for word from the abstract
- population a 75-year-old female patient with a one-year history of painless rectal bleeding
- intervention Definitive treatment was achieved through transanal full-thickness excision
- comparator Definitive treatment was achieved through transanal full-thickness excision, with complete resolution of symptoms and no recurrence at the three-month follow-up.
- primaryOutcome complete resolution of symptoms and no recurrence at the three-month follow-up
- result complete resolution of symptoms and no recurrence at the three-month follow-up
- n a 75-year-old female patient
- followUp three-month follow-up
Cureus · PMID 40525030 · Read it on PubMed ↗
Liu et al. 2025
Acute Hemorrhagic Rectal Ulcer in a Uremic Patient: A Case Report and Literature Review
Found harmCase seriesVery low qualityRelated question
1 people2025
bleeding recurred despite treatment and she died after developing heart failure and multi-organ failure
Who was studied
an elderly woman on dialysis for kidney failure
What they received
endoscopic treatment of a rectal ulcer (clips, injection, tissue glue)
Compared with
none
Main outcome
stopping the rectal bleeding and survival
Quality
this is a single patient case report, so it cannot show what usually happens or what helps.
Limitations
single case, patient had kidney failure and multiple other illnesses, no comparison group
Taken word for word from the abstract
- n A 78-year-old female with ESRD presented with rectal bleeding.
- population A 78-year-old female with ESRD presented with rectal bleeding.
- intervention managed with clips, injections, and adhesives
- comparator Endoscopic therapy was key, but systemic decline dominated.
- primaryOutcome The patient experienced recurrent bleeding, requiring multiple endoscopic interventions
- result Despite initial hemostasis, she developed worsening heart failure and multi-organ failure, dying at home after ICU admission.
Hemodial Int · PMID 40506688 · Read it on PubMed ↗
Gu et al. 2025
Rectal arterial embolization for hemostasis of acute hemorrhagic rectal ulcers: A case series
Embolization stopped the rectal bleeding.Case seriesLow quality
6 people2025
Treatment stopped bleeding in all patients initially, with technical success in 5 of 6 and rebleeding in 2 of 6
Who was studied
patients with massive painless rectal bleeding from acute hemorrhagic rectal ulcers
What they received
rectal arterial embolization to stop the bleeding
Compared with
none (single-group case series, endoscopic treatment mentioned only as general alternative)
Main outcome
successful stopping of bleeding (technical and clinical success) and rebleeding
Quality
This was a very small case series of only six patients with no comparison group, so it cannot reliably prove the treatment works better than alternatives.
Limitations
Small number of patients (6), single center, no control group, and authors state further validation in larger cohorts is needed.
Taken word for word from the abstract
- population sudden onset, painless, massive, and fresh rectal bleeding
- intervention Rectal arterial embolization (RAE)
- comparator endoscopic hemostasis remains prominent therapy
- primaryOutcome Technical success was achieved in 83% (5/6) of cases, with clinical success was achieved in 100% cases (6/6)
- result Technical success was achieved in 83% (5/6) of cases, with clinical success was achieved in 100% cases (6/6). Rebleeding after initial RAE procedure occurred in 33% (2/6) of cases
- n six patients with massive AHRU-related bleeding
Sci Prog · PMID 40388936 · Read it on PubMed ↗
Pospisilova et al. 2024
Anorectal hemangioma, a rare cause of lower gastrointestinal bleeding, treated with selective embolization: A case report
Rare blood vessel growth, treated with embolization.Case seriesVery low quality
1 people2024
Bleeding improved temporarily after embolization; a small ischemic ulcer developed but healed without narrowing of the bowel
Who was studied
21-year-old man with painless rectal bleeding since childhood, initially misdiagnosed as ulcerative colitis
What they received
selective embolization (blocking blood vessels) of an anorectal hemangioma
Compared with
surgical treatment (which carried high risk of fecal incontinence)
Main outcome
improvement in rectal bleeding and healing of the lesion
Quality
This is a single patient case report, so it cannot show how well this treatment works in general.
Limitations
Only one patient was described, and the abstract notes the improvement was 'temporarily,' with no long-term follow-up data given.
Taken word for word from the abstract
- population A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis.
- intervention selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice
- comparator possible surgical treatment was associated with a high risk of fecal incontinence
- primaryOutcome The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis.
- result The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis.
- n A 21-year-old male patient
World J Gastrointest Surg · PMID 39220052 · Read it on PubMed ↗
Alharbi et al. 2024
Colonic Angiolipoma: A Rare Cause of Chronic Anemia and Rectal Bleeding
Rare tumor removed, bleeding resolved.Case seriesVery low quality
1 people2024
after surgery, symptoms went away and blood counts returned to normal
Who was studied
52-year-old woman with no major health problems, painless rectal bleeding and anemia for six months
What they received
surgical removal of a colon tumor (angiolipoma)
Compared with
none
Main outcome
resolution of bleeding and anemia
Quality
This is a single patient case report, so it cannot show what usually causes or cures this problem.
Limitations
Only one patient was described, so findings may not apply to others.
Taken word for word from the abstract
- population a 52-year-old woman with no significant medical history who presented with generalized weakness, fatigue, and intermittent, painless rectal bleeding over six months
- n a 52-year-old woman
- intervention Histopathological analysis following surgical resection confirmed the diagnosis of a colonic angiolipoma
- comparator The patient's recovery, marked by the resolution of symptoms and normalization of hemoglobin levels, underscores the effectiveness of surgical treatment.
- primaryOutcome The patient's recovery, marked by the resolution of symptoms and normalization of hemoglobin levels
- result The patient's recovery, marked by the resolution of symptoms and normalization of hemoglobin levels, underscores the effectiveness of surgical treatment.
Cureus · PMID 38646340 · Read it on PubMed ↗
D'Sa et al. 2024
An Unusual Case of Gastric Heterotopia Presenting as Rectal Prolapse
Rare: stomach-tissue growth in rectum.Case seriesVery low quality
1 people2024
the abnormal tissue was completely removed by endoscopic surgery
Who was studied
a 2-year-old previously healthy girl with rectal prolapse and painless bleeding
What they received
endoscopic removal of misplaced stomach-like tissue in the rectum (after acid-reducing medication didn't work)
Compared with
none
Main outcome
complete removal of the abnormal tissue causing bleeding
Quality
This is a single patient case report, so it cannot show how common or reliable this cause or treatment is.
Limitations
Only one patient was described, and the abstract does not report how she did after the procedure.
Taken word for word from the abstract
- n We report a case of HGM in the rectum of a 2-year-old previously healthy girl
- population a 2-year-old previously healthy girl, who presented with rectal prolapse and painless bleeding
- intervention Endoscopic mucosal resection was performed to completely resect the lesion after the patient failed to respond to proton pump inhibitors.
- comparator after the patient failed to respond to proton pump inhibitors
- primaryOutcome Endoscopic mucosal resection was performed to completely resect the lesion
- result Endoscopic mucosal resection was performed to completely resect the lesion after the patient failed to respond to proton pump inhibitors.
ACG Case Rep J · PMID 38274300 · Read it on PubMed ↗
Acevedo Forero et al. 2023
[Videocapsule Endoscopy as a Diagnostic Tool for Meckel's Diverticulum in Pediatrics: a Case Report]
Painless bleeding found to be Meckel's diverticulum.Case seriesVery low quality
size not given2023
video capsule endoscopy allowed direct visualization to clarify the cause of small intestine bleeding
Who was studied
children with suspected Meckel's diverticulum causing rectal bleeding
What they received
video capsule endoscopy to directly view the small intestine
Compared with
no comparator; Meckel's scan mentioned as alternative diagnostic test
Main outcome
accurate diagnosis of the cause of painless rectal bleeding
Quality
This is a single case report, so it cannot show how often this diagnosis explains painless bleeding in general.
Limitations
Case report format with no patient numbers given; findings may not generalize.
Taken word for word from the abstract
- population Meckel's diverticulum is a common congenital anomaly of the small intestine
- intervention video capsule endoscopy, a useful tool to clarify the etiology of bleeding in the small intestine
- comparator the most sensitive is Meckel's scan
- primaryOutcome direct visualization is the way to make an accurate diagnosis
- result video capsule endoscopy, a useful tool to clarify the etiology of bleeding in the small intestine
- population The most common symptom is painless rectal bleeding
Acta Gastroenterol Latinoam · PMID 41341644 · Read it on PubMed ↗
Khadka et al. 2023
Cap Polyposis: A Case Report
Polyp removal treated painless rectal bleeding.Case seriesVery low quality
1 people2023
patient treated with immediate and interval polypectomy for cap polyposis, described as curable
Who was studied
18-year-old male with one year of painless rectal bleeding
What they received
polypectomy (removal of polyps) in multiple settings
Compared with
none reported
Main outcome
resolution of polyposis and bleeding after treatment
Quality
this is a single case report, which cannot show whether the treatment works in general.
Limitations
Only one patient was described, with no comparison group and no long-term outcome data reported.
Taken word for word from the abstract
- n a case of a 18-year-old male patient
- population He presented with one year of painless rectal bleeding and polyposis in a recto-sigmoid area on colonoscopy
- intervention He was managed with immediate and interval polypectomy.
- comparator underwent polypectomy for polyposis in multiple settings
- primaryOutcome Though cap polyposis is rare, it can be cured as it is laparoscopically resectable.
- result He was managed with immediate and interval polypectomy.
JNMA J Nepal Med Assoc · PMID 37464856 · Read it on PubMed ↗
Qasim et al. 2023
Dieulafoy's Lesion of the Duodenum: A Rare and Fatal Cause of Gastrointestinal Bleed
Rare vessel defect found causing bleeding.Case seriesVery low quality
1 people2023
found to have a duodenal Dieulafoy lesion, a rare cause of painless GI bleeding
Who was studied
a 71-year-old woman with severe iron deficiency anemia needing repeated blood transfusions
What they received
endoscopic diagnosis and treatment of a bleeding vessel in the duodenum (Dieulafoy's lesion)
Compared with
none
Main outcome
identifying the cause of gastrointestinal bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
only one patient described; no comparison group or outcome data after treatment reported.
Taken word for word from the abstract
- n a 71-year-old female
- population a 71-year-old female who had a history of severe IDA requiring multiple blood transfusions and intravenous iron in the past
- intervention The diagnosis is established by esophagogastroduodenoscopy (EGD)
- comparator We present here a case of a 71-year-old female
- primaryOutcome was found to have duodenal DL
- result was found to have duodenal DL
Cureus · PMID 37425531 · Read it on PubMed ↗
Devi et al. 2023
Hemorrhoid Disease: A Review on Treatment, Clinical Research and Patent Data
No specific finding reported here.Narrative reviewVery low qualityRelated question
size not given2023
review summarizes newer molecules and past studies but does not report a specific outcome result
Who was studied
people with hemorrhoid disease
What they received
various treatments for hemorrhoids (reviewed)
Main outcome
safety and clinical efficacy of hemorrhoid treatments
Quality
this is a narrative review of literature and patents, not a study testing a treatment, so it gives no direct evidence about outcomes.
Limitations
no original data, no outcome statistics reported, purpose is to summarize drug development and patents rather than test treatment effectiveness
Taken word for word from the abstract
- population Hemorrhoid disease (HD) is an anal-rectal ailment that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue.
- intervention newer molecules to overcome hemorrhoids
- primaryOutcome To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.
- result This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.
Infect Disord Drug Targets · PMID 37106517 · Read it on PubMed ↗
Singh et al. 2023
Primary amelanotic melanoma of anorectum - a rare case report with diagnostic challenge
Rare melanoma cause found.Case seriesVery low quality
1 people2023
diagnosed as a rare amelanotic malignant melanoma of the anorectum, treated with surgery
Who was studied
a 47-year-old woman with painless rectal bleeding
What they received
biopsy with histomorphology and immunohistochemistry to diagnose the cause
Main outcome
identifying the cause of painless rectal bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatments work generally
Limitations
only one patient; no comparison group; cannot generalize cause of rectal bleeding to other patients
Taken word for word from the abstract
- n We report a case of a 47-year-old woman who experienced painless rectal bleeding.
- population We report a case of a 47-year-old woman who experienced painless rectal bleeding.
- intervention Biopsies were obtained under endoscopic guidance for histomorphology and immunohistochemistry.
- primaryOutcome A definitive diagnosis of amelanotic malignant melanoma was rendered.
- result The patient underwent abdominoperineal resection with a hysterectomy and bilateral salpingo-oophorectomy.
Pol J Pathol · PMID 38477093 · Read it on PubMed ↗
Fair et al. 2022
A giant hemangioma of the sigmoid colon as a cause of lower gastrointestinal bleeding in a young man
Rare colon growth found and removed.Case seriesVery low quality
1 people2022
surgery successfully removed the large hemangioma causing bleeding
Who was studied
37-year-old man with recurrent painless rectal bleeding for 2 months
What they received
laparoscopic surgical removal of the sigmoid colon section
Compared with
none
Main outcome
successful treatment of the bleeding source
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Single case report; no comparison group; findings may not generalize to other patients.
Taken word for word from the abstract
- n a 37-year-old man
- population a 37-year-old man with a 2-month history of intermittent rectal bleeding
- intervention successfully treated with elective laparoscopic sigmoid resection
- comparator successfully treated with elective laparoscopic sigmoid resection
- primaryOutcome successfully treated with elective laparoscopic sigmoid resection
- result successfully treated with elective laparoscopic sigmoid resection
Proc (Bayl Univ Med Cent) · PMID 36304634 · Read it on PubMed ↗
Abdulghaffar et al. 2022
A rectosigmoid haemangioma: A rare etiology of rectal bleeding
Rare blood vessel growth caused bleeding.Case seriesVery low quality
1 people2022
CT and MRI confirmed a cavernous hemangioma of the rectosigmoid colon, treated with surgical resection
Who was studied
26-year-old man with long history of recurrent rectal bleeding
What they received
CT scan, MRI imaging and surgical resection of the rectosigmoid colon with colo-anal anastomosis
Compared with
none
Main outcome
diagnosis and treatment of the cause of rectal bleeding
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Only one patient was described, with no comparison group or long-term outcome data reported.
Taken word for word from the abstract
- n a 26-year-old male patient with a long history of recurrent rectal bleeding
- population a 26-year-old male patient with a long history of recurrent rectal bleeding
- intervention Contrast-enhanced CT scan of the abdomen and pelvis and MRI confirmed the diagnosis of cavernous hemangioma. Further surgical treatment with rectosigmoid resection and colo-anal anastomosis represents the optimum path of management for our patient.
- comparator Further surgical treatment with rectosigmoid resection and colo-anal anastomosis represents the optimum path of management for our patient.
- result Contrast-enhanced CT scan of the abdomen and pelvis and MRI confirmed the diagnosis of cavernous hemangioma.
- primaryOutcome Contrast-enhanced CT scan of the abdomen and pelvis and MRI confirmed the diagnosis of cavernous hemangioma.
BJR Case Rep · PMID 36211606 · Read it on PubMed ↗
Hui et al. 2022
Adjunctive endoscopic clip marking enhances non-operative management of massive lower gastrointestinal bleeding
Clip-guided embolization controlled bleeding well.Case seriesLow qualityRelated question
36 people2022
non-operative management succeeded in 83.3% of patients, with 0% death within 30 days
Who was studied
patients with massive lower gastrointestinal bleeding from colon diverticular disease, often causing painless rectal bleeding
What they received
endoscopic clip marking (EPM) to guide artery-blocking embolization (TAE) of the bleeding vessel
Compared with
no separate comparison group; outcomes reported within the same treated patients
Main outcome
whether bleeding could be controlled without surgery (successful non-operative management) and survival
Quality
This is a small, single-centre case series without a comparison group, so it can't prove the technique is better than usual care.
Limitations
Retrospective case series spanning many years, small number of patients, no control group for comparison, and only six patients had the specific clip-then-embolization sequence analysed in detail.
Taken word for word from the abstract
- n there were 36 patients with massive LGB from diverticular disease encompassing 44 separate bleeding episodes
- population Colonic diverticula disease (CD) is the leading cause of painless haematochezia and haemodynamic instability.
- intervention The use of a novel technique of endoscopic pre-marking (EPM) with radiopaque metal clips to localize is described. EPM guided superselective active transarterial embolization (A-TAE)
- comparator Spontaneous haemostasis was observed in 18.2% (8/44).
- primaryOutcome The overall success rate in non-operative management was 83.3% (30/36) patients.
- result The overall success rate in non-operative management was 83.3% (30/36) patients.
- result The 30-day mortality was 0%.
ANZ J Surg · PMID 36074650 · Read it on PubMed ↗
Balhorn et al. 2022
Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic
Fewer follow-up visits needed overall.RetrospectiveLow qualityRelated question
268 people5 year follow up
new clinic protocol had far fewer follow-up visits than old system, with similar detection of cancer
Who was studied
patients referred with rectal bleeding (painful and painless) at a hospital surgical clinic
What they received
new clinic protocol allowing patient-initiated follow up (PIFU)
Compared with
historical controls using traditional physician-initiated follow up
Main outcome
rate of follow-up appointments needed
Quality
This is a small retrospective comparison with historical (not randomized) controls, so differences could be due to other factors over time.
Limitations
Abstract does not discuss causes of rectal bleeding, uses historical rather than randomized controls, and does not report how diagnoses were made.
Taken word for word from the abstract
- population patients referred with rectal bleeding at a large tertiary public hospital in South Auckland, New Zealand
- intervention Patient initiated follow up (PIFU) allows patients to initiate a hospital follow up appointment on an 'as required' basis
- comparator this was compared to historical controls (HC)
- primaryOutcome The primary outcome was the rate of follow up appointments.
- result There were 133 patients in the NC and 135 in the HC, with significantly less follow ups in the NC (6% versus 45%, p < 0.0001).
- n There were 133 patients in the NC and 135 in the HC
- followUp At 5 year follow up, there was a single colorectal malignancy found in both groups.
ANZ J Surg · PMID 35429226 · Read it on PubMed ↗
Hermosa et al. 2021
Diffuse cavernous hemangioma of the rectum
Rare vascular tumor causing painless bleeding.Case seriesVery low quality
1 people2021
the patient needed full removal surgery because the growth affected the anal sphincter area
Who was studied
34-year-old man with a vascular growth in the rectum and anus
What they received
surgical removal of the rectum and anus (abdominoperineal resection)
Main outcome
diagnosis and treatment of painless rectal bleeding
Quality
This is a report on a single patient, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Single case report; no comparison group; findings may not generalize.
Taken word for word from the abstract
- population We present a 34-year-old male with a DCH of the rectum and anus
- intervention required an APR because of affection of dentate line
- primaryOutcome The most frequent symptom is chronic rectal bleeding which is painless, often begins in the infancy and sometimes is uncontrollable.
- result We present a 34-year-old male with a DCH of the rectum and anus who required an APR because of affection of dentate line.
- n We present a 34-year-old male
Cir Cir · PMID 34851591 · Read it on PubMed ↗
Callanan et al. 2021
Meckel's Masquerade: Penetrating the Disguise
Meckel's here caused pain, not painless bleeding.Case seriesVery low qualityRelated question
4 people2021
all 4 patients had abdominal pain from Meckel's diverticulum complications, none had painless rectal bleeding
Who was studied
children seen in a pediatric emergency department with abdominal pain
What they received
none - observational case series
Compared with
none
Main outcome
how Meckel's diverticulum complications presented in these patients
Quality
this is a tiny report of only 4 patients from one hospital describing cases, not a study comparing treatments or testing a cause directly.
Limitations
Very small case series (4 patients) from a single center over 6 months, describing abdominal pain presentations rather than painless bleeding specifically.
Taken word for word from the abstract
- n we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum
- population Children with abdominal pain are frequently seen in emergency departments
- intervention we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum
- comparator we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum
- primaryOutcome Meckel's diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation
- result None presented with painless rectal bleeding, the complication of which physicians are most aware
Pediatr Emerg Care · PMID 34507344 · Read it on PubMed ↗
Alyahyawi 2021
Rare cause of painless lower gastrointestinal bleeding: A case report
Rare bowel endometriosis caused bleeding; surgery fixed it.Case seriesVery low quality
1 people2021
bleeding was caused by intestinal endometriosis; patient recovered after surgical removal of the affected bowel segment
Who was studied
44-year-old woman with intermittent painless rectal bleeding for three months, no other symptoms
What they received
surgical removal of part of the colon (ileocecal resection) for intestinal endometriosis
Compared with
none
Main outcome
cause of painless rectal bleeding and outcome after surgery
Quality
this is a single patient case report, so it cannot show how common this cause is or whether surgery generally helps others.
Limitations
single case report with no comparison group; findings may not generalize to other patients with painless rectal bleeding.
Taken word for word from the abstract
- population A 44-year-old female patient suffering from intermittent hematochezia for the past three months was presented with no medical history or any other symptoms correlating with current complaints.
- intervention Laparoscopically assisted ileocecal resection with a sutured side-to-side ileoascendostomy was then performed.
- comparator Colonoscopic biopsies and histopathological examination revealed only colon mucosa with mucosal oedema and an unspecific inflammatory reactive regenerative polypoid with no evidence of tumor tissue adenoma.
- primaryOutcome Intermittent hematochezia of the patient got worse in the following months without any other concurrent symptom.
- result The patient was kept on enhanced recovery program and was discharged on the fourth post-operative day with analgesics.
- n A 44-year-old female patient suffering from intermittent hematochezia for the past three months
Int J Surg Case Rep · PMID 34252643 · Read it on PubMed ↗
Malik et al. 2021
Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis
Painless bleeding from diverticula, described technique only.Case seriesVery low qualityRelated question
size not given2021
the rapid prep and clipping approach appeared to help achieve hemostasis, but authors say its exact necessity remains unclear
Who was studied
people with severe sudden bleeding from colon diverticula (pouches)
What they received
fast bowel-cleansing with a low-volume laxative drink plus endoscopic clipping with epinephrine
Compared with
traditional higher-volume bowel prep
Main outcome
stopping the bleeding (hemostasis) and successful colonoscopy visualization
Quality
this is a case report/case series describing technique, not a controlled study, so it cannot reliably show whether the treatment works.
Limitations
no control group, small case-based evidence, authors state the importance of the bowel prep for hemostasis 'remains elusive'
Taken word for word from the abstract
- population Colonic diverticular bleeding is an established cause of painless acute lower gastrointestinal hemorrhage.
- intervention rapid bowel preparation with a very-low-volume novel 1 L polyethylene glycol ascorbate solution
- intervention endoscopic technique using epinephrine followed by direct hemoclipping
- comparator The 1-L regimen may demonstrate similar efficacy to that of traditional higher volume preparations
- primaryOutcome rapid bowel preparation with 1 L polyethylene glycol ascorbate solution's imperativeness to achieve hemostasis with direct hemoclipping remains elusive
- result rapid bowel preparation with 1 L polyethylene glycol ascorbate solution's imperativeness to achieve hemostasis with direct hemoclipping remains elusive
J Investig Med High Impact Case Rep · PMID 33596710 · Read it on PubMed ↗
Ferdaus et al. 2021
Giant Villous Adenoma: A Rare Case of Colorectal Adenoma that Mimic Colorectal Cancer
Rare large polyp caused bleeding.Case seriesVery low quality
1 peopletwo months after ileostomy reversal, patient asymptomatic
Large benign rectal polyp (villous adenoma) found and removed; patient became symptom-free
Who was studied
65-year-old woman with long-term painless rectal bleeding and mucus discharge
What they received
surgical removal of rectal polyp (low anterior resection with coloanal anastomosis and ileostomy)
Compared with
none
Main outcome
diagnosis and resolution of symptoms after surgery
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Only one patient described; no comparison group; findings may not generalize.
Taken word for word from the abstract
- n a 65 years female
- population intermittent fresh, painless, scanty per rectal bleeding along with weakness and fatigue for last 5 years
- intervention intersphincteric ultra-low anterior resection with coloanal anastomosis with covering ileostomy was done
- primaryOutcome Resected specimen was sent for histopathological study and it reveals- villous adenoma with low grade dysplasia
- result now the patient is under regular follow up and now she is asymptomatic
- comparator intersphincteric ultra-low anterior resection with coloanal anastomosis with covering ileostomy was done
Mymensingh Med J · PMID 33397878 · Read it on PubMed ↗
Stratta et al. 2021
Conservative Treatment of Hemorrhoidal Disease
Hemorrhoids are common, usually painless bleeding causeNarrative reviewVery low quality
size not given2021
conservative treatment helps most patients with early-stage hemorrhoids, but evidence quality is weak
Who was studied
people with hemorrhoidal disease (hemorrhoids)
What they received
conservative treatments: diet/lifestyle changes, oral medications, and topical medications
Main outcome
control of symptoms and effectiveness of treatment
Quality
this is a narrative review admitting very few randomized trials exist and most evidence comes from uncontrolled case series.
Limitations
the abstract states few randomized controlled trials exist and most studies are uncontrolled case series, with calls for larger better-designed studies
Taken word for word from the abstract
- population patients complaining of early stages of the disease
- intervention Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms. The use of topical medications
- result Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease.
- result very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series
- primaryOutcome the most common cause of painless rectal bleeding during defecation with or without prolapsing anal tissue
Rev Recent Clin Trials · PMID 33087033 · Read it on PubMed ↗
Alkhamis et al. 2020
Good Outcome of Early-Stage Rectal Cancer Diagnosed During Pregnancy
Rare case: early rectal cancer found, successfully removedCase seriesVery low qualityRelated question
1 peoplefull term pregnancy
mass removed, diagnosed as early cancer, pregnancy continued bleeding-free with healthy baby born full term
Who was studied
30-year-old pregnant woman at 9 weeks gestation with painless rectal bleeding
What they received
sigmoidoscopy with removal of rectal mass (polypectomy)
Main outcome
diagnosis and resolution of rectal bleeding, maternal and fetal outcome
Quality
this is a single patient case report, so it cannot show how common this cause is or what usually happens to others with similar symptoms
Limitations
single case report; findings cannot be generalized to explain typical causes of painless rectal bleeding
Taken word for word from the abstract
- population A 30-year-old patient, gravida 3, presented at 9-week gestation with a history of sudden painless, fresh, rectal bleeding with no aggravating factors such as constipation or hemorrhoids.
- intervention The mass was completely removed during the sigmoidoscopy procedure
- primaryOutcome the histopathological diagnosis was a tubulovillous adenoma with focal intramucosal carcinoma
- result After the polypectomy procedure, the patient had an uneventful, bleeding-free pregnancy and delivered a healthy baby at full term.
- n A 30-year-old patient, gravida 3
Am J Case Rep · PMID 32866137 · Read it on PubMed ↗
Xu et al. 2020
Primary anorectal malignant melanoma: A case report
Rare melanoma found; surgery worked for one patientCase seriesVery low qualityRelated question
1 people24 month
Diagnosed with a rare malignant melanoma of the anus/rectum; after surgery, no cancer recurrence at 24 months
Who was studied
66-year-old man with 2 months of painless rectal bleeding
What they received
Surgery to remove the rectum and anus (abdominoperineal resection)
Compared with
No comparator (single case)
Main outcome
Whether cancer came back after surgery
Quality
This is a single patient case report, so it cannot show what causes painless rectal bleeding in general or whether this treatment works for others.
Limitations
Single case report with no comparison group; findings may not generalize to other causes of painless rectal bleeding.
Taken word for word from the abstract
- population A 66-year-old male patient presented with a 2-months history of painless rectal bleeding.
- intervention The patient underwent abdominoperineal resection with no other adjuvant therapy.
- comparator The patient underwent abdominoperineal resection with no other adjuvant therapy.
- primaryOutcome The patient is doing well at 24 month after the operation, with no signs of recurrence.
- result Immunohistochemistry analyses confirmed malignant melanoma.
- result The patient is doing well at 24 month after the operation, with no signs of recurrence.
- n A 66-year-old male patient presented
- followUp at 24 month after the operation
Medicine (Baltimore) · PMID 32000450 · Read it on PubMed ↗
Voltaggio et al. 2020
A novel group of HPV-related adenocarcinomas of the lower anogenital tract (vagina, vulva, and anorectum) in women and men resembling HPV-related endocervical adenocarcinomas
Rare HPV cancer caused painless bleeding.Case seriesVery low qualityRelated question
9 people2020
Some patients with anorectal tumors had painless rectal bleeding as their presenting symptom, linked to HPV-positive adenocarcinoma
Who was studied
men and women with rare HPV-related adenocarcinomas of the vagina, vulva, or anorectal area
What they received
none; this is a descriptive pathology study with no treatment tested
Compared with
none
Main outcome
clinical presentation and tumor characteristics, including symptoms like bleeding
Quality
It is a small case series of only nine patients with no control group, so it cannot show how common this cause of bleeding is or compare treatments.
Limitations
Very small sample size, no comparison group, and follow-up data available for only five of nine patients.
Taken word for word from the abstract
- n We report a series of nine HPV-related adenocarcinomas of the lower anogenital tract distal to the cervix.
- population Two of the three anorectal cases involved men.
- intervention We report the first well-documented series of HPV-associated primary adenocarcinomas of the vagina, vulva, and anorectum
- comparator We report a series of nine HPV-related adenocarcinomas of the lower anogenital tract distal to the cervix.
- primaryOutcome Patients presented with a vulvar or vaginal mass/nodule, painless rectal bleeding, or during screening colonoscopy.
- result Patients presented with a vulvar or vaginal mass/nodule, painless rectal bleeding, or during screening colonoscopy.
Mod Pathol · PMID 31857682 · Read it on PubMed ↗
Chandnani et al. 2019
CLINICAL UTILITY OF RISK SCORES IN VARICEAL BLEEDING
Painless bleeding linked to variceal causeProspective cohortLow qualityRelated question
300 people30 days
each score predicted only some outcomes, not all, and none worked well across the board
Who was studied
patients with upper gastrointestinal bleeding, including those with and without esophageal varices
What they received
four risk scoring systems (AIMS65, Rockall, Glasgow Blatchford, PNED) used to predict outcomes
Compared with
patients with non-variceal upper GI bleeding
Main outcome
predicting death, rebleeding, need for blood transfusion, or need for procedures within 30 days
Quality
it is an observational study validating prediction scores, not a treatment trial, and no factor was significant after adjusting for other factors
Limitations
abstract states no factor was significant on multivariate analysis, and this study is about predicting outcomes in known variceal bleeding, not about explaining painless rectal bleeding in general
Taken word for word from the abstract
- n Three hundred subjects with UGIB were screened prospectively
- population Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases
- intervention validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes
- comparator risk scores were calculated and compared to non-variceal cases
- primaryOutcome followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention
- result All four scores had lower predictive potential in predicting events in variceal bleed. However, AIMS65 & Rockall score were significant in predicting mortality, while GBS in predicting need of transfusion and intervention. PNED score was significant in all events except mortality.
- plainFinding Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001)
Arq Gastroenterol · PMID 31633727 · Read it on PubMed ↗
Sağ et al. 2020
Constitutional Mismatch Repair Gene Defect Syndrome Presenting With Adenomatous Polyposis and Cafe au Lait Spots: A Case Report
Rare genetic disorder caused the bleeding.Case seriesVery low quality
1 people2 years
Found to have a genetic mismatch repair gene defect causing multiple colon polyps, one with early cancer changes, eventually requiring colon removal
Who was studied
16-year-old girl with painless rectal bleeding, abdominal pain, and anorexia for a year
What they received
none (diagnostic workup and polyp removal)
Compared with
none
Main outcome
underlying cause of painless rectal bleeding and colon polyps
Quality
This is a single patient case report, which cannot show how common this cause is or how it compares to other explanations.
Limitations
Single case report; findings may not generalize to other people with painless rectal bleeding.
Taken word for word from the abstract
- n A 16-year-old female patient
- population admitted with painless rectal bleeding, chronic abdominal pain, and anorexia for 1 year
- intervention Polypectomy was performed 4 times in 2 years period
- comparator CASE: A 16-year-old female patient admitted with painless rectal bleeding
- primaryOutcome we want to present a rare patient who had adenomatous polyposis and in situ carcinoma and was detected biallelic MMR gene defect
- result Genetic analysis revealed a homozygous mutation in the PMS2 gene [c.1164delT (p.H388Qfs*10) (p.His388GInfsTer10)] and she was diagnosed with constitutional MMR gene defect syndrome
- result she underwent colectomy because of high risk of colorectal cancer
J Pediatr Hematol Oncol · PMID 31599855 · Read it on PubMed ↗
Memon et al. 2019
An Incidental Finding of Anemia: Rectal Adenocarcinoma in a Young Adult
Painless bleeding was colon cancer.Case seriesVery low quality
1 people2019
colonoscopy found an 8 cm mass that was diagnosed as advanced (stage IV) rectal adenocarcinoma
Who was studied
a 34-year-old man with painless rectal bleeding and anemia
What they received
none (diagnostic workup including colonoscopy)
Quality
This is a single patient case report, so it cannot show how common this cause is or apply broadly.
Limitations
Single case report; findings in one patient cannot be generalized to explain all cases of painless rectal bleeding.
Taken word for word from the abstract
- population A 34-year-old Caucasian male presented with the incidental finding of anemia during a preliminary evaluation for rheumatoid arthritis.
- population Past medical history was positive for only a three-year history of occasional spotty, painless rectal bleeding attributed to internal hemorrhoids.
- intervention he was evaluated for a lower gastrointestinal source of bleeding by colonoscopy, which revealed an 8 cm circumferential mass at the anal verge.
- result Pathological evaluation of biopsy samples revealed a moderately differentiated invasive adenocarcinoma.
- n a 34-year-old male patient
Cureus · PMID 31275778 · Read it on PubMed ↗
Schwenk 2019
[Endoscopy, angiography, surgery: diagnostic and therapeutic algorithms for diverticular bleeding]
Painless bleeding often from diverticula, usually stops alone.Narrative reviewLow quality
size not given2019
most diverticular bleeding stops on its own, and when it doesn't, endoscopy can usually find and treat the source; surgery is reserved for severe or recurrent cases
Who was studied
people with diverticular disease who have painless rectal bleeding
What they received
diagnostic workup with endoscopy, angiography, or CT angiography, followed by endoscopic, radiological, or surgical treatment if needed
Compared with
not applicable - review of diagnostic and treatment algorithms, no comparison group
Main outcome
identifying the source of bleeding and stopping it
Quality
this is a narrative review summarizing expert recommendations and general knowledge, not original research testing an intervention.
Limitations
no original data, patient numbers, or study methodology described; it is a review article based on existing guidelines and literature.
Taken word for word from the abstract
- population Diverticular bleeding is a complication of diverticular disease
- intervention Interdisciplinary diagnostic and therapeutic algorithms recommend primary endoscopy in acute as well as chronic recurrent diverticular bleeding. If endoscopy fails to provide an exact localization of the origin of bleeding, angiography or computed tomography (CT) angiography can be performed.
- comparator The main symptom of diverticular hemorrhage is painless hematochezia
- primaryOutcome further diagnostics of suspected diverticular bleeding should be performed in hospital
- result More than 90% of diverticular hemorrhages stop spontaneously; however, it is general agreed that an active diverticular bleeding detected during colonoscopy should be immediately treated endoscopically.
- result In the rare case of severe bleeding that cannot otherwise be stopped or if the bleeding vessel cannot be located, laparotomy and total colectomy can be recommended.
Chirurg · PMID 30976892 · Read it on PubMed ↗
Ganesananthan et al. 2019
Multiple venous malformations in the left colon and rectum: a long-standing case managed conservatively and an update of current literature
Rare vein defect caused bleeding.Case seriesVery low quality
1 people2019
patient had venous malformations causing painless bleeding, previously misdiagnosed as colitis and angiodysplasia
Who was studied
65-year-old patient with painless rectal bleeding
What they received
treatment options discussed for venous malformations of the colon/rectum
Compared with
previously managed as colitis and angiodysplasia
Main outcome
diagnosis and management of bleeding source
Quality
This is a single patient case report, so it cannot show how well treatments generally work.
Limitations
Single case report; diagnosis delayed for years; no comparison group
Taken word for word from the abstract
- population a 65-year-old patient who presented with occult, painless rectal bleeding
- intervention discussing patient treatment options and potential challenges faced in patient management.
- comparator had been managed variously as colitis and angiodysplasia
- primaryOutcome principal clinical clues to aid the diagnosis
- result had been managed variously as colitis and angiodysplasia
- n a 65-year-old patient
BMJ Case Rep · PMID 30902841 · Read it on PubMed ↗
Case et al. 2019
Solitary ascending colon ulcer diagnosed as gastrointestinal CMV disease
Rare viral ulcer caused bleeding.Case seriesVery low qualityRelated question
1 people2019
found a solitary ulcer in the ascending colon caused by CMV infection
Who was studied
42-year-old woman on chemotherapy for bile duct cancer, with painless rectal bleeding
Main outcome
cause of painless rectal bleeding
Quality
this is a single patient case report, so it cannot show how common or typical this cause is.
Limitations
single case, specific to a chemotherapy patient, cannot generalize to other causes of painless bleeding
Taken word for word from the abstract
- population A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia.
- result She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated.
- primaryOutcome This is an unusual case of a solitary proximal colon ulcer.
- n A 42-year-old woman
BMJ Case Rep · PMID 30739086 · Read it on PubMed ↗
Ramos et al. 2018
Gastrointestinal Bleeding Secondary to Iliac Artery Pseudoaneurysm in a Patient With Remote Pancreas Transplant: A Case Report
Rare artery defect caused bleeding; fixed with stenting.Case seriesVery low qualityRelated question
1 people2018
bleeding was caused by an artery pseudoaneurysm eroding into the pancreas-bowel connection; after balloon and stent treatment, bleeding stopped
Who was studied
49-year-old man with type 1 diabetes and a pancreas transplant 4 years earlier that had failed
What they received
surgery and stenting to fix a bulging artery (pseudoaneurysm) eroding into the bowel connection
Compared with
no comparator, single patient case
Main outcome
stopping painless rectal bleeding (hematochezia)
Quality
this is a single patient case report, so it cannot show how often this cause applies to others or prove the treatment works in general
Limitations
only one patient, from a very specific context (prior pancreas transplant with enteric drainage), not generalizable to painless rectal bleeding in general
Taken word for word from the abstract
- n A 49-year-old man with history of type 1 diabetes mellitus presented for evaluation
- population A 49-year-old man with history of type 1 diabetes mellitus presented for evaluation with a 2-day history of painless hematochezia. He had undergone PT 4 years prior to presentation, which failed due to acute cellular rejection after 1 year.
- intervention After combined endovascular procedure with ballooning and stenting of the right iliac artery, optimal hemostasis was achieved without further episodes of hematochezia.
- comparator CASE REPORT
- primaryOutcome presented for evaluation with a 2-day history of painless hematochezia
- result Exploration revealed a right common iliac artery pseudoaneurysm eroding into the pancreatic-ileal anastomosis, which required initial digital compression for initial hemostasis. After combined endovascular procedure with ballooning and stenting of the right iliac artery, optimal hemostasis was achieved without further episodes of hematochezia.
Transplant Proc · PMID 30577321 · Read it on PubMed ↗
Salomon et al. 2019
Antimicrobial Lubricant Did Not Reduce Infection Rate in Transrectal Biopsy Patients in a Large Randomized Trial Due to Low Complication Rates
No benefit from antimicrobial lubricant; bleeding uncommonRandomised trialModerate qualityRelated question
732 people3-wk
no significant reduction in infectious complications with the antimicrobial lubricant; overall complication rates were low, with rectal bleeding in 7.4% of patients
Who was studied
men undergoing transrectal prostate biopsy
What they received
antimicrobial lubricant used during prostate biopsy
Compared with
standard (non-antimicrobial) lubricant
Main outcome
infectious complications after prostate biopsy
Quality
it was a large randomized trial, but only 73% of patients returned questionnaires and it was limited to one center, which weakens confidence.
Limitations
Our results stem from a large German single center and therefore are limited to this patient group.
Taken word for word from the abstract
- n Return rate was 73.2% (n=732)
- population Transrectal prostate biopsy (pbx) is the most frequent outpatient procedure in the urological field.
- intervention Randomization for pbx with the instillation of an antimicrobial lubricant (intervention group, n=385)
- comparator or the standard lubricant (control group, n=347) was performed.
- primaryOutcome To evaluate complication rates with or without an antimicrobial lubricant.
- result The use of an antimicrobial lubricant did not reduce infection rate. Overall complication rate was very low.
- result Most common complications were hematospermia (47.4%), macrohematuria (23.8%), and rectal bleeding (7.4%).
Eur Urol Focus · PMID 29941389 · Read it on PubMed ↗
Talathi et al. 2020
Perforated Meckel Diverticulum: A Rare Cause of Acute Abdomen in Children
Meckel diverticulum can cause painless bleeding.Case seriesVery low qualityRelated question
1 people2020
a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation
Who was studied
a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out
What they received
exploratory laparoscopy to find the cause
Main outcome
identifying the cause of acute abdomen
Quality
This is a single case report, so it cannot show how common or reliable this cause is.
Limitations
Single patient case report describing a child with acute abdominal pain and perforation, not specifically painless bleeding.
Taken word for word from the abstract
- population We report a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out
- intervention a diagnosis of MD was established on exploratory laparoscopy
- primaryOutcome This report emphasizes the need for maintaining a high index of suspicion towards a possibility of a complicated MD in patients presenting with an acute abdomen
- result a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation
- n We report a patient with acute abdomen
Pediatr Emerg Care · PMID 29324630 · Read it on PubMed ↗
Vitor et al. 2016
Hemangioma of the rectum - How misleading can hematochezia be?
Rectal hemangioma caused painless bleeding.Case seriesVery low quality
1 people2016
the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms
Who was studied
an 18-year-old male patient that was referred to our gastrenterology department with history of intermittent painless hematochezia since childhood
What they received
We adopted a conservative strategy with clinical surveillance and iron supplementation.
Compared with
After discussion, we considered to perform a sphincter-sparing procedure, namely pull through transection and coloanal anastomosis.
Main outcome
the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatments work.
Limitations
Single case report; no control group; surgical treatment was not performed so its effectiveness could not be assessed in this patient.
Taken word for word from the abstract
- n We present the case of an 18-year-old male patient
- population an 18-year-old male patient that was referred to our gastrenterology department with history of intermittent painless hematochezia since childhood
- intervention We adopted a conservative strategy with clinical surveillance and iron supplementation.
- comparator After discussion, we considered to perform a sphincter-sparing procedure, namely pull through transection and coloanal anastomosis.
- primaryOutcome the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms
- result the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms
Rev Esp Enferm Dig · PMID 27554385 · Read it on PubMed ↗
James et al. 2016
Rectal adenocarcinoma infiltrating the bulbar urethra and metastasising to the penis
Rectal cancer spread to penis.Case seriesVery low qualityRelated question
1 people2016
Rectal cancer had spread to the penis and did not respond to chemoradiotherapy
Who was studied
A man with constipation and rectal bleeding, found to have rectal cancer
What they received
Diversion colostomy and chemoradiation
Compared with
None
Main outcome
Response of tumour to treatment
Quality
This is a single patient case report, which cannot show whether treatments work in general.
Limitations
Single case report with no comparison group; describes advanced cancer with spread, not a general cause of painless rectal bleeding.
Taken word for word from the abstract
- n We report a case of rectal adenocarcinoma with synchronous painless penile nodules.
- population A patient presented with constipation and rectal bleeding.
- intervention Diversion colostomy was performed and the patient referred for chemoradiation.
- comparator the penile lesions were left unaltered
- primaryOutcome Repeat imaging after concurrent chemoradiotherapy showed no response.
- result Repeat imaging after concurrent chemoradiotherapy showed no response.
BMJ Case Rep · PMID 27312852 · Read it on PubMed ↗
Itriyeva et al. 2015
Not Just Painless Bleeding: Meckel's Diverticulum as a Cause of Small Bowel Obstruction in Children-Two Cases and a Review of the Literature
Meckel's diverticulum can cause blockage, not just bleedingCase seriesVery low qualityRelated question
2 people2015
two children had intestinal obstruction caused by Meckel's diverticulum, not painless bleeding
Who was studied
children presenting to the emergency department with bowel problems
What they received
not applicable (diagnostic case review)
Main outcome
cause of intestinal obstruction symptoms
Quality
this is just two patient cases, not a study designed to measure how well a treatment works
Limitations
only two cases described, no comparison group, cannot show how common this is
Taken word for word from the abstract
- population young patients with MD
- intervention We present two cases of intestinal obstruction diagnosed in our emergency department, with Meckel's diverticulum being the etiology.
- primaryOutcome Meckel's diverticulum being the etiology
- result young patients with MD will most commonly present with signs of intestinal obstruction
- n We present two cases of intestinal obstruction diagnosed in our emergency department
Case Rep Emerg Med · PMID 26788380 · Read it on PubMed ↗
Lohsiriwat 2015
Treatment of hemorrhoids: A coloproctologist's view
Painless bleeding is typical of hemorrhoids.Narrative reviewVery low quality
size not given2015
the abstract describes treatment options by severity but does not report a specific outcome measurement or benefit comparison
Who was studied
people with hemorrhoids
What they received
various hemorrhoid treatments (medication, rubber band ligation, sclerotherapy, surgery)
Compared with
no single comparator specified
Quality
this is an expert review/editorial describing general treatment practices, not a study testing a specific treatment with measured results.
Limitations
no original data, no outcome measures, no comparison results reported; it is an editorial/review of clinical practice.
Taken word for word from the abstract
- population Hemorrhoids is recognized as one of the most common medical conditions in general population.
- result It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue.
- intervention low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy)
- intervention several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices
- comparator Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred.
World J Gastroenterol · PMID 26309351 · Read it on PubMed ↗
Karakus et al. 2015
Rare causes of gastrointestinal hemorrhage in infancy
Rare bowel conditions can cause painless bleeding.Case seriesVery low qualityRelated question
size not given2015
describes rare causes of bleeding including heterotopic pancreas and juvenile polyps, which often cause painless rectal bleeding
Who was studied
infants with gastrointestinal bleeding
What they received
none (diagnostic case description)
Main outcome
cause of gastrointestinal bleeding
Quality
This is a small case report series describing rare conditions, not a study testing a treatment or comparing outcomes.
Limitations
Case report of rare conditions in infants; no sample size, no comparison group, and no quantitative outcome data given.
Taken word for word from the abstract
- population Gastrointestinal hemorrhage in children is a critical condition that demands quick and effective management.
- result Juvenile polyps are common during childhood and present most often with painless rectal hemorrhage.
- primaryOutcome In this study, we describe rare causes of gastrointestinal system hemorrhage in infancy and discuss some diagnostic and therapeutic approaches.
- intervention Colonoscopic polypectomy is the most effective procedure in the treatment of juvenile polyps.
Pediatr Int · PMID 25868947 · Read it on PubMed ↗
Olatoke et al. 2014
Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution
Symptom-free after electrotherapy treatmentCase seriesLow qualityRelated question
size not given16 months
all treated patients were free of symptoms at a mean follow-up of 16 months, with no complications
Who was studied
people with symptomatic grade 1, 2 or 3 internal or mixed hemorrhoids, most commonly presenting with rectal bleeding
What they received
direct current electrotherapy applied to the hemorrhoid tissue via a proctoscope
Compared with
no comparison group; all patients received the same treatment
Main outcome
whether symptoms (bleeding, prolapse, pain, itching) resolved after treatment
Quality
this was a single-arm case series without a control group, so it cannot show whether the improvement was due to the treatment itself.
Limitations
no control group, no randomization, and the abstract does not report how many patients were enrolled overall
Taken word for word from the abstract
- population Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated
- population The most common symptom was rectal bleeding (94.7%)
- intervention using direct current electrotherapy in the treatment of haemorrhoids
- comparator No bowel preparations, medications, anesthesia nor admission was required.
- primaryOutcome indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip
- result All patients treated remained symptom free at a mean duration of follow up of 16 months.
- followUp mean duration of follow up of 16 months
Pan Afr Med J · PMID 25419283 · Read it on PubMed ↗
Vidal et al. 2015
Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases
New procedure stopped bleeding in most patients.Case seriesVery low quality
14 people1 month
72% of patients had bleeding resolve at one month, with no pain or complications in most
Who was studied
patients with ongoing rectal bleeding from hemorrhoids
What they received
embolization of the hemorrhoid arteries (emborrhoid technique)
Compared with
none (no comparison group)
Main outcome
whether bleeding stopped and how safe the procedure was
Quality
Only 14 patients were treated with no comparison group, so it can't show the procedure truly works better than other options.
Limitations
small uncontrolled case series; authors state additional studies needed to evaluate efficacy
Taken word for word from the abstract
- n Fourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique
- population Fourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique
- intervention The 'emborrhoid' technique consists of the embolization of the hemorrhoidal arteries.
- comparator Fourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique
- primaryOutcome Clinical success at 1 month was 72 % (10/14).
- result Clinical success at 1 month was 72 % (10/14).
- result No pain or ischemic complications were observed in 13 patients.
Cardiovasc Intervent Radiol · PMID 25366092 · Read it on PubMed ↗
Mokhtare et al. 2013
Lower Gastrointestinal Bleeding due to Non-Steroid Anti-Inflammatory Drug-Induced Colopathy Case Report and Literature Review
NSAID drug caused painless rectal bleeding.Case seriesVery low quality
1 people2013
NSAID use was linked to colon damage causing painless rectal bleeding; bleeding addressed by stopping the drug
Who was studied
43-year-old woman taking NSAIDs for low back pain
What they received
NSAID use (non-steroidal anti-inflammatory drugs)
Compared with
none
Main outcome
rectal bleeding (painless passage of blood in stool)
Quality
This is a single patient case report, so it cannot show how common or reliable this cause is.
Limitations
Single case report; no control group; causality inferred rather than proven.
Taken word for word from the abstract
- n the case of a 43-year-old female
- population a 43-year-old female, NSAID user due to low back pain, who was admitted to the hospital with painless hematochezia
- intervention NSAID user due to low back pain
- primaryOutcome admitted to the hospital with painless hematochezia
- result Discontinuation of the offending drug is mandatory.
- comparator Here, we have reported the case of a 43-year-old female, NSAID user due to low back pain, who was admitted to the hospital with painless hematochezia.
Middle East J Dig Dis · PMID 24829679 · Read it on PubMed ↗
Chintamaneni et al. 2014
Hematochezia Associated with Sevalamer-Induced Mucosal Injury
Bleeding from a drug-caused colon ulcer.Case seriesVery low quality
1 people2014
a colon ulcer caused by sevelamer crystals embedded in the colon lining led to painless bleeding
Who was studied
61-year-old woman with end-stage kidney disease on anticoagulation
What they received
sevelamer (phosphate binder medication)
Compared with
none
Main outcome
cause of painless rectal bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is or apply broadly.
Limitations
only one patient described; no comparison group; rare and specific cause.
Taken word for word from the abstract
- population a 61-year-old woman with end-stage renal disease (ESRD) who developed painless hematochezia following initiation of anticoagulation
- intervention sevelamer crystals embedded in the colonic mucosa, consistent with sevelamer crystal-mediated injury
- result Work-up revealed a large ulceration in the sigmoid colon, and histologic images revealed sevelamer crystals embedded in the colonic mucosa, consistent with sevelamer crystal-mediated injury
- primaryOutcome painless hematochezia
- n a 61-year-old woman
- comparator This is a novel cause of gastrointestinal hemorrhage that has not previously been described in the literature.
ACG Case Rep J · PMID 26157856 · Read it on PubMed ↗
Bhattacharjee et al. 2013
Combined adenocarcinoma-carcinoid tumor of transverse colon
Rare colon tumor found as causeCase seriesVery low quality
1 peoplea year
found to have a rare mixed tumor (adenocarcinoma and carcinoid) of the colon; after surgery and chemotherapy, no recurrence at one year
Who was studied
a 65-year-old man with painless rectal bleeding, abdominal cramps, diarrhea, and an abdominal mass
What they received
surgical removal of the colon tumor and adjacent bowel
Compared with
none
Main outcome
diagnosis and outcome after surgery for the tumor
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general
Limitations
single case, no comparison group, short follow-up
Taken word for word from the abstract
- population A 65-year-old male presented with painless hematochezia associated with episodic cramps in upper abdomen, watery diarrhea, and a slowly growing mass in upper abdomen.
- n A 65-year-old male presented
- intervention The patient underwent resection of the growth along with the segment of adherent ileum.
- comparator Continuity was re-established by a colo-colic and ileo-ileal anastomosis respectively.
- primaryOutcome Post-operative histopathology demonstrated a composite histological pattern with an admixture of carcinoid tumor and adenocarcinoma
- result Patient was followed-up for a year and was doing well without any evidence of recurrence.
- followUp followed-up for a year
J Cancer Res Ther · PMID 24518735 · Read it on PubMed ↗
Grandel et al. 2013
[Evidence-based treatment of hemorrhoidal disease]
Painless bleeding often from hemorrhoids.Narrative reviewVery low qualityRelated question
size not given2013
the abstract notes painless rectal bleeding is a common early symptom of hemorrhoids and offers general treatment guidance, without presenting trial results
Who was studied
people with hemorrhoidal disease (hemorrhoids)
What they received
various operative and non-operative treatments for hemorrhoids
Main outcome
not clearly stated as a measured outcome
Quality
this is a general review summarizing expert experience and existing knowledge rather than presenting new study data or outcomes.
Limitations
the abstract does not describe a specific study design, sample, or measured results, so it cannot establish cause or treatment effect by itself.
Taken word for word from the abstract
- population Hemorrhoidal disease represents a prevalent benign condition of the lower gastrointestinal tract.
- result As a common and early symptom of hemorrhoids, patients present with painless rectal bleeding during or after defecation.
- intervention a large variety of operative and non-operative therapeutic options exists
- primaryOutcome the authors aim to provide guidance for stage-directed therapy of hemorrhoidal disease based on up-to-date knowledge and the authors' own clinical experience.
Ther Umsch · PMID 23798019 · Read it on PubMed ↗
Maneerattanaporn et al. 2012
Acute hemorrhagic rectal ulcer syndrome: the first case series from Thailand
Painless bleeding from ulcers near anus.Case seriesVery low quality
9 people2012
the ulcers were multiple, round or oval, located just above the dentate line, with surface damage and signs of recent bleeding confined to the lining of the rectum, and no infectious organisms were found
Who was studied
elderly hospitalized patients with multiple other illnesses who had painless rectal bleeding
What they received
none (descriptive review of colonoscopy and biopsy findings)
Compared with
none
Main outcome
the endoscopic and tissue characteristics of the rectal ulcers causing bleeding
Quality
This is a small descriptive case series of only nine patients with no comparison group, so it cannot show whether any treatment helps.
Limitations
Only nine cases from one hospital, purely descriptive, no treatment or outcome comparison reported.
Taken word for word from the abstract
- n The authors reported nine cases of AHRUS.
- population The common setting can be found in elderly patients who were hospitalized with multiple comorbidities.
- population The predominant feature of these ulcers is profuse and painless rectal bleeding.
- intervention All underwent complete colonoscopy to evaluate endoscopic appearances.
- primaryOutcome Histopathologic findings were thoroughly reviewed.
- result The characteristics of the ulcers are multiple, round or oval shape located just above the dentate line, with/without evidence of bleeding stigmata.
- result Histopathologic features included superficial necrosis, erosions with acute inflammatory cell infiltration and evidence of recent hemorrhage, all of which were confined to the mucosal layer.
- result No organisms were discovered from the lesions.
- comparator These cases were reviewed from the records of endoscopic procedures which were performed at Siriraj Endoscopy Center between September-December 2006.
J Med Assoc Thai · PMID 22574529 · Read it on PubMed ↗
Mounsey et al. 2011
Hemorrhoids
Painless bleeding often just means hemorrhoids.Narrative reviewLow quality
size not given2011
internal hemorrhoids typically cause painless bleeding or prolapse, and treatments vary in pain, recovery, and recurrence rates
Who was studied
people with hemorrhoids, including those with painless rectal bleeding
What they received
various hemorrhoid treatments including stool softeners, rubber band ligation, excisional hemorrhoidectomy, and stapled hemorrhoidopexy
Compared with
different treatment options compared with each other
Main outcome
symptom relief, bleeding, pain, and recurrence after treatment
Quality
this is a general review describing typical hemorrhoid symptoms and treatments, not a study testing one treatment's effect with data to judge reliability
Limitations
no study design, sample size, or original data are given; it summarizes general clinical knowledge rather than reporting a specific trial's results
Taken word for word from the abstract
- population Internal hemorrhoids typically present with prolapse or painless rectal bleeding.
- intervention Medical therapy should be initiated with stool softeners plus local therapy to relieve swelling and symptoms.
- intervention Rubber band ligation is the treatment of choice for grades 1 and 2 hemorrhoids.
- comparator Rubber band ligation causes less postoperative pain and fewer complications than excisional hemorrhoidectomy and stapled hemorrhoidopexy, but has a higher recurrence rate.
- primaryOutcome Rubber band ligation causes less postoperative pain and fewer complications than excisional hemorrhoidectomy and stapled hemorrhoidopexy, but has a higher recurrence rate.
- result Internal hemorrhoids typically present with prolapse or painless rectal bleeding.
Am Fam Physician · PMID 21766771 · Read it on PubMed ↗
Arroyo et al. 2011
Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids
Low bleeding after hemorrhoid surgery.Case seriesLow qualityRelated question
200 peopleMedian follow-up was 110 months
At a median follow-up of about 9 years, 2% of patients reported daily rectal bleeding, 7% had recurrence with prolapse, and anal pressure measurements were unchanged from before surgery
Who was studied
patients with long-standing (chronic) third-degree hemorrhoids
What they received
double-pursestring stapled hemorrhoidopexy surgery for hemorrhoids
Compared with
no separate comparison group; same patients compared before and after surgery
Main outcome
long-term clinical and manometric (anal pressure) results after surgery, including bleeding, pain, and recurrence
Quality
This is a single-arm follow-up of one surgery type with no untreated or alternative-treatment comparison group, so it cannot show whether the surgery itself caused the good or bad outcomes.
Limitations
No control group, patients were a 'selected group' treated by expert surgeons, which limits how well results generalize.
Taken word for word from the abstract
- population 200 consecutive patients with third-degree hemorrhoids
- intervention double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler
- comparator Manometry was repeated at the 6-month, 1-year, and 5-year follow-up.
- primaryOutcome evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy
- result Four patients (2%) reported daily rectal bleeding.
- result Fourteen patients (7%) experienced recurrence with symptomatic prolapse.
- result There were no statistically significant differences between preoperative and postoperative manometric values.
- n 200 consecutive patients with third-degree hemorrhoids
- followUp Median follow-up was 110 months
Dis Colon Rectum · PMID 21471763 · Read it on PubMed ↗
Rana et al. 2010
Periampullary Dieulafoy's lesion: an unusual cause of gastrointestinal bleeding
Rare lesion found causing painless bleedingCase seriesVery low quality
1 people2010
a rare bleeding lesion near the bile duct opening was found and treated, with surgery ultimately needed
Who was studied
a 52-year-old woman with intermittent painless rectal/GI bleeding
What they received
endoscopic evaluation and adrenaline injection, followed by surgery
Compared with
none
Main outcome
finding and stopping the source of bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatments generally work
Limitations
only one patient; initial tests missed the lesion; bleeding recurred despite initial treatment
Taken word for word from the abstract
- population a 52-year-old female who presented with intermittent painless melena
- intervention A side view endoscopy was performed which revealed a bleeding periampullary Dieulafoy's lesion. Immediate hemostasis was achieved with an injection of adrenalin.
- comparator Her upper gastrointestinal endoscopy and colonoscopy were normal.
- primaryOutcome as there was presence of fresh blood in the proximal jejunum, a push enteroscopy was performed which revealed the presence of fresh blood in the duodenum and proximal jejunum. But no bleeding lesion could be identified.
- result Other episodes of bleeding occurred and the patient was finally treated surgically.
- n a 52-year-old female
JOP · PMID 20442525 · Read it on PubMed ↗
Saleh et al. 2009
Multiple synchronous granular cell tumors involving the colon, appendix and mesentery: a case report and review of the literature
Rare benign tumor, not cancer.Case seriesVery low qualityRelated question
1 people2009
the multiple growths in the colon, appendix and mesentery were all benign granular cell tumors, not cancer
Who was studied
a 62-year-old woman with a colon mass found during screening
What they received
none (diagnostic workup and surgical removal of the mass)
Main outcome
whether the growths were cancer or a benign tumor
Quality
this is a single patient case report, so it cannot show what causes bleeding in general or how common this is.
Limitations
Only one patient is described, so the findings may not apply broadly; it does not establish a general cause of painless rectal bleeding.
Taken word for word from the abstract
- n a 62 year-old woman
- population a 62 year-old woman who was found to have submucosal rectosigmoid mass at screening sigmoidoscopy
- intervention surgical resection of all the masses in an exploratory laporatomy
- primaryOutcome raising the suspicion of malignant metastatic disease
- result surgical resection of all the masses in an exploratory laporatomy proved them to be benign GCTs
J Gastrointestin Liver Dis · PMID 20076822 · Read it on PubMed ↗
Wilkins et al. 2009
Diverticular bleeding
Painless bleeding from diverticula usually stops by itself.Narrative reviewLow quality
size not given2009
bleeding stops on its own in most patients; various procedures can stop ongoing bleeding
Who was studied
people with diverticular disease who have rectal bleeding
What they received
diagnostic and treatment approach for diverticular bleeding (colonoscopy, embolization, vasopressin, surgery)
Compared with
not applicable
Main outcome
resolution of bleeding
Quality
This is a general review article describing typical management, not a study testing whether a treatment works.
Limitations
This is a review summarizing general knowledge, not original research with its own patient group or control comparison.
Taken word for word from the abstract
- population Patients typically present with massive and painless rectal hemorrhage.
- intervention The recommended initial diagnostic test is colonoscopy
- comparator If the bleeding source is not identified, radionuclide imaging (i.e., technetium-99m-tagged red blood cell scan) should be performed, usually followed by arteriography.
- primaryOutcome Diverticular hemorrhage resolves spontaneously in approximately 80 percent of patients.
- result Diverticular hemorrhage resolves spontaneously in approximately 80 percent of patients.
Am Fam Physician · PMID 19873964 · Read it on PubMed ↗
Dultz et al. 2009
Ileocecal valve lipoma with refractory hemorrhage
Found a benefitCase seriesVery low quality
size not given2009
bleeding was caused by an ulcerated lipoma at the ileocecal valve, successfully treated with surgical removal
Who was studied
elderly man with painless rectal bleeding
What they received
surgical removal of the mass (laparoscopic right hemicolectomy)
Compared with
none
Main outcome
identifying cause of bleeding and stopping it
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general
Limitations
only one patient described; no comparison group; findings may not generalize
Taken word for word from the abstract
- population an elderly male who presented with painless hematochezia
- intervention laparoscopic-assisted right hemicolectomy to resect the mass
- comparator Herein, we describe the case of an elderly male who presented with painless hematochezia.
- primaryOutcome Because of continuing bleeding, the patient required laparoscopic-assisted right hemicolectomy to resect the mass.
- result Both gross and microscopic pathology were consistent with lipoma at the ileocecal valve.
- result a rare case of an ulcerated ileocecal valve lipoma presenting as lower gastrointestinal bleeding that was treated successfully with laparoscopic resection
JSLS · PMID 19366548 · Read it on PubMed ↗
Erkan et al. 2008
Rapidly growing giant solitary cavernous hemangioma in a patient with ulcerative colitis
Rare hemangioma caused painless bleedingCase seriesVery low qualityRelated question
1 people2008
a rapidly growing cavernous hemangioma was found and removed, explaining the bleeding
Who was studied
61-year-old man with ulcerative colitis who had painless rectal bleeding
What they received
surgical excision of the rectal mass
Compared with
none
Main outcome
cause of painless rectal bleeding and outcome after removal
Quality
this is a single patient case report, so it cannot show how common this cause is or how treatment generally works
Limitations
single case report; findings may not generalize to other people with painless rectal bleeding
Taken word for word from the abstract
- population We present a 61-year-old man with painless rectal bleeding due to a solitary cavernous hemangioma of the rectum.
- n We present a 61-year-old man with painless rectal bleeding due to a solitary cavernous hemangioma of the rectum.
- intervention Following excision, histopathologic examination of the mass was consistent with cavernous hemangioma.
- comparator Following excision, histopathologic examination of the mass was consistent with cavernous hemangioma.
- primaryOutcome He had been diagnosed with distal type ulcerative colitis in 2003.
- result Following excision, histopathologic examination of the mass was consistent with cavernous hemangioma.
Turk J Gastroenterol · PMID 19119488 · Read it on PubMed ↗
Uras et al. 2008
Circular stapled hemorrhoidopexy: experience of a single center with 445 cases
Surgery for hemorrhoids, low complication rates.Case seriesLow qualityRelated question
445 people23 months
low recurrence (1%) and complication rates, with a relatively painless recovery, though some patients had bleeding, itching, or other symptoms afterward
Who was studied
people with second to fourth degree hemorrhoids
What they received
circular stapled hemorrhoidopexy (surgery for hemorrhoids)
Compared with
none (single group followed over time)
Main outcome
complications, residual symptoms, and recurrence after surgery
Quality
this is a single-center case series without a comparison group, so it cannot show whether the surgery itself caused the outcomes seen.
Limitations
No control group; abstract does not address painless rectal bleeding without hemorrhoid surgery as a cause.
Taken word for word from the abstract
- population second-, third-, and fourth-degree hemorrhoidal disease
- intervention circular stapled hemorrhoidopexy (CSH)
- comparator The medical records of 483 patients who had undergone circular stapled hemorrhoidopexy for symptomatic hemorrhoidal disease
- primaryOutcome Data regarding complications, residual symptoms, and recurrence were collected.
- result Circular stapled hemorrhoidopexy can be safely performed with low recurrence and complication rates while offering a relatively painless postoperative period for the patient.
- n The study included 445 patients (283 men, 162 women)
- followUp The median follow-up was 23 months (6-70 months).
World J Surg · PMID 18553195 · Read it on PubMed ↗
Dahshan 2008
Life threatening rectal bleeding due to a giant solitary juvenile polyp in a child. A case report and review of the literature
Found a benefitCase seriesVery low quality
1 people2008
A giant juvenile polyp was found and removed, resolving the bleeding
Who was studied
A nine-year-old boy with painless rectal bleeding
What they received
Colonoscopy with polyp resection
Compared with
None
Main outcome
Cause of massive painless rectal bleeding and outcome after treatment
Quality
This is a single patient case report, which cannot show how common this cause is or how well treatment works in general.
Limitations
Single case report; evaluation was delayed; no comparison group
Taken word for word from the abstract
- population A nine-year-old previously healthy Hispanic boy with prior history of recurrent abdominal pain and vomiting for 4 months presented with sudden onset of massive painless hematochezia and hemorrhagic shock.
- n A nine-year-old previously healthy Hispanic boy
- intervention colonoscopy was performed and revealed a giant pedunculated solitary polyp in the traverse colon. After resection
- comparator Following blood transfusion the bleeding spontaneously stopped.
- primaryOutcome Histological evaluation revealed juvenile retention polyp.
- result After resection, the polyp measured 3.2 x 2.2 x 1.7 cm. Histological evaluation revealed juvenile retention polyp.
J Okla State Med Assoc · PMID 18472711 · Read it on PubMed ↗
Sylla et al. 2008
Cavernous, arteriovenous, and mixed hemangioma-lymphangioma of the rectosigmoid: rare causes of rectal bleeding--case series and review of the literature
Rare blood vessel growths can cause painless bleeding.Case seriesVery low quality
3 people2008
surgery removed the malformations, but diagnosis was often delayed for years due to misdiagnosis as hemorrhoids or inflammatory bowel disease
Who was studied
people with rectal bleeding caused by rare vascular malformations of the rectosigmoid colon
What they received
surgical removal of the affected bowel segment
Compared with
no comparator (case series)
Main outcome
clinical presentation and outcome after surgical treatment
Quality
This is just a report of three patients' cases, not a controlled study, so it cannot show whether treatment works.
Limitations
Only three cases reported, no comparison group, and no systematic data on how well treatment worked.
Taken word for word from the abstract
- population Cavernous hemangiomas of the sigmoid colon and rectum are uncommon vascular malformations usually found in young adults with a long history of episodic and painless rectal bleeding.
- n We report three cases of hemangioma of the rectosigmoid
- intervention Definitive treatment consists of complete resection with a sphincter-preserving procedure or abdominoperineal resection, based on extent of disease.
- comparator We report three cases of hemangioma of the rectosigmoid including one case of cavernous hemangioma, one case of arteriovenous hemangioma, and one case of hemangiolymphangiomatosis
- primaryOutcome with emphasis on clinical presentation, radiologic, operative, and pathologic findings
- result Therapy is typically delayed by several years in these patients due to erroneous diagnosis and failed treatment of hemorrhoids and inflammatory bowel disease.
Int J Colorectal Dis · PMID 18330577 · Read it on PubMed ↗
Domínguez Jiménez et al. 2007
[An atypical case of massive gastrointestinal hemorrhage]
Rare tumor caused painless bleeding.Case seriesVery low quality
1 people2007
diagnosed with a jejunal gastrointestinal stromal tumor (GIST), treated with surgical removal
Who was studied
29-year-old woman with severe gastrointestinal bleeding
What they received
none (diagnostic workup and surgery)
Compared with
none
Main outcome
cause of severe gastrointestinal bleeding (melena)
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Only one patient described; no comparison group or statistical analysis.
Taken word for word from the abstract
- population a 29-year-old woman who presented to the emergency room with severe gastrointestinal bleeding manifested by melena
- n We report the case of a 29-year-old woman
- primaryOutcome severe gastrointestinal hemorrhage
- intervention Esophagogastroduodenoscopy, computed tomography, angiography and urgent surgical intervention
- result led to diagnosis of a jejunal GIST
- comparator Treatment is mainly surgical through complete tumoral resection.
Gastroenterol Hepatol · PMID 17266878 · Read it on PubMed ↗
Demirbaş et al. 2006
Mechanical bowel obstruction due to colonic hemangioma: report of a case
Rare colon tumor caused blockage, bleeding.Case seriesVery low qualityRelated question
1 people2006
surgery found a benign blood vessel tumor (cavernous hemangioma) causing blockage, and the patient recovered with no complications
Who was studied
a 62-year-old man with bowel blockage symptoms
What they received
surgery to remove part of the colon (transverse colectomy)
Compared with
none
Main outcome
diagnosis of the cause and outcome after surgery
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Only one patient; this case had bowel obstruction rather than just bleeding, and the abstract does not address painless bleeding as the main problem.
Taken word for word from the abstract
- n A 62-year-old male patient was admitted to the hospital with the complaints of mechanical bowel obstruction.
- population A 62-year-old male patient was admitted to the hospital with the complaints of mechanical bowel obstruction.
- intervention transverse colectomy and end-to-end anastomosis were performed
- comparator No postoperative complications occurred.
- primaryOutcome The pathologic examination revealed cavernous hemangioma of the transverse colon.
- result The pathologic examination revealed cavernous hemangioma of the transverse colon. This report describes a very rare case of bowel obstruction due to colonic hemangioma.
- population The frequent presentation is repetitive painless rectal bleeding.
Turk J Gastroenterol · PMID 17205412 · Read it on PubMed ↗
Fernández-Pineda et al. 2006
[Meckel's diverticulum as a cause of massive rectal bleeding]
Rare bowel defect caused painless bleeding.Case seriesVery low quality
1 people2006
Meckel's diverticulum was found to be the cause of the bleeding, treated with blood transfusion, stabilization, and emergency surgery
Who was studied
a three month old baby boy
What they received
none (diagnostic workup and surgery for bleeding)
Main outcome
cause and management of massive painless rectal bleeding
Quality
This is a single case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Only one patient was described, so findings may not apply to others; no comparison group or outcome tracking.
Taken word for word from the abstract
- population A fit three months old male baby was admitted in our hospital with a history of massive painless fresh rectal bleeding.
- intervention Blood transfusion, hemodynamic stabilization and emergency laparotomy were necessary because of the high suspect of Meckel's diverticulum as the cause of bleeding.
- primaryOutcome history of massive painless fresh rectal bleeding
- result Blood transfusion, hemodynamic stabilization and emergency laparotomy were necessary because of the high suspect of Meckel's diverticulum as the cause of bleeding.
- n A fit three months old male baby was admitted in our hospital
Cir Pediatr · PMID 16671513 · Read it on PubMed ↗
Tan et al. 2006
Hemangiomas of the pelvis
Rare hemangiomas can cause painless bleeding.Narrative reviewVery low quality
size not given2006
describes hemangiomas as a rare, often misdiagnosed cause of painless rectal bleeding, with diagnosis via endoscopy/imaging and treatment by sphincter-sparing surgery
Who was studied
people with rectal/colon hemangiomas causing blood in stool
What they received
surgical resection preserving sphincters
Compared with
no comparator discussed
Main outcome
diagnosis and treatment of painless rectal bleeding due to hemangiomas
Quality
This is a descriptive overview of a condition, not a study testing a treatment's effect, so it cannot show whether an intervention works.
Limitations
No study design, patient numbers, or outcome data are given; this is a general description of the condition and treatment approach.
Taken word for word from the abstract
- population Hemangiomas of the colon and rectum are rare but often misdiagnosed causes of hematochezia.
- primaryOutcome recurrent episodes of painless rectal bleeding, multiple ectopic phleboliths on plain radiographs, and cutaneous hemangiomas
- intervention Surgical resection with preservation of the sphincters is the recommended treatment.
- comparator Surgical resection with preservation of the sphincters is the recommended treatment.
- result Hemangiomas of the colon and rectum are rare but often misdiagnosed causes of hematochezia.
Clin Colon Rectal Surg · PMID 20011316 · Read it on PubMed ↗
Attard et al. 2006
Diagnosis and management of gastrointestinal polyps: pediatric considerations
Painless bleeding often from harmless childhood polyps.Narrative reviewLow quality
size not given2006
Painless bright red rectal bleeding is the classic sign of colorectal polyps in children; most are isolated and don't need further monitoring, but some rare syndromes require follow-up
Who was studied
Children with painless rectal bleeding
What they received
Diagnosis and removal of colorectal polyps
Compared with
No comparator described
Main outcome
Identifying which patients need follow-up for polyp syndromes versus those who don't
Quality
This is a narrative review describing typical presentations and management guidance, not a study testing a treatment or reporting original outcome data.
Limitations
No original patient data, sample size, or outcome statistics are reported; it is a general review article.
Taken word for word from the abstract
- population Painless, bright red, rectal bleeding with normal stool frequency and consistency is the hallmark presentation of colorectal polyps at any age.
- intervention isolated, colorectal juvenile polyps that do not require any further surveillance after they are removed
- primaryOutcome to correctly identify the patients who do not require follow-up and the smaller group of patients who do require follow-up because of syndromic polyp conditions
- result Most polyps in children are sporadic, usually isolated, colorectal juvenile polyps that do not require any further surveillance after they are removed.
- comparator There is, however, increasing recognition of syndromes, including familial adenomatous polyposis, juvenile polyposis coli, Peutz-Jeghers syndrome, and infrequent conditions, such as PTEN hamartoma and hereditary mixed polyposis syndromes.
Gastroenterol Nurs · PMID 16552295 · Read it on PubMed ↗
Chao et al. 2005
Capsule endoscopy for gastrointestinal bleeding with an obscure etiology
Found bleeding source in most patientsCase seriesLow qualityRelated question
35 peopleup to 2 months after ingestion
abnormal findings were seen in 89% of patients, and a clear cause explaining their bleeding was found in 57.2%, most often small blood vessel abnormalities (angiodysplasia) or Crohn's disease
Who was studied
adults with unexplained gastrointestinal bleeding after normal upper endoscopy and colonoscopy
What they received
capsule endoscopy (a swallowed camera pill) to look for a bleeding source
Compared with
no comparison group
Main outcome
whether the capsule endoscopy found a cause of the bleeding
Quality
this was a small single-group study without a comparison group, so it shows the test can find causes of bleeding but not how it compares to other methods.
Limitations
small sample size, single center, no control group, and bowel preparation was not standardized for all patients
Taken word for word from the abstract
- n 35 patients with obscure gastrointestinal bleeding among 43 consecutive patients with suspected small bowel pathology were enrolled
- population patients with obscure gastrointestinal bleeding
- population A negative panendoscopy and colonoscopic study were required for study eligibility.
- intervention An M2A video capsule endoscope was swallowed by each patient
- comparator This study investigated the safety and diagnostic value of CE in patients with obscure gastrointestinal bleeding.
- primaryOutcome Abnormal findings were noted in 31 of 35 patients (89%), 20 (57.2%) of whom had gastrointestinal pathology explaining their symptoms.
- result Angiodysplasia was the most common source of bleeding (37%), followed by Crohn's disease (14%).
- result No discomfort or side effects were noted up to 2 months after ingestion.
J Formos Med Assoc · PMID 16276441 · Read it on PubMed ↗
Koh et al. 2005
Stapled haemorrhoidectomy: bothersome staple line bleeding
Bleeding is a common surgery complication.RetrospectiveLow qualityRelated question
39 people2005
44% had bleeding during surgery and 23% were readmitted for bleeding after surgery
Who was studied
patients who had stapled haemorrhoidectomy surgery for prolapsing haemorrhoids
What they received
stapled haemorrhoidectomy procedure
Compared with
patients without staple line bleeding noted during surgery
Main outcome
bleeding from the staple line during and after surgery
Quality
This is a small retrospective review of surgical records without a control group, so it can't prove cause or compare treatments reliably.
Limitations
Retrospective design, no comparison group of a different treatment, small sample size.
Taken word for word from the abstract
- n 39 stapled haemorrhoidectomy procedures were performed
- population consecutive stapled haemorrhoidectomy procedures performed in patients over a 1-year period
- intervention stapled haemorrhoidectomy procedure
- comparator compared with 14% in those without evidence of bleeding
- primaryOutcome the incidence of intraoperative staple line bleeding, its management and early postoperative outcomes
- result Intraoperative staple line bleeding was recorded in 17 patients (44%)
- result Nine patients (23%) were admitted for postoperative per rectal bleeding
Asian J Surg · PMID 16024315 · Read it on PubMed ↗
Helmke et al. 2004
BRAF mutations distinguish anorectal from cutaneous melanoma at the molecular level
Anorectal melanoma genetics differ from skin melanoma.Case seriesVery low qualityRelated question
19 people2004
BRAF mutations found in 2 of 19 anorectal melanoma cases, no NRAS mutations, and the common skin-melanoma mutation was absent, showing a different mutation pattern than skin melanoma
Who was studied
people with anorectal melanoma, a rare tumor near the anus/rectum
What they received
genetic testing of tumor tissue for BRAF and NRAS gene mutations
Compared with
cutaneous (skin) melanoma mutation rates
Main outcome
presence of BRAF or NRAS gene mutations in the tumor
Quality
This is a very small case series of tumor tissue looking at genetics, not a treatment study, so it says little about the causes of rectal bleeding in general.
Limitations
Very small number of cases (19), focused only on one rare tumor type, and purely molecular/genetic analysis rather than a study of bleeding causes or outcomes.
Taken word for word from the abstract
- n We detected BRAF mutations in 2 of 19 cases and NRAS mutations in none of the cases.
- population Anorectal melanoma (AM) is a rare but highly malignant tumor
- intervention DNA from formalin-fixed and paraffin-embedded AM was PCR amplified and sequenced.
- comparator Because BRAF mutations were recently identified in the majority of CM and nevi, we investigated AM for BRAF mutations
- primaryOutcome we investigated AM for BRAF mutations and mutations of NRAS
- result With regard to the frequency of V599E BRAF mutations, AM significantly differs from CM (P < or = .0001), which suggests that BRAF mutations distinguish anorectal from cutaneous melanoma at the molecular level.
Gastroenterology · PMID 15578519 · Read it on PubMed ↗
Mandhan 2004
Juvenile colorectal polyps in children: experience in Pakistan
Painless bleeding often caused by childhood polyps.Case seriesLow qualityRelated question
129 people1 year
All polyps were successfully removed, with recurrence in 7 children within 1 year
Who was studied
Children aged 14 years or younger in Pakistan who had colorectal polyps
What they received
Removal of colorectal polyps via proctosigmoidoscopy
Compared with
No comparison group
Main outcome
Successful polyp removal and recurrence of polyps
Quality
This is an uncontrolled case series describing one group of children, so it can't compare treatments or rule out other causes of bleeding.
Limitations
No control group, retrospective case series, limited to children, no statistical comparison of treatments
Taken word for word from the abstract
- n 154 polyps were documented in 129 children
- population juvenile colorectal polyps in children (< or =14 years) from Pakistan
- intervention All polyps were successfully removed by proctosigmoidoscopy.
- comparator This report describes an experience with juvenile colorectal polyps in children
- primaryOutcome Recurrence occurred in seven children within 1 year of initial removal.
- result All polyps were successfully removed by proctosigmoidoscopy.
- result Recurrence occurred in seven children within 1 year of initial removal.
Pediatr Surg Int · PMID 15148618 · Read it on PubMed ↗
Lu et al. 2003
Laparoscopy diagnosis and treatment excision of bleeding Meckel's diverticulum in a child: report of one case
Painless bleeding from Meckel's diverticulum, fixed by surgery.Case seriesVery low quality
1 people48 hours
laparoscopy found and removed the bleeding Meckel's diverticulum after all other tests came back negative, and the child recovered quickly
Who was studied
a 1-year-7-month-old boy with painless rectal bleeding for about a year
What they received
laparoscopy for diagnosis and surgical removal of Meckel's diverticulum
Compared with
standard tests like abdominal x-ray, ultrasound, scope exam, and nuclear scan
Main outcome
successful diagnosis and treatment of the bleeding cause
Quality
this is a single patient case report, so it cannot show how often this works or compares to other approaches.
Limitations
only one patient; no comparison group; cannot generalize findings
Taken word for word from the abstract
- population a 1-year-7-month-old boy presenting with intermittent episodes of painless low gastrointestinal bleeding for about one year
- intervention successfully diagnosed along with excision of Meckel's diverticulum by laparoscopy
- comparator plain abdominal films, abdominal ultrasound, rectosigmoidoscopy and repeated Tc-99m Meckel's scan, all showed negative finding
- primaryOutcome it was successfully diagnosed along with excision of Meckel's diverticulum by laparoscopy
- result The patient made a rapid recovery and discharged at 48 hours after the procedure.
- n a 1-year-7-month-old boy presenting with intermittent episodes of painless low gastrointestinal bleeding for about one year
- followUp discharged at 48 hours after the procedure
Acta Paediatr Taiwan · PMID 12800384 · Read it on PubMed ↗
Erdman et al. 2002
Gastrointestinal polyps and polyposis syndromes in children
Painless rectal bleeding often just a polyp.Narrative reviewLow quality
size not given2002
most polyps in children are isolated and not linked to genetic disease or cancer risk, but some occur in genetic polyposis syndromes with higher cancer risk
Who was studied
children with gastrointestinal polyps
Main outcome
identifying polyps and polyposis syndromes, and cancer risk
Quality
this is a narrative review summarizing general knowledge, not a study testing a treatment or measuring outcomes in a defined group of patients.
Limitations
no original data, no patient numbers, no methodology described for how conclusions were reached.
Taken word for word from the abstract
- population Gastrointestinal polyps are common during childhood and most often present with painless rectal bleeding.
- result Most polyps occur as isolated colonic lesions and are not harbingers of an underlying genetic disorder, nor do they bestow a risk of gastrointestinal cancer.
- result occasionally polyps may occur in the context of a genetic polyposis disorder characterized by an increase in the life-time risk of cancer in the gastrointestinal tract and other organ systems
- primaryOutcome This review outlines the major polyposis syndromes affecting children and highlights associated findings that might clue the alert physician to an underlying diagnosis.
Curr Opin Pediatr · PMID 12352251 · Read it on PubMed ↗
Kenny et al. 2001
Double blind randomised controlled trial of topical glyceryl trinitrate in anal fissure
No benefit over placebo for fissures.Randomised trialLow qualityRelated question
40 people16 week study period
no difference between GTN and placebo in pain scores, time to painless defecation, or rate of rectal bleeding
Who was studied
children with a new anal fissure
What they received
topical glyceryl trinitrate (GTN) paste plus oral laxatives
Compared with
placebo paste plus oral laxatives
Main outcome
pain scores and time to pain-free bowel movements
Quality
it was a randomized trial but very small, with only 40 children recruited and just 31 completing it, so it can't reliably detect small differences.
Limitations
small sample size, high dropout (31 of 40 completed), and the children studied had anal fissures, which usually cause pain, unlike painless bleeding
Taken word for word from the abstract
- population acute anal fissure in children
- intervention Individual children were randomised to receive GTN paste or placebo for six weeks in addition to oral senna and lactulose.
- comparator Individual children were randomised to receive GTN paste or placebo for six weeks in addition to oral senna and lactulose.
- primaryOutcome Main outcome measures were validated standardised pain scores and time to painless defaecation.
- result No differences in the proportion of those achieving pain free defaecation with relation to time were seen between the two groups.
- result there were no significant differences in pain scores between the two groups over the 16 week study period
- result There were no differences in the incidence of rectal bleeding, faecal soiling, presence of visible fissure, skin tag, or faecal loading
- n Forty subjects were recruited from 46 eligible children; 31 children completed the trial
- followUp over the 16 week study period
Arch Dis Child · PMID 11668104 · Read it on PubMed ↗
Enns 2001
Dieulafoy's lesions of the rectum: a rare cause of lower gastrointestinal bleeding
Bleeding stopped after treatment.Case seriesVery low quality
1 people2001
Bleeding completely stopped after endoscopic treatment
Who was studied
72-year-old man with massive painless rectal bleeding
What they received
Endoscopic treatment with adrenaline injection and electrocautery
Compared with
No comparator described
Main outcome
Stopping the bleeding
Quality
This is a single patient case report, so it cannot show how often this treatment works for others.
Limitations
Only one patient described; no comparison group; long-term outcomes beyond this case not reported.
Taken word for word from the abstract
- population a 72-year-old man who presented with massive hematochezia and who was discovered to have a Dieulafoy's lesion within the rectum
- intervention successfully treated with adrenaline and electrocautery
- comparator The present report details the case of a 72-year-old man who presented with massive hematochezia
- primaryOutcome endoscopic therapy appears to result in complete cessation of bleeding
- result was successfully treated with adrenaline and electrocautery
- n a 72-year-old man
Can J Gastroenterol · PMID 11544540 · Read it on PubMed ↗
Gupta et al. 2001
Experience with juvenile polyps in North American children: the need for pancolonoscopy
Painless bleeding often from colon polyps.RetrospectiveLow quality
184 people2001
Painless rectal bleeding was the most common symptom, and full colonoscopy found that about a third of children had polyps higher up in the colon that a limited exam would miss
Who was studied
children with juvenile colon polyps
What they received
full colonoscopy (pancolonoscopy) examining the whole colon
Compared with
limited colonoscopy examining only part of the colon
Main outcome
where polyps were found in the colon and whether proximal polyps were missed
Quality
This is a retrospective chart review without a comparison group testing treatment, so it only describes patterns rather than proving what causes painless bleeding or what fixes it.
Limitations
Retrospective design, no control group, based on chart review over 9 years, single type of cause (juvenile polyps) studied.
Taken word for word from the abstract
- population juvenile polyps (JP) in a large cohort of North American children
- n 331 JP were encountered during 195 procedures in 184 patients
- intervention pancolonoscopy (PC) is needed in all children with suspected polyps
- comparator PC was performed in 42% (82/195) of procedures
- primaryOutcome Overall, proximal polyps were seen in 37% (31/82) of PC.
- result Painless rectal bleeding was the commonest symptom.
- result 32% (56/177) were proximal to the splenic flexure (i.e., proximal polyps)
Am J Gastroenterol · PMID 11419816 · Read it on PubMed ↗
Drobco 1999
[Leiomyosarcoma of Meckel's diverticulum--a rare cause of acute hemorrhage in the lower part of the digestive system]
Rare tumor caused painless bleeding.Case seriesVery low quality
1 people1999
bleeding was caused by a rare tumor (leiomyosarcoma) growing in Meckel's diverticulum, a pouch in the intestine
Who was studied
an adult male with sudden painless intestinal bleeding
What they received
not applicable - diagnostic case report
Main outcome
cause of painless intestinal bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is or what usually happens.
Limitations
only one patient described; findings cannot be generalized to other cases of painless bleeding.
Taken word for word from the abstract
- population We describe the case of an adult male with acute painless intestinal bleeding the cause of which was a leiomyosarcoma arising in Meckel's diverticulum.
- n We describe the case of an adult male with acute painless intestinal bleeding
- primaryOutcome We describe the case of an adult male with acute painless intestinal bleeding the cause of which was a leiomyosarcoma arising in Meckel's diverticulum.
- result We describe the case of an adult male with acute painless intestinal bleeding the cause of which was a leiomyosarcoma arising in Meckel's diverticulum. It was diagnosed during an acute operation.
- intervention It was diagnosed during an acute operation.
Rozhl Chir · PMID 10596577 · Read it on PubMed ↗
Brown et al. 1999
Gastrointestinal bleeding in infants and children: Meckel's diverticulum and intestinal duplication
Painless bleeding often from Meckel's diverticulum.Narrative reviewLow quality
size not given1999
Meckel's diverticula and intestinal duplications cause painless, sometimes massive bleeding due to ectopic gastric mucosa, diagnosed by radionuclide scan and treated with surgical resection
Who was studied
infants and children with gastrointestinal bleeding
What they received
technetium 99m pertechnetate scanning and surgical resection
Compared with
no comparator described
Main outcome
diagnosis and treatment of cause of bleeding
Quality
This is a narrative review describing typical causes and treatments rather than a study testing a specific outcome.
Limitations
No original data, sample size, or comparative outcomes are reported; it is a descriptive review.
Taken word for word from the abstract
- population Gastrointestinal bleeding in infants and children can be quite alarming
- intervention The advent of technetium (Tc) 99m pertechnetate radionuclide scanning has greatly facilitated the diagnosis of Meckel's diverticula
- comparator Resection is the treatment of choice.
- primaryOutcome require a high index of suspicion for diagnosis
- result Bleeding usually is painless but may be massive.
- result The significance of ectopic gastric mucosa is that it contains acid-secreting parietal cells, which may cause ulceration and bleeding.
Semin Pediatr Surg · PMID 10573430 · Read it on PubMed ↗
Demircan et al. 1998
Diffuse cavernous hemangioma of the rectum and sigmoid colon
Surgery stopped bleeding; patient later died of brain bleed.Case seriesVery low quality
1 people10 months
no rectal bleeding occurred after surgery, but the patient died of a massive brain bleed 10 months later
Who was studied
an 18-year-old man with painless rectal bleeding and hematuria due to diffuse cavernous hemangioma of the rectum and sigmoid colon
What they received
surgery removing the affected rectum and part of the bladder (low anterior resection and partial cystectomy)
Main outcome
whether rectal bleeding stopped after surgery
Quality
this is a single patient case report, so it cannot show whether the treatment works in general.
Limitations
only one patient described, no comparison group, and the cause of the later fatal brain bleed is not explained
Taken word for word from the abstract
- population an 18-year-old man with painless rectal bleeding, hematuria and diffuse cavernous hemangioma of the rectum and sigmoid colon
- n an 18-year-old man
- intervention Low anterior resection and partial cystectomy were performed.
- result During the postoperative period no rectal bleeding occurred, but he died of massive intracerebral bleeding 10 months after the operation.
- primaryOutcome During the postoperative period no rectal bleeding occurred
- followUp 10 months after the operation
Dig Surg · PMID 9845644 · Read it on PubMed ↗
Wilcox et al. 1997
Features associated with painless peptic ulcer bleeding
Painless ulcer bleeding is common and normal.Prospective cohortModerate quality
449 people1997
About 43% of patients with bleeding peptic ulcers had no abdominal pain; pain was linked to larger ulcer size, tobacco use, and age under 80
Who was studied
patients hospitalized with upper GI bleeding caused by peptic ulcer
What they received
having a peptic ulcer causing bleeding
Compared with
presence vs absence of abdominal pain in these patients
Main outcome
whether abdominal pain was present or absent alongside the bleeding
Quality
This was a reasonably large prospective study, but it only describes patterns of pain in ulcer bleeding rather than testing a treatment, so it can't say why any one person's bleeding occurs.
Limitations
Observational description of symptoms only; relies on patient-reported history; excluded patients where history was unreliable or ulcer was malignant.
Taken word for word from the abstract
- population Patients admitted for upper GI bleeding at a large inner-city hospital
- n 449 patients with upper GI bleeding caused by peptic ulcer were evaluated
- intervention Painless peptic ulcer bleeding is well recognized
- comparator abdominal pain was absent in 191 (43%; 95% confidence interval, 38-47%)
- primaryOutcome questioned prospectively at the time of initial evaluation regarding the presence of any dyspepsia and/or abdominal pain
- result The only statistically significant correlates with abdominal pain were ulcer size (77% of patients with ulcers >2 cm reported pain as compared with 49% of patients with ulcers <1 cm; p < 0.001), tobacco use (p = 0.041), and age <80 yr (p = 0.02)
Am J Gastroenterol · PMID 9260791 · Read it on PubMed ↗
Grimsley et al. 1997
Hemangiopericytoma: an unusual cause of upper gastrointestinal hemorrhage
Rare tumor caused hidden stomach bleeding.Case seriesVery low qualityRelated question
1 people1997
A rare tumor (hemangiopericytoma) near the spleen caused increased blood vessels and erosions in the stomach wall leading to bleeding, without the tumor directly invading the stomach
Who was studied
A patient with repeated severe bleeding from the upper digestive tract
What they received
None (diagnostic case report)
Compared with
None
Main outcome
Cause of the bleeding and how it was diagnosed
Quality
This is a single patient case report, so it cannot show how common or typical this cause is.
Limitations
Single case; no comparison group; findings may not generalize to other causes of painless rectal or GI bleeding.
Taken word for word from the abstract
- n An unusual case is reported here of a patient presenting with recurrent massive upper gastrointestinal (GI) bleeding
- population a patient presenting with recurrent massive upper gastrointestinal (GI) bleeding
- intervention Diagnosis of these tumors roentgenographically is nonspecific, but angiography is helpful.
- comparator In prior reports, however, a mural origin of the tumor and subsequent bleeding into the GI lumen was demonstrated.
- primaryOutcome It is proposed that superficial gastric erosions combined with the tumor-associated increased vascularity within the stomach wall led to recurrent major bleeding.
- result marked dilatation of the gastric and splenic vessels was noted, but there was no direct pathologic involvement of the stomach wall
Am Surg · PMID 9036893 · Read it on PubMed ↗
Castellví et al. 1996
[Options in the surgical treatment of diffuse cavernous hemangioma of the rectum]
Surgery described for rectal hemangioma bleeding.Case seriesVery low quality
1 people1996
the abstract describes the surgical options and recommends conservative proctectomy with colo-anal anastomosis when other pelvic organs are not affected, as determined by MRI
Who was studied
a 17-year-old patient with cavernous hemangioma of the rectum causing painless rectal bleeding
What they received
conservative proctectomy with colo-anal anastomosis
Compared with
colo-anal sleeve anastomosis with large rectal mucosectomy, or abdominoperineal resection
Main outcome
surgical management of the rectal hemangioma while avoiding abdominoperineal resection
Quality
this is a single case report describing one patient's surgery, so it cannot show how well the treatment generally works.
Limitations
only one patient described; no outcome data such as recurrence, complications, or recovery reported.
Taken word for word from the abstract
- population We present a case in a seventeen years old patient.
- population Patients usually present with painless massive rectal bleeding that generally begins at an early age
- intervention it is easier to do a conservative proctectomy with colo-anal anastomosis
- comparator a procedure of colo-anal sleeve anastomosis, that includes a large rectal mucosectomy, has been described
- comparator To avoid abdominoperineal resection of the rectum in these patients
- primaryOutcome To avoid abdominoperineal resection of the rectum in these patients, a procedure of colo-anal sleeve anastomosis, that includes a large rectal mucosectomy, has been described.
- result if affectation of other pelvic organs can been excluded by MRI, it is easier to do a conservative proctectomy with colo-anal anastomosis
- n We present a case in a seventeen years old patient.
Rev Esp Enferm Dig · PMID 8962763 · Read it on PubMed ↗
Jaspersen et al. 1992
[Proctoscopic Doppler ultrasound in diagnosis and therapy of symptomatic first degree hemorrhoids ]
Doppler-guided injection cured hemorrhoids better.Randomised trialLow qualityRelated question
124 people2 weeks
87% cured with Doppler-guided treatment versus 37% cured without Doppler guidance
Who was studied
patients with first degree hemorrhoids causing painless rectal bleeding
What they received
Doppler ultrasound-guided sclerotherapy injection for hemorrhoids
Compared with
standard sclerotherapy injection without Doppler guidance
Main outcome
complete elimination of hemorrhoids and arterial blood flow at 2-week follow-up
Quality
Although randomized and controlled, this is a small, old study without detail on blinding or long-term outcomes, and it addresses treatment of hemorrhoids rather than the broader question of why bleeding occurs.
Limitations
Abstract does not report blinding, long-term follow-up beyond 2 weeks, or how randomization was performed.
Taken word for word from the abstract
- population two comparable collectives with each 62 patients and symptomatic first grade hemorrhoidal disease were examined. Guiding symptom was painless hematochezia.
- intervention The hemorrhoids of collective A were evaluated with the aid of transproctoscopic Doppler ultrasound.
- comparator The patients of collective B were only investigated by means of proctoscopy and sclerosed without Doppler.
- primaryOutcome Success of therapy was controlled in all patients 2 weeks later Doppler sonographically
- result In 87% of the Doppler controlled treated patients the hemorrhoids were completely eliminated and no more arterial blood flow could be scanned. On the contrary only 37% of the initially not Doppler scanned patients were cured.
- n two comparable collectives with each 62 patients
Z Gastroenterol · PMID 1481551 · Read it on PubMed ↗
Schneider et al. 1992
Primary adenosquamous and squamous cell carcinoma of the colon and rectum
Rare rectal cancer causes painless bleeding.Case seriesVery low quality
3 people1992
all three patients presented with painless rectal bleeding; tumors were treated with surgery, and two also had chemoradiation
Who was studied
patients with squamous cell or adenosquamous carcinoma of the rectum
What they received
surgical removal of the tumor, with chemoradiation therapy afterward in two patients
Compared with
no comparison group
Main outcome
presenting symptoms and tumor characteristics
Quality
this is a report of just three cases with no comparison group, so it cannot show whether any treatment works, only that this rare cancer can cause painless bleeding
Limitations
only three cases reported, no control group, and no outcome data on survival or recurrence given in the abstract
Taken word for word from the abstract
- n Three new cases of squamous cell and adenosquamous carcinoma of the rectum are reported
- population squamous cell and adenosquamous carcinoma of the rectum
- intervention Therapy was by surgical resection followed by chemoradiation therapy in two patients.
- comparator Three new cases of squamous cell and adenosquamous carcinoma of the rectum are reported, bringing the total number of cases in the English medical literature to 72.
- primaryOutcome Each of the three patients presented with painless hematochezia.
- result Each of the three patients presented with painless hematochezia. Therapy was by surgical resection followed by chemoradiation therapy in two patients.
Int J Colorectal Dis · PMID 1402312 · Read it on PubMed ↗
Kizilcan et al. 1992
Duplication of the rectum resembling a juvenile polyp
Rare cause: rectal duplication cyst.Case seriesVery low quality
1 people1992
the rectal mass, initially thought to be a polyp, was actually a cystic duplication of the rectum
Who was studied
a five-year-old boy with painless rectal bleeding and a rectal mass
What they received
not applicable - case report describing diagnosis
Compared with
none
Main outcome
diagnosis of the cause of painless rectal bleeding and rectal mass
Quality
this is a single case report, so it cannot show how common this cause is or how it compares to other causes.
Limitations
only one patient described, no comparison group, and no information on treatment outcome.
Taken word for word from the abstract
- population A five-year-old boy with a rectal mass mimicking a rectal polyp
- primaryOutcome In a child with painless rectal bleeding, a mass palpated during rectal examination is usually diagnosed initially as being a rectal polyp.
- result which proved to be a cystic duplication of the rectum
- n A five-year-old boy
- intervention a rectal mass mimicking a rectal polyp, which proved to be a cystic duplication of the rectum, is presented
- comparator the case presented revealed the possibility of rectal duplication
Turk J Pediatr · PMID 1485388 · Read it on PubMed ↗
Vandoni et al. 1992
Rectal leiomyosarcoma: acute presentation after local injury
Rare tumor found and removed successfully.Case seriesVery low qualityRelated question
1 people4 years
Surgery removed a rare rectal tumor (leiomyosarcoma); no recurrence after 4 years
Who was studied
66-year-old woman with no symptoms before a fall
What they received
surgical removal of rectum (abdominoperineal excision)
Compared with
none
Main outcome
diagnosis and recurrence after surgery
Quality
This is a single patient case report, so it cannot show what usually causes or treats painless rectal bleeding.
Limitations
Only one patient, no comparison group, and findings may not generalize.
Taken word for word from the abstract
- n A 66 year old asymptomatic female presented with painless rectal bleeding after a fall.
- population A 66 year old asymptomatic female presented with painless rectal bleeding after a fall.
- intervention Abdominoperineal excision (APE) remains the only effective treatment.
- comparator No adjuvant therapy was given; there is no recurrence 4 years later.
- primaryOutcome Following APE, histopathology confirmed a leiomyosarcoma.
- result No adjuvant therapy was given; there is no recurrence 4 years later.
Eur J Surg · PMID 1356474 · Read it on PubMed ↗
Jaspersen 1991
[Proctoscopic Doppler sonography in hemorrhoidal hemorrhage--vascular diagnosis and therapy follow-up]
Describes a hemorrhoid imaging test.Narrative reviewVery low qualityRelated question
size not given1991
the abstract states that arterial blood supply can be reliably imaged and that therapy success can be verified and documented after injecting a sclerosing substance
Who was studied
people with first or second degree hemorrhoids causing painless bright red rectal bleeding
What they received
20 MHz microvascular Doppler sonography used with proctoscopy to look at the blood vessels and check treatment results
Main outcome
ability to image the arterial blood supply of hemorrhoids and confirm whether sclerosing injection therapy worked
Quality
this is a descriptive report about a diagnostic imaging technique, not a study comparing treatments or outcomes in a defined group of patients.
Limitations
no patient numbers, no comparison group, and no quantified outcome data are given in the abstract
Taken word for word from the abstract
- population Painless bright red peranal bleeding is a leading symptom of first and second degree hemorrhoid.
- intervention Arterial blood supply can be reliably imaged with the aid of 20 MHz microvascular Doppler sonography
- primaryOutcome the success of therapy can be verified as well as documented after injecting a sclerosing substance
- result Arterial blood supply can be reliably imaged with the aid of 20 MHz microvascular Doppler sonography and the success of therapy can be verified as well as documented after injecting a sclerosing substance.
Leber Magen Darm · PMID 1798351 · Read it on PubMed ↗
St-Vil et al. 1991
Meckel's diverticulum in children: a 20-year review
Painless rectal bleeding from Meckel's diverticulum.Case seriesLow quality
164 people1991
Of 117 symptomatic patients, 45 (38%) had severe painless rectal bleeding, and 67% of those needed a blood transfusion; a nuclear medicine scan correctly found the diverticulum in 85% of those tested
Who was studied
children who had a Meckel's diverticulum found during abdominal surgery
What they received
surgical removal (resection) of Meckel's diverticulum, studied over 20 years
Main outcome
how patients with Meckel's diverticulum presented, including rectal bleeding
Quality
This is a retrospective review of past surgical cases without a comparison group, so it describes patterns but cannot prove cause and effect.
Limitations
Retrospective design, abstract truncated, no control group, relies on surgical records from 1970-1989.
Taken word for word from the abstract
- n a Meckel's diverticulum was discovered in 164 children at laparotomy
- population Meckel's diverticulum occurs in 2% of the population and may present at any age
- intervention 25 were resected
- primaryOutcome 45 (38%) had rectal bleeding
- result Severe painless rectal bleeding occurred in 45 patients, 30 of whom (67%) required blood transfusion. A nuclear medicine Meckel scan was positive in 32 of 37 patients (85%).
J Pediatr Surg · PMID 1812259 · Read it on PubMed ↗
Arthur et al. 1990
Colocolic intussusception in a three-year-old child caused by a colonic polyp
Painless bleeding caused by colon polyp.Case seriesVery low quality
1 people1990
Juvenile colonic polyps were identified as the cause of painless hematochezia and, when large, could act as a lead point for intussusception
Who was studied
a three-year-old child with colocolic intussusception caused by a colonic polyp
What they received
Colonoscopic polypectomy performed by an experienced endoscopist
Compared with
surgical removal of the polyp
Main outcome
cause of painless rectal bleeding (hematochezia) in children
Quality
This is a single case report of one child, so it cannot show how common or reliable this cause of bleeding is.
Limitations
Only one patient reported, no control group, and findings based on a single case plus literature review.
Taken word for word from the abstract
- n a three-old-child
- population We report a case in a three-old-child of colocolic intussusception caused by a colonic polyp
- intervention Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp.
- comparator Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp.
- primaryOutcome These tumors most often cause painless hematochezia.
- result In a significant number of these cases juvenile polyps were identified as leading points.
Conn Med · PMID 2225816 · Read it on PubMed ↗
Yeoman et al. 1989
Computerized tomography appearances of pelvic haemangioma involving the large bowel in childhood
Rare blood vessel growth found as cause.Case seriesVery low qualityRelated question
2 people1989
CT identified a pelvic haemangioma involving the rectum as the cause of bleeding in both children
Who was studied
children with painless rectal bleeding, one with Vater association and one with Klippel-Trenaunay syndrome
What they received
CT scan to diagnose pelvic haemangioma
Compared with
plain abdominal X-ray
Main outcome
ability to diagnose the cause of painless rectal bleeding
Quality
Only two cases described, so this cannot show how common this cause is or how reliable CT is in general.
Limitations
Extremely small case series (two children) with specific underlying syndromes, not a general study of rectal bleeding causes.
Taken word for word from the abstract
- n pelvic haemangioma involving the rectum in two children
- population Both cases complained of painless rectal bleeding
- intervention The Computed Tomography (CT) appearance of a pelvic haemangioma involving the rectum in two children
- comparator the diagnosis was suggested by the presence of pelvic phleboliths on the plain abdominal radiograph
- primaryOutcome CT provides a simple, non-invasive method of diagnosing such lesions and assessing their extent.
- result the diagnosis was suggested by the presence of pelvic phleboliths on the plain abdominal radiograph. CT provides a simple, non-invasive method of diagnosing such lesions and assessing their extent.
Pediatr Radiol · PMID 2771480 · Read it on PubMed ↗
Goldberg et al. 1984
Isolated gastric varices due to spontaneous splenic vein thrombosis
Rare clot caused painless bleeding.Case seriesVery low quality
size not given1984
bleeding was caused by gastric varices from a blood clot in the splenic vein, treated by removing the spleen
Who was studied
a patient with unexplained, painless recurrent gastrointestinal bleeding and an enlarged spleen
What they received
diagnostic workup (barium contrast, endoscopy, arteriography) leading to splenectomy
Compared with
none
Main outcome
finding the cause of painless recurrent bleeding
Quality
This is a single patient case report, so it cannot show how often this cause applies to others.
Limitations
Only one patient described; no comparison group; findings may not generalize.
Taken word for word from the abstract
- population obscure, painless recurrent bleeding in our patient
- intervention Arteriography is essential in demonstrating an obstructed splenic vein. Splenectomy is the treatment of choice
- comparator Isolated bleeding gastric varices due to a spontaneous idiopathic thrombosis of the splenic vein was found to be the cause of obscure, painless recurrent bleeding in our patient.
- primaryOutcome was found to be the cause of obscure, painless recurrent bleeding in our patient
- result Isolated bleeding gastric varices due to a spontaneous idiopathic thrombosis of the splenic vein was found to be the cause of obscure, painless recurrent bleeding in our patient.
Am J Gastroenterol · PMID 6608875 · Read it on PubMed ↗
Cucchiara et al. 1983
Sigmoidoscopy, colonoscopy, and radiology in the evaluation of children with rectal bleeding
Painless bleeding sometimes stays unexplained.Case seriesLow qualityRelated question
103 people1983
most cases were diagnosed with exam and sigmoidoscopy, further tests found the cause in almost all the rest, but 6 children with mild painless bleeding stayed undiagnosed
Who was studied
children with rectal bleeding, average age about 3.5 years
What they received
visual exam of anus, sigmoidoscopy with biopsy, colonoscopy, and contrast X-ray of the colon
Compared with
no separate comparator group; different diagnostic tests compared against each other
Main outcome
whether a cause of the rectal bleeding could be found
Quality
this is a small, uncontrolled case series describing diagnostic tests rather than a comparative study of treatment or outcomes.
Limitations
only looked at children, no control group, and did not explain what caused the bleeding in a small subset of cases
Taken word for word from the abstract
- n 103 children with rectal bleeding
- population The children's mean age was 44 months, with a range from 1 month to 12 years.
- intervention the diagnostic role of sigmoidoscopy, colonoscopy, and double contrast radiology
- comparator sigmoidoscopy, colonoscopy, and double contrast radiology in 103 children with rectal bleeding
- primaryOutcome a positive diagnosis
- result In 74.5% of the subjects investigated, visual inspection of the anus and sigmoidoscopy with rectal biopsy disclosed a positive diagnosis. Of the remaining patients, a conclusive diagnosis was reached by either colonoscopy or double contrast radiology in all but six patients. These six, with mild painless hematochezia, remained without a diagnosis.
J Pediatr Gastroenterol Nutr · PMID 6606026 · Read it on PubMed ↗
Euler et al. 1981
The role of sigmoidoscopy, radiographs, and colonoscopy in the diagnostic evaluation of pediatric age patients with suspected juvenile polyps
Painless bleeding usually caused by benign polyps.Case seriesLow quality
43 people1981
sigmoidoscopy found and removed polyps in 31 of 43 children; barium enema found more polyps further up in only 4 of those 31, but in 7 of 12 children whose sigmoidoscopy was negative; colonoscopy found further polyps in 8 of 11 children who had polyps removed
Who was studied
children with painless rectal bleeding, likely due to juvenile polyps
What they received
diagnostic exams: rigid sigmoidoscopy, barium enema x-ray, and colonoscopy
Compared with
different diagnostic tests compared to each other
Main outcome
finding and removing polyps in the colon
Quality
this is a small, retrospective look at test results in 43 children with no control group, so it shows how testing was used rather than proving one approach is better.
Limitations
small number of patients, no comparison group, retrospective description of diagnostic practice
Taken word for word from the abstract
- population Juvenile polyps are the most common cause of painless hematochezia in pediatric Age patients after the first year of life.
- intervention This study evaluated the role of rigid proctosigmoidoscopy, air contrast barium enema examinations, and colonoscopy in the diagnostic approach to 43 such patients.
- comparator This study evaluated the role of rigid proctosigmoidoscopy, air contrast barium enema examinations, and colonoscopy in the diagnostic approach to 43 such patients.
- primaryOutcome During sigmoidoscopy, polyps were removed from 31 children.
- result During sigmoidoscopy, polyps were removed from 31 children. On subsequent barium enema examination, more proximal lesions were found in only 4 of these 31 patients, but were seen in 7 of the 12 children who had negative sigmoidoscopic evaluations.
- result Eight of these 11 children had proximal lesions seen during radiographic studies.
- n 43 such patients
J Pediatr Surg · PMID 7277147 · Read it on PubMed ↗
Murie et al. 1980
Comparison of rubber band ligation and haemorrhoidectomy for second- and third-degree haemorrhoids: a prospective clinical trial
Surgery worked better but hurt more.Randomised trialModerate qualityRelated question
100 peopleOne year
Surgery relieved more patients' symptoms than banding (44 of 45 vs 34 of 43, P<0.05), but banding caused less pain and much less time off work (3 days vs 32 days, P<0.001)
Who was studied
adults with second- or third-degree prolapsing hemorrhoids
What they received
rubber band ligation (outpatient procedure)
Compared with
surgical hemorrhoidectomy
Main outcome
relief of hemorrhoid symptoms (bleeding and prolapse) at one year
Quality
It was a randomized trial comparing two treatments, but it was small, old, and some patients were lost to follow-up by one year.
Limitations
Not all patients were reassessed at one year; no untreated or placebo comparison group; study is from 1980 and may not reflect modern practice.
Taken word for word from the abstract
- population One hundred patients with second- or third-degree haemorrhoids
- intervention rubber band ligation
- comparator haemorrhoidectomy
- primaryOutcome Haemorrhoidectomy relieved 44 of 45 patients and rubber band ligation relieved 34 of 43
- result Haemorrhoidectomy relieved 44 of 45 patients and rubber band ligation relieved 34 of 43 (P < 0.05)
- result Mean time off work was 32 days for haemorrhoidectomy and 3 days for rubber band ligation (P < 0.001)
- n One hundred patients with second- or third-degree haemorrhoids were randomly allocated to haemorrhoidectomy (50) or rubber band ligation (50)
- followUp One year after treatment
Br J Surg · PMID 6968608 · Read it on PubMed ↗
Wienert 1977
[Ambulatory hemorrhoidectomy through rubber band ligation-review of the literature]
Most symptom-free after band ligation.Systematic reviewLow qualityRelated question
3,244 people1977
80% of patients were free of symptoms afterward, with most reporting no or mild pain during treatment
Who was studied
patients with internal hemorrhoids
What they received
rubber band ligation treatment for hemorrhoids
Compared with
no direct comparator; discussed relative to sclerotherapy and surgical hemorrhoidectomy
Main outcome
pain experienced and freedom from symptoms after treatment
Quality
this is an older literature review pooling case histories without a controlled comparison group, so it can't reliably prove the treatment works better than alternatives.
Limitations
abstract does not describe study design details, randomization, or control group; it is a review of case histories only
Taken word for word from the abstract
- n the literature on the case histories of 3244 patients who were treated by this technique is reviewed
- population internal haemorrhoids
- intervention Rubber band ligation
- comparator an alternative to sclerotherapy and to surgical haemorrhoidectomy
- primaryOutcome 36% of the patients found this form of therapy to be painless, 41% suffered little and 14% severe pain. 80% of all patients finally were free of symptoms.
- result 80% of all patients finally were free of symptoms.
Fortschr Med · PMID 301845 · Read it on PubMed ↗
Cooper 1976
Diagnosis of Meckel diverticulum by sodium pertechnetate Tc 99m scan
Scan found hidden intestinal pouch causing bleeding.Case seriesVery low qualityRelated question
1 people1976
the scan correctly identified Meckel diverticulum before surgery, but this type of scan misses the problem in about half of cases
Who was studied
a 2-year-old child with painless rectal bleeding
What they received
sodium pertechnetate Tc 99m scan to find the cause of bleeding
Main outcome
whether the scan could detect Meckel diverticulum as the cause of bleeding
Quality
this is a single child's case, not a study comparing treatments or testing a larger group
Limitations
only one patient described; the abstract itself says the test misses the diagnosis in about half of all cases of this condition
Taken word for word from the abstract
- n a 2-year-old child
- population recurrent rectal bleeding in a 2-year-old child
- intervention sodium pertechnetate Tc 99m scan
- primaryOutcome Meckel diverticulum was diagnosed preoperatively as the cause of recurrent rectal bleeding
- result false-negative scans have been reported to occur in approximately 50% of all cases of Meckel diverticulum
- limitations Although false-negative scans have been reported to occur in approximately 50% of all cases of Meckel diverticulum
JAMA · PMID 946447 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Gastrointestinal Hemorrhage"[Mesh] OR "Hematochezia"[tiab] OR "rectal bleeding"[tiab] OR "blood in stool"[tiab]) AND ("Hemorrhoids"[Mesh] OR "Fissure in Ano"[Mesh] OR "Colorectal Neoplasms"[Mesh] OR etiology[tiab] OR cause[tiab] OR causes[tiab]) AND (painless[tiab] OR "no pain"[tiab]); PubMed expanded that to: ("Gastrointestinal Hemorrhage"[MeSH Terms] OR "Hematochezia"[Title/Abstract] OR "rectal bleeding"[Title/Abstract] OR "blood in stool"[Title/Abstract]) AND ("Hemorrhoids"[MeSH Terms] OR "Fissure in Ano"[MeSH Terms] OR "Colorectal Neoplasms"[MeSH Terms] OR "etiology"[Title/Abstract] OR "cause"[Title/Abstract] OR "causes"[Title/Abstract]) AND ("painless"[Title/Abstract] OR "no pain"[Title/Abstract])
What came back: 110 records found · 110 read · 104 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

110records came back from the search
110were read
104actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

Bleeding without pain feels less alarming, so it's easy to assume it isn't serious.
Hemorrhoids are so common that many people assume that must be the cause without getting checked.
Embarrassment about rectal symptoms makes people put off seeing a doctor.
The bleeding often stops on its own for a while, which can feel like reassurance that nothing is wrong.

Common questionsShort answers, drawn from the same studies.

Does blood in stool mean cancer?: Usually not. In one large community survey, only 1 in 709 people with rectal bleeding was diagnosed with colorectal cancer. But because cancer is one of the possible causes, and studies disagree on exactly how common it is, any new painless bleeding is worth having checked.
Is bright red blood in stool bad?: Bright red blood usually comes from the lower colon or rectum and is most often linked to hemorrhoids, diverticulosis, or a rectal ulcer rather than an emergency. Still, studies show it can occasionally signal something more serious, so it shouldn't be ignored, especially if it continues or is heavy.
What does it mean if my poop is lined with blood (just a little)?: Small streaks of blood on the outside of stool are most often described with hemorrhoids or minor irritation near the anus in the studies reviewed here. A doctor can usually tell this apart from bleeding coming from higher up in the bowel with a simple exam.
What causes bright red blood when you poop?: In the largest study looking at this, the most common findings were diverticulosis (small pouches in the colon wall), rectal ulcers, hemorrhoids, and abnormal blood vessels in the bowel lining. Less often, case reports describe rarer causes such as polyps, tumors, or inflammatory conditions.
Should I just wait and see if it stops on its own?: No — waiting isn't supported by this evidence. Because studies show painless bleeding can occasionally come from a rectal ulcer, bowel tissue damage, a medication reaction, or cancer, the safer step is to see a doctor for an exam, and a colonoscopy if recommended, rather than watching and waiting.
If something could be seriously wrong, what should I do instead of waiting?: See a doctor or go to urgent care to get examined rather than watching and waiting, since painless blood in the stool can come from very different sources — from hemorrhoids to rectal ulcers to, less often, polyps or cancer — and you can't tell which from symptoms alone. In one large study of adults hospitalized with this type of bleeding, colonoscopy found a specific cause in about 95% of cases, so a direct look is what actually answers the question. If bleeding is heavy, recurs, or comes with weakness or dizziness, treat it as an emergency and seek care right away rather than trying to manage it at home.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.