1. RECTAL BLEEDING , DURING
PREGNANCY
Prof. M.C.Bansal
MBBS. MS. FICOG. MICOG.
Funder Principal 7 CONTROLLER.,
Jhalawar Medical college & Hospital Jhalawar.
Ex Principal & controller., MGMC &H Sitapura,
Jaipur.

2. Rectal Bleeding In Pregnancy
 Rectal bleeding usually occurs from disease
involving anus , rectum and colon .
 Bleeding from upper GIT can present a dark
red blood loss per rectum because of a rapid
transient time, but usually as Meleana .
 Rectal bleeding may be chronic or acute and
sudden in on set.
 Patients with little and chronic blood loss
present with chronic Iron deficiency anaemia
and occult blood in stool.

3. Causes of rectal Bleeding in
Pregnancy
 Anorectal Conditions
Haemorrhoids.
Anal Fissure.
Solitary Rectal Ulcer
Rectal Mucosal Prolapse
Large Bowel Conditions
Inflammatory bowel disease.
Adenomatous Polyp.
Carcinoma.
Arteriovenous Malformations.
Mecle’s Diverticulum.

4. Clinical Evaluation
 Detailed history from patient can reveal the
underlying cause of rectal bleeding .
 Bright red blood separate from stool suggests an
anorectal cause.
 Diarrhoea with mucus mixed dark blood
suggests colitis or carcinoma., where as faecal
urgency ,acute bleeding and colic indicates
colitis . History of altered bowel habits , alternate
constipation and diarrhoea with abdominal
discomfort may suggest malignancy.

5. Clinical Examination
 Per re3ctal digital examination , proctoscopy ,
sigmoidoscopy can help in diagnosing anorectal
cause.
 Colonoscopy although difficult in active
bleeding patient ,but it can help at least to
identify the segment involved.
 A women with active rectal bleeding and
hemodynamic compromise , surgical and
treatment in emergency is required.
 Incases of melaena upper GIT is to be evaluated
with the help of upper GI endoscopy.

6. Anorectal Disease
1.Haemorrhoids
Very common in pregnancy due to increased
circulating blood volume , increased venous
congestion owing to compression of superior
rectal veins by enlarged gravid uterus as well as
relaxing effect of progesterones on smooth
muscles of vessels.
Haemorrhoids may present as bleeding, prolapse,
mucoid discharge, pruritus , constipation and
rectal discomfort. Diagnosis is very simple on
proctoscopy .

7. Haemorrhoids----
 Treatment during pregnancy is mainly to relieve
rectal pain , pruritus and bleeding along with
correction of anaemia.
 Conservative management includes dietary advice,
laxative , increased fluid intake, haematenics , local
analgesic ointment’s use before and after
defecation.
 Definitive treatment can be done after delivery as
majority of pregnant patient get relief and
hemorrhoids resolve spontaneously after delivery .
 When no relief rubber band ligation and even
haemorrhoidectomy can be considered as a safe
procedure in pregnancy.

8. Anorectal Disease----
 2. Anal Fissure
Anal fissure is painful condition.
It is usually caused by passing hard stools damaging
tear in anal mucosa.
This leads to painful defecation with fresh blood in a
line on hard stool.
Anal fissure are common in pregnancy due to
increased incidence of constipation .
Progesterone's smooth muscle relaxation effect and
iron therapy have constipating effect.
Local analgesic gels ,laxatives , dilatation and
stretching of anal sphincter will give relief .

9. Large Bowel Conditions
 1.Inflammatory Bowel Disease-
Most of pregnant women with pre existing inflammatory bowel
disease have uneventful pregnancies and exacerbation can
safely and easily controlled by drugs which they have been
taking.
It is rare that inflammatory bowel disease to present for the first
time in pregnancy.
Relapses of Crohn’s disease occur in 1st trimester . Medical
treatment is sufficient. Surgery can safely be undertaken when
presence of abscess causing peritonism develops.
Many patient with H/O ulcerative colitis managed by ileal
pouch anal anastomosis will become pregnant .
Long term prognosis in these cases is good so far pregnancy
and safe vaginal delivery is concerned .

10. Large Bowel Disease
 2. Colorectal Carcinoma-
It is rare in pregnancy . Cancer diagnosed in pregnancy are of
rectal origin .
presenting symptoms of rectal cancer such as rectal bleeding,
nausea , vomiting and constipation are often attributed to
common benign conditions reported in pregnancy.
once suspected ., PR , flexible Sigmoidoscopy and colonoscopy
directed biopsy will confirm it.
Treatment of colorectal cancer (in pregnancy < 30 -32 weeks )
follows the same general guidelines as for non pregnant
woman . If it is detected in late trimester than treatment may
be delayed to achieve foetal maturity and planned LSCS.s