Rectal bleeding, medically known as hematochezia, is a serious symptom that always requires medical evaluation to determine its source. The question is whether the herpes simplex virus (HSV), a common infection, can be the cause. While many causes are benign and local, others indicate a severe issue requiring prompt attention.
Understanding Herpes-Related Colitis
The Herpes Simplex Virus (HSV), typically HSV-2, can cause blood in the stool by infecting the lining of the rectum or lower colon. This infection leads to herpes proctitis (inflammation of the rectal lining) or colitis.
The viral infection causes the tissue in the rectum and colon to become inflamed, leading to the formation of ulcers and erosions in the mucosal lining. These open sores are fragile and can bleed when stool passes over them, resulting in the presence of blood in the feces.
Herpes-related colitis is an uncommon cause compared to other gastrointestinal issues. It is seen more frequently following receptive anal intercourse, which is the primary route of transmission to the rectal area. The risk is significantly higher in individuals who are immunocompromised, such as those with HIV or those taking immunosuppressive medications.
Symptoms Specific to Herpes-Induced Bleeding
When herpes proctitis causes blood in the stool, it is rarely an isolated symptom. Patients frequently experience severe anorectal pain and tenesmus—a feeling of needing to pass stool even when the rectum is empty. This rectal pain, along with difficulty or pain during bowel movements, are hallmark signs.
Other associated symptoms can include a discharge of mucus or pus from the rectum, fever, body aches, and swollen lymph nodes in the groin area. In some instances, a patient may notice the classic painful, fluid-filled blisters or ulcers around the perianal area. The presence of these combined neurological and inflammatory symptoms helps distinguish herpes proctitis from the more common causes of rectal bleeding.
Other Frequent Causes of Rectal Bleeding
The vast majority of rectal bleeding episodes are caused by common, localized conditions in the lower gastrointestinal tract. Hemorrhoids, which are swollen veins in the rectum or anus, are the most frequent cause. They typically result in painless, bright red blood that streaks the toilet paper or drips into the bowl, usually not mixed into the stool itself.
Anal fissures are small tears in the lining of the anal canal, often caused by passing hard stools. Bleeding from a fissure is usually bright red and scanty, appearing as a streak on the stool or toilet paper. This bleeding is accompanied by sharp, severe pain during and after a bowel movement, which is a key distinguishing factor from hemorrhoidal bleeding.
Bleeding originating higher in the colon, such as from diverticulosis, presents differently, often involving a sudden, large volume of blood that can be dark red or maroon in color and may be mixed into the stool. Diverticular bleeding is often painless and occurs when small pouches, called diverticula, in the colon wall erode a blood vessel. Bleeding can also be a symptom of Inflammatory Bowel Disease (IBD), such as ulcerative colitis. IBD involves inflammation and ulcers in the colon lining, causing bright red blood and often bloody diarrhea.
When Immediate Medical Evaluation is Necessary
While the cause of blood in the stool may be a minor issue like a fissure, the symptom itself warrants prompt medical evaluation to rule out serious conditions. Certain accompanying signs indicate a high-volume or upper-tract bleed that requires immediate emergency attention.
This includes passing a large amount of blood, such as if the toilet water turns red and cloudy, or noticing large blood clots. The presence of black, tarry, and sticky stool, known as melena, is a sign of bleeding higher in the digestive tract that has been digested and is an urgent concern.
Symptoms suggesting significant blood loss or hemodynamic instability, such as lightheadedness, dizziness, fainting (syncope), confusion, or a rapid heart rate, require immediate transport to an emergency room. Unexplained weight loss, persistent fever, or severe, new abdominal pain in conjunction with rectal bleeding are red flags that necessitate an urgent workup. Ultimately, any instance of unexplained rectal bleeding should not be self-diagnosed, as a medical examination is the only way to accurately determine the source and secure an appropriate treatment plan.