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Causes of Rectal Bleeding

Rectal or anal bleeding is common. Lots of people get it.  However it is not normal and you should get it looked at by an expert. Most causes of rectal bleeding are entirely benign and easily treatable. The commonest causes are “haemorrhoids” or “piles” and a “fissure” or “tear” in the anus. When you come to see me with rectal bleeding I will spend some time taking a history to try and work out how best to investigate your problem. I will do a rigid sigmoidoscopy (a little telescope that I insert into your rectum to examine the potential causes of your problem) and possibly a proctoscopy (a shorter telescope to look mainly at your anal canal). Depending upon your history I will often recommend that you have further examination called a flexible sigmoidoscopy or a colonoscopy to make sure that the blood is not coming from higher up in the bowel and dripping down.

Haemorrhoids or Piles

Piles are little lumps that may come down or “prolapse” when you pass a motion or stool. Most people have them to some extent and usually they cause no problems what so ever. Piles are more common in those that have a tendancy to be constipated or those that strain when they go to the toilet. They can cause bleeding, itchiness, irritation or pain in the area. Generally speaking the worse the haemorrhoids the worse the symptoms.

Piles can be graded according to how bad they are and range from 1 to 4.

Grade 1 Haemorrhoids

These may bleed from time to time but no physical lump is seen or felt. These are relatively minor and can often be treated with simple measures such as improving your diet, increasing your fluid intake and keeping your stools soft to avoid straining or constipation.

Grade 2 Haemorrhoids

These may cause bleeding, irritation or pain. You might notice lumps coming out when you pass a stool. These lumps go back up again on their own after you have finished your bowel movement. I can treat these for you with a simple procedure done in clinic with out any pain killers or anaesthetic. This procedure is called ‘rubber band ligation’. This procedure works very well and sometimes may need to be repeated some weeks afterwards.

Grade 3 Haemorrhoids

These may cause more severe bleeding, irritation or pain.  There are lumps that come out when you open your bowels and these don’t go back in by them selves. They need to be pushed back.  I may try rubber band ligation for these as it is simple and often works.  When rubber band ligation fails I would recommend “haemorrhoidectomy” or the “Rafaello” procedure.

Grade 4 Haemorrhoids

These may cause even worse symptoms still.  Here the lumps around your anus are permananetly out. They are often painful and can bleed quite heavily. You might have problems with hygiene and keeping the area clean.  Depending on how big they are “rafaello” procedure may an option.  Haemorrhoidectomy is the only treatment that works for the very big haemorrhoids.

Haemorrhoidectomy

This is one of the oldest operations that has ever been done and probably the one with the best track record for the treatment of piles. It involves a general anaesthetic or being put to sleep. It is usually a day case operation which means you are home the same day. I will of course explain everything to you in much more detail in clinic but it basically involves cutting the haemorrhoids away and tying off the blood vessel that feeds them.  

It is a safe and relatively quick procedure and takes about an hour to do. The biggest down side of this operation is that it is painful and you can expect around 6 weeks of pain whilst the area heals. The reason it takes such a long time to heal is that every time you wipe or wash the area you are undoing the “scab” that is needed to heal. I have done hundreds of these operations with excellent results. I take extreme care to cut away the haemorrhoid and carefully peal it away from your anal sphincter muscle but there is a small chance that the muscle can get damaged, This may mean that there is some disturbance in controlling wind or loose stools but this is usually short lived.

Rafaello Procedure

This is a state of the art treatment for piles. I have received special training to be able to offer this procedure. It can usually be done with gentle sedation meaning that you don’t need to be put to sleep. The area is numbed using a local anaesthetic injection and a small needle is inserted into the haemorrhoid.  High frequency sound waves are then passed through the needle which causes the haemorrhoid to shrink and shrivel up. The greatest advantage of this procedure is that it is virtually painless and if it does not work haemorrhoidectomy is always still an option. The greatest disadvantage is that it not available on the NHS.  I do however offer this procedure at both the BMI Hospitals in Birmingham and Little Aston Spire in Sutton Coldfield.

What exactly are haemorrhoids?

What exactly are haemorrhoids?

What causes haemorrhoids?

​What are the causes of haemorrhoids?

What are the symptoms of haemorrhoids?

​How will I know if I have haemorrhoids?

​How are haemorrhoids treated?

​What treatments are available for haemorrhoids?

Anal Fissure or Tear

An anal fissure or tear is reasonably common in people that suffer with constipation. It can also happen during and persist after child birth. It can be linked to certain conditions such as Crohn’s disease. The tear is intensely painful and you will experience pain during passage of the stool and immediately after. It can last several hours and may even be painful without any bowel movement. Some people say it is amongst the worst pains you can experience. The tear itself can be associated with bleeding but the main problem is usually pain. It is important to avoid constipation as this can make the symptoms worse. Once fully investigated and more serious causes of your symptoms have been ruled out it is reasonably easy to treat.

Most people get better with the use of creams for six to eight weeks. A small pea sized amount is placed over the anus, once in the morning and once in the evening for a period of six to eight weeks. If treatment fails with one cream, a stronger cream is used. Most people get better with creams alone but it is very important to address diet, fluid intake and bowel habits to prevent the fissure returning. If creams fail the next step would be a very small operation where you are put to sleep and Botox is injected in to your anus. This is painless.  The risks are minimal and the vast majority of people get better with Botox. If Botox fails, the next step would be a slightly bigger operation.  We would need to discuss this at length as the risks are increased. 

What exactly is an anal fissure?

​What exactly is an anal fissure?

What are the treatment options for an anal fissure?

​How is an anal fissure treated?

Anal Skin Tags

​These are over growths of skin around your pack passage. They are extremely common.

Skin tags can swell from time to time and be painful. They can be very itchy – particularly at night. You may find it difficult to keep the area clean and may be self conscious and this may have consequences during intimate moments.

Treating the symptoms involves keeping the area dry and clean. Trying to avoid scratching. Often washing rather than wiping helps. Some people say that using a hair dryer to keep the area dry before going to bed helps with the symptoms.

Unfortunately removal of anal skin tags are not funded on the NHS.  Removing them however does significantly improve symptoms and quality of life.

Removing anal skin tags involves a general anaesthetic (being put to sleep) and cutting the skin tags away.  The area can be painful for a few weeks after the procedure.  The procedure is usually done as a day case and you will be home the same day of the operation.

Anal Fistula or Abscess

Another common cause for pain, itching and bleeding from the bottom is an abscess around the anus. To learn more about this problem click here.​

Case study: A patient with Haemorrhoids

Mr B had been suffering for years with haemorrhoids. He had been seen in the NHS and was fully investigated for his symptoms and haemorrhoiods were confirmed as the cause. Due to the size and nature of the haemorrhoids the specialist in the NHS recommended Haemorrhoidectomy. He was correctly councilled that it would be a painful procedure and that he may be in pain for anything up to six weeks. Mr B wanted a less painful alternative.  He discussed with some friends from the golf club and wanted to explore the Rafello procedure. Mr B saw Mr Peravali at the BMI Edgbaston Hospital. A few weeks later Mr Peravali performed the procedure. Mr B had an excellent result and is now symptom free. He commented:


“I didn’t even experience 2 minutes of pain!”.

Mr B – West Bromwich


What Patients Say

“I cannot fault the care I received”

I would like to take this opportunity to thank you and your team for the care and kindness you showed me before during and after my prolapse operation.  I cannot fault the care I received and I hope you carry on providing this high level of care to your patients.

Mrs. F.A.

“I have no hesitation in recommending your skills to other people”

You carried out an operation for my abdominal hernias at Spire Little Aston Hospital.

I wish to express my thanks to you and your staff for the high standard of clinical and patient care I received. The pain and discomfort from the hernias have gone and I now feel so much better after the operation.

Thank you so much and I have no hesitation in recommending your skills to other people with similar problems.

Mr. B.B.

“The care I received was first class”

Just a short note to thank you and your team for the treatment and care you gave me during and after my cancer operation.

After first meeting you,  both my wife and myself had total confidence in you. What really impressed us was the aftercare you and your team provided.

The care I received was first class and I witnessed first-hand how dedicated you and your team are to your patients.

Mr. L.D. & Mrs. T.D.

“We really appreciated your honest and comforting approach”

I would like to say a big thank you to you for my mom’s treatment. We really appreciated your honest and comforting approach and support – sometimes with not good news but always with a smile, a plan and complete reassurance that in your hands my mom would be ok.

We particularly welcomed your well needed lightness and laughter.  On the day of the surgery you took time to talk to my mom as well as myself and my sister which really helped us all. My mom has made a fantastic recovery and is better than ever – thank you once again and we will be for ever indebted to you.

Mrs. M.K.

“Excellent outcome”

We are writing to say how pleased we are with Dr Rajeev Peravali who saved my mum’s life in March when she was admitted to Hospital with severe abdominal pain. She had an ileostomy at the time. He subsequently reversed her ileostomy and has had an excellent outcome once again thanks to Dr Peravali.

Mrs. A.S. & family

“Helped me a great deal”

I would like to take this opportunity to thank you and your team for the surgery you performed to remove a cancer from my colon.

I would also like to thank you for the time and information you gave me throughout and after the procedure, I found that helped me a great deal.

Mr. R.U.

“The work you do is outstanding”

I would like to say a huge thank you to you and your team for the specialist care you gave throughout my operation. The work you do is outstanding and I will be forever grateful for what you have done for me.

Mr. D.W.

“I will never be able to thank you enough”

I am writing to express my gratitude for the treatment I received at your hands. Everyone was so wonderful. The day I was admitted to hospital was one of the toughest times in my life. The personal attention and kindness shown by you, coupled by the caring attitude of the hospital staff helped me overcome my fears about surgery.

I want you to know that you are doing a wonderful job and I will never be able to thank you enough. The support and advice I received from you before undergoing the surgery was crucial in my speedy recovery. I will recommend you not just as a doctor but also as a great human being who is a good listener with lots of patience with a caring attitude.

Mr. I. W.


Contact Us

BMI The Edgbaston Hospital

22 Somerset Rd

West Midlands

Birmingham B15 2QQ

(0121) 446 1684

Spire Little Aston Hospital

Little Aston Hall Drive

The Royal Town of Sutton Coldfield

Birmingham ​B74 3UP

(0121) 580 7302