Rectal discharge is intermittent or continuous expression of liquid from the anus ( per rectum). Normal rectal mucus is needed for proper excretion of waste. Otherwise, this is closely related to types of

fecal incontinence Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred ...

(e.g., fecal leakage) but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.

Types

Different types of discharge are described. Generally "rectal discharge" refers to either a mucous or

purulent Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collect ...

discharge, but, depending upon what definition of rectal discharge is used, the following could be included: * Purulent rectal discharge * Mucous rectal discharge * Watery rectal discharge * Steatorrhoea ("fatty diarrhea" caused by excess fat in stools, or an oily anal leakage) *

Keriorrhea Keriorrhea is the production of greasy, orange-colored stools which results from the consumption of indigestible wax esters found in oilfish and escolar. See also * Steatorrhea * Rectal discharge Rectal discharge is intermittent or continu ...

(orange oily anal leakage caused by high levels of escolar and oilfish in the diet) * Rectal bleeding, melena and

hematochezia Haematochezia is the passage of fresh blood through the anus path, usually in or with stools (contrast with melena). The term is from Greek αἷμα ("blood") and χέζειν ("to defaecate"). Hematochezia is commonly associated with lower gastro ...

* Feculent rectal discharge (fecal rectal discharge), e.g.

fecal leakage Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...

encopresis Encopresis is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. Children with encopresis often leak stool into thei ...

and incontinence of liquid stool elements *

Diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

Symptoms

There are many different types of rectal discharge, but the most common presentation of a discharge is passage of mucus or pus wrapped around an otherwise normal bowel movement. Rectal discharge has many causes, and may present with other symptoms: * Staining of undergarments * Constant feeling of dampness around anus * Frequent urge to open bowels, but passage of only small amounts of mucus or pus-like liquid rather than normal feces *

Rectal pain Rectal pain is the symptom of pain in the area of the rectum. A number of different causes (68) have been documented. Differential diagnosis Anal fissures One of the most common causes of rectal pain is an anal fissure. It involves a tear in th ...

* Rectal malodor, when the discharge is foul-smelling, e.g. associated with certain infections *

Pruritus ani Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch. The intensity of anal itching increases from moisture, pressure, and rubbing caused by clothing and sitting. At worst, anal ...

* Rectal bleeding * Perianal

erythema Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not assoc ...

, swelling and tenderness

Purulent rectal discharge (suppurative discharge)

Pus Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...

usually indicates

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

. Frequently medical sources do not differentiate between the two types of discharge, instead using the general term

mucopurulent discharge Mucopurulent discharge is the emission or secretion of fluid containing mucus and pus (''muco-'' pertaining to ''mucus'' and ''purulent'' pertaining to ''pus'') from the eye, nose, cervix, vagina or other part of the body due to infection and i ...

, which, strictly speaking, should only be used to refer to a discharge that contains both mucus and pus. Purulent discharges may be blood-streaked.

Mucous rectal discharge (mucinous rectal discharge, mucoid rectal discharge)

Mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...

coats the walls of the colon in health, functioning as a protective barrier and also to aid

peristalsis Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...

lubrication Lubrication is the process or technique of using a lubricant to reduce friction and wear and tear in a contact between two surfaces. The study of lubrication is a discipline in the field of tribology. Lubrication mechanisms such as fluid-lubric ...

of stool. Mucous discharges can be thought of in three broad categories: * Normal physiologically produced mucus * Inappropriately expressed physiologically produced mucus (e.g. in the presence of sphincter defects, or lesions preventing normal sphincter closure, allowing seepage or soiling) * Mucus produced in pathological quantities (e.g. from a

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

, or generalized coloproctitis or as a result of bacterial overgrowth) A mucous rectal discharge may be blood-streaked. With some conditions, the blood can be homogenously mixed with the mucus, creating a pink goo. An example of this could be the so-called "red currant jelly" stools in intussusception. This appearance refers to the mixture of sloughed

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

, mucus, and blood. Note: "mucus" is a noun, used to name the substance itself, and "mucous" is an adjective, used to describe a discharge. "Mucoid" is also an adjective and means mucus-like. "Mucinous" strictly speaking refers to something having a

mucin Mucins () are a family of high molecular weight, heavily glycosylated proteins (glycoconjugates) produced by epithelial tissues in most animals. Mucins' key characteristic is their ability to form gels; therefore they are a key component in most ...

-like attribute, but it often is used interchangeably with the word "mucous" (as mucus usually contains a high percentage of mucin).

Differential diagnosis

The differential diagnosis of rectal discharge is extensive, but the general

etiological Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

themes are

and

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

. Some lesions can cause a discharge by mechanically interfering with, or preventing the complete closure of, the

anal canal The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segment ...

. This type of lesion may not cause discharge intrinsically, but instead, allow transit of liquid stool components and mucus. * Common causes include:

haemorrhoids Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''he ...

, proctitis,

anal fissure An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation, but with chroni ...

rectal prolapse A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depend ...

, perianal warts (anal condyloma acuminatum), * Less common causes include:

colorectal carcinoma Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel ...

irritable bowel syndrome Irritable bowel syndrome (IBS) is a "disorder of gut-brain interaction" characterized by a group of symptoms that commonly include abdominal pain and or abdominal bloating and changes in the consistency of bowel movements. These symptoms may ...

solitary rectal ulcer syndrome Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the rectal mucosa (the lining of the rectum). It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as l ...

, anal

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

e, villous adenoma, poor anal hygiene * Rare causes include:

sexually transmitted diseases Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral sex ...

(e.g.

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...

, rectal

gonorrhea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium '' Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with ...

, chlamydia), anal carcinoma,

AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...

rectal foreign body Rectal foreign bodies are large foreign items found in the rectum that can be assumed to have been inserted through the anus, rather than reaching the rectum via the mouth and gastrointestinal tract. It can be of clinical relevance if the pat ...

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Eith ...

rectocele In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pe ...

enterocele An enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal. It may be treated transvaginally or by laparoscopy. An enterocele may also obstruct the rectum, leading to symptoms of obstructed defecation. Enteroceles ...

ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and a ...

, bacterial colitis (e.g. syphilitic colitis), anal/perianal

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...

perianal abscess Anorectal abscess (also known as an anal/rectal abscess, or perianal/perirectal abscess) is an abscess adjacent to the anus. Most cases of perianal abscesses are sporadic, though there are certain situations which elevate the risk for developin ...

(when ruptured). Perianal

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...

is associated with fistulizing, fissuring and perianal abscess formation. After

colostomy A colostomy is an opening ( stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it int ...

, the distal section of bowel continues to produce mucus despite fecal diversion, often resulting in mucinous discharge. Occasionally, intestinal parasitic infection can present with discharge, for example

whipworm ''Trichuris trichiura, Trichocephalus trichiuris'' or whipworm, is a parasitic roundworm (a type of helminth) that causes trichuriasis (a type of helminthiasis which is one of the neglected tropical diseases) when it infects a human large intes ...

Perianal discharge

Several pathologies can present with perianal discharge. Although not exactly the same as rectal discharge, perianal discharge can be misinterpreted as such, given the anatomical proximity.

Fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

e draining into the perianal region, as well as pilonidal diseases, are the main entities that fall within this category. Perianal tumours can also discharge when they fungate or otherwise become cystic or necrotic.

Causes

Proctitis

Proctitis is inflammation of the lining of the rectum including the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

of the rectum. Proctitis has many causes. Common infection causes include: sexual intercourse with someone who has a sexually transmitted disease (STD), infection from a foodborne illness, and strep throat (in children). Proctitis may also be caused by some types of inflammatory bowel disease, radiation therapy, injury to the rectum or anus, or some types of antibiotic.

Tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...

proctitis can create a mucous discharge.

Infections

Anal warts (condyloma acuminatum, anogenital warts)

Anal warts are irregular, verrucous lesions caused by

human papilloma virus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the '' Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...

. Anal warts are usually transmitted by unprotected, anoreceptive intercourse. Anal warts may be asymptomatic, or may cause rectal discharge, anal wetness, rectal bleeding, and

pruritus ani Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch. The intensity of anal itching increases from moisture, pressure, and rubbing caused by clothing and sitting. At worst, anal ...

. Lesions can also occur within the anal canal, where they are more likely to create symptoms.

Chlamydia

The bacterium ''

Chlamydia trachomatis ''Chlamydia trachomatis'' (), commonly known as chlamydia, is a bacterium that causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflamma ...

'' can cause 2 conditions in humans; viz.

trachoma Trachoma is an infectious disease caused by bacterium ''Chlamydia trachomatis''. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of ...

and

lymphogranuloma venereum Lymphogranuloma venereum (LGV; also known as climatic bubo, Durand–Nicolas–Favre disease, poradenitis inguinale, lymphogranuloma inguinale, and strumous bubo) is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a, L2 ...

. Trachoma can cause an asymptomatic proctitis, but the symptoms of lymphogranuloma venereum are usually more severe, including

, purulent rectal discharge,

rectal pain Rectal pain is the symptom of pain in the area of the rectum. A number of different causes (68) have been documented. Differential diagnosis Anal fissures One of the most common causes of rectal pain is an anal fissure. It involves a tear in th ...

and

diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

. Lymphogranuloma venereum can cause

s, strictures and

anorectal abscess Anorectal abscess (also known as an anal/rectal abscess, or perianal/perirectal abscess) is an abscess adjacent to the anus. Most cases of perianal abscesses are sporadic, though there are certain situations which elevate the risk for developin ...

es if left untreated. Hence, it can be confused with Crohn's disease.

Rectal gonorrhea

Rectal gonorrhea is caused by ''Neisseria gonorrhoeae''. The condition is usually asymptomatic, but symptoms can include rectal discharge (which can be creamy, purulent or bloody),

, tenesmus, and possibly

. When symptomatic, these usually appear 5–7 days post-exposure. Discharge is the most common symptom, and it is usually a brownish mucopurulent consistency.

Syphilis

Anorectal syphilis is caused by ''

Treponema pallidum ''Treponema pallidum'', formerly known as ''Spirochaeta pallida'', is a spirochaete bacterium with various subspecies that cause the diseases syphilis, bejel (also known as endemic syphilis), and yaws. It is transmitted only among humans. It is ...

'' and is contracted through anoreceptive intercourse. Symptoms are usually minimal, but mucous discharge, bleeding, and tenesmus may be present.

Anorectal fistulae

Ileocolic actinomycosis

Non-infectious inflammation

Ulcerative colitis

Diversion colitis

When the fecal stream is diverted as part of a

, a condition called diversion colitis may develop in the section of bowel that no longer is in contact with stool. The mucosal lining is nourished by short-chain fatty acids, which are produced as a result of bacterial fermentation in the gut. Long-term lack of exposure to these nutrients can cause inflammation of the colon (colitis). Symptoms include rectal bleeding, mucous discharge, tenesmus, and

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

Volvulus

Colonic ulcers

Functional

Mucosal prolapse syndromes

* Solitary rectal ulcer syndrome * * Internal intussusception * Mucosal prolapse * Rectal prolapse

Irritable bowel syndrome

Pneumatosis cystoides intestinalis

Pruritus ani

Malignancy

Anal carcinoma

Anal carcinoma is much less common than

colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel m ...

. The most common form is squamous cell carcinoma, followed by

adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or ...

and

melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...

. SCC usually occurs in the anal canal, and more rarely on the anal margin. Anal margin SCC presents as a lesion with rolled, everted edges and central ulceration. Symptoms include a painful lump, bleeding,

, tenesmus, discharge or possibly

. SSC in the anal canal most commonly causes bleeding, but may also cause anal pain, a lump,

, discharge, tenesmus, change in bowel habits and

. Because these symptoms are so unspecific, and because symptoms of anal carcinoma may not always be typical, this can lead to delays in diagnosis. Rare neoplasms at this site that can give rise to discharge include Paget's disease (which is possibly a type of adenocarcinoma) and verrucous carcinoma.

Colorectal cancer

Pelvic sepsis

Orlistat

Colorectal polyp

Adenoma An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenom ...

is the most common colorectal polyp. Adenomas are not malignant, but rarely

can develop from them. Large adenomas can cause rectal bleeding, mucus discharge, tenesmus, and a sensation of urgency. Mucus production may be so great that it can cause

electrolyte An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon dis ...

disturbances in the blood.

Juvenile polyps

Juvenile polyps may cause rectal discharge.

Familial adenomatous polyposis

References

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