Different conditions affect children compared to adults and this is why we first ask about age.
Paediatric conditions
- Intussusception : This is when the bowel ‘telescopes’ in on itself / part of the bowel rolls up inside the other part, commonly due to lymph nodes or a Meckel’s diverticulum. This leads to reduced blood flow to part of the bowel. Symptoms include severe tummy pain that comes and goes, each episode lasting 2-3 minutes, and can progress to a constant pain if not treated.
- Meckel’s diverticulum : This is a congenital condition where a small ‘extra’ pouch develops in the child’s intestine. Most children with it will be unaware of it, but it can start to bleed if an ulcer forms on it. Children may also get pain from it as this pouch can cause twisting of the bowel (ie volvulus) or a telescoping of the bowel (ie intussusception).
- Constipation : This is common in children and can lead to straining and pain on pooing. It is not an urgent issue, but needs a face-to-face appointment to review and provide management.
Adult conditions
- Diverticular bleed : A diverticulum is an ‘outpouching’ from the gut and is quite common in older patients. Patients may develop inflammation of this ‘sac’ and this can lead to a bleed from an underlying vessel. These patients often present without pain. The bleeding may settle by itself or it may need either surgical or endovascular intervention
- Cancer : This may be the first sign of cancer and so we have a sooner appointment for patients who have other signs of cancer ie unintentional weight loss, change in bowel habit
- Colonic angiodysplasia : This is a common cause of bleeding via the back passage in older patients. This condition means there are fragile and leaky blood vessels that can spontaneously start bleeding. Bleeding often stops without medication or treatment, but patients with a lot of blood loss need to be reviewed.
- Infection : This can include a diarrhoeal illness (ie gastroenteritis) or an abscess/infection around the anus, both presentations can have blood as part of the clinical picture
- Haemorrhoids : Pharmacists can provide OTC medications for treatment of simple haemorrhoids