Understanding the Causes and Management of Canine Hematochezia

1. Introduction

Hematochezia is a term used in the veterinary context to describe the presence of fresh blood mixed with feces. It may have different origins due to the anatomical localization of its location, deriving from the lower urinary, genital, or digestive tracts. A mixture of melena and hematochezia is called hemafecia. Recognition and consideration of the significance of hematochezia by both pet owners and veterinarians is necessary for the determination of diagnostic and treatment measures. Hematochezia results sometimes from lower gastrointestinal processes such as proctitis, colitis, neoplasia, or polyps of the colon. This condition may present as an acute and sporadic case or as a regular, chronic condition. Different breeds may have a different predilection for the presentation of hemorrhagic hematochezia. It is concerning to the pet owner due to the hemorrhage aspect and underlying fears that have been generated by stories and images not belonging in the pet’s environment. Some pet owners feel anxious about seeing blood and conclude that the matter they had not seen is actually true because of the presence of blood. Gastrointestinal conditions have implications for the emotional life of the animals and are reflected in the owners witnessing it. Hematochezia results from the presence of blood in the lower GI at the time of its release, when it mixes with the fecal matter. Because the amount of blood loss from the upper GI tract and the small intestine is small, the blood is not always automatically and inevitably visible. Blood from the small bowel or upper GI bleeding can appear as melena in the dog with poor upper GI motility. Hematochezia likely has a lot of importance in the veterinary medicine field of canine and clinical context of patients.

2. Common Causes of Hematochezia

While hematochezia may be terrifying for pet owners, it is one of the more straightforward clinical complaints for veterinarians to rule out potential causes. Hematochezia is not always the result of a life-threatening condition. However, hematochezia can create significant anxiety in pet owners, especially if it appears to be substantial. The more common reasons for hematochezia in dogs can be divided into dietary, infectious, inflammatory, and neoplastic (both benign and malignant) causes, as well as idiopathic inflammatory bowel disease.

Hematochezia from dietary indiscretion can be due to milk, other lactose-based products, or certain grains or fruits for some individuals. Infection with gastrointestinal parasites can lead not only to diarrhea but also, if severe enough, blood in the stool in fresh cases because it is typically due to a large number of worms migrating or holding onto the intestinal lining, as well as other organisms that cross into the digestive lining. The three most common parasites to cause this are Giardia spp., Trichuris vulpis (whipworms), and hookworms. In chronic cases, or in conjunction with a parasitic infection, blood can be seen in the stool due to chronic diarrhea that causes inflammation of the intestines. Diarrhea is a byproduct of the body flushing those infectious agents out through the colon; a hallmark of this is the presence of pain, which indicates a chronic state of infection. A couple of people have reported seeing clostridial enteritis. Clostridial infections may be contagious and are difficult to distinguish from other causes of diarrhea; long-term antibiotic therapy may be necessary to eradicate.

2.1. Dietary Factors

Research has shown that dietary factors can affect gut microbiota function and health, and the health of the gastrointestinal system of dogs is affected by natural and processed canine foods. The importance of a balanced diet in the treatment of foreign bodies, viral diseases, and growth-related injuries has been identified in the management of diarrhea. Diets containing protein additives have been shown to increase the sensitivity of food allergens in dogs. Common allergens include beef, cow's milk, corn, wheat, and soy products; allergic reactions to pork products have also been reported. Large breed dogs, particularly Labrador and Golden Retrievers, are predisposed to protein food allergies, particularly beef and dairy products. Additives and incomplete proteins, as well as clients supplementing the diet with scraps and snacks, can be considered potential factors associated with canine disease. Mushy, absorbing foods force the dog's gastrointestinal tract to accommodate, reducing the physiological effect of the natural cleansing process. Sudden changes in dog food can lead to diarrhea, so changes in a puppy's diet should be made gradually over a few weeks, and adult dogs should gradually transition to new diets over a period of one to two weeks. Clostridium perfringens can cause self-limiting bloody diarrhea and coccidia. All raw meat products should be flash frozen and defrosted before feeding to minimize the risk of bacterial contamination. Consult your veterinarian before making any radical dietary changes to your pet's diet.

2.2. Parasites and Infections

Parasites are described as a major factor for hematochezia. Several breeds may present symptoms of parasites in young dogs, and it is important for pet owners to come for annual examinations and fecal exams to confirm the absence of parasitic infections. The more common parasitic worms are whipworms, which can cause colitis (inflammation of the colon), and hookworms that can produce bloody diarrhea due to bleeding in the intestines. Other less common culprits are tapeworms and roundworms, which may also lead to intestinal inflammation and bleeding. Protozoan infections such as giardia and coccidia can be responsible for bloody diarrhea in dogs. Stress can lead to a decline in immunocompetency and a flare in infections due to lowered immunoglobulin production. A combination of bacteria, viruses, and fungi can amplify the severity of enteric disease or vice versa.

Bacterial, viral, and fungal infections can cause problems in the GI tract, resulting in symptoms such as intestinal inflammation, diarrhea, and sometimes leading to colitis with the presence of blood in the stool. Signs of infection may include lethargy, vomiting, diarrhea, anorexia, and abdominal pain. A fecal exam may confirm the presence of bacteria such as clostridia, likely causing solitary benign hemorrhagic diarrhea, or other bacteria. HGE is interpreted as a skewed immune response to the presence of low numbers of bacteria causing watery diarrhea. MUO is not substantiated in the majority of dogs with suspected MUO. Performing a fecal culture is recommended to confirm the absence of certain infections and to identify the specific bacterial pathogen. Deworming for parasites and administration of the correct antibiotic is necessary in several digestive and circulatory system diseases, such as inflammation and bleeding from the large bowel or colon.

2.3. Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a condition in which an animal's body mounts an inappropriate immune response against the bacteria residing in the gastrointestinal tract, resulting in chronic inflammation that can extend from the esophagus to the colon. In dogs, this chronic inflammation is characterized by the accumulation of large numbers of cells involved in the immune response, predominantly those of inflammatory nature in the wall of the gastrointestinal tract. IBD can have a crippling impact on a dog's quality of life and may manifest itself with a range of clinical signs. Some dogs may manifest with vomiting and/or diarrhea, whereas more severe cases may have hematochezia. IBD is defined as a group of idiopathic, chronic, relapsing enteropathies; this suggests that there are likely different forms of IBD such as food responsive, antibiotic-responsive, and steroid-responsive forms. Currently, we can only diagnose IBD when all of the other potential causes of hematochezia have been ruled out. A definitive diagnosis of IBD can only be determined by obtaining biopsies and looking for major inflammatory infiltrates at the histologic level in addition to sub-classifying the disease form according to the type of inflammatory cells present in the biopsies.

The clinical signs of IBD depend on the extent of the inflammation, which part of the gastrointestinal tract is affected, and whether or not the disorder is recurrent. The risk of IBD in cases of recurrent IHE is higher. Dogs with IBD are also at a higher risk of developing pancreatitis. A complete blood count and serum biochemistry are carried out to evaluate the general health of your dog, look for other causes of gastrointestinal inflammation, and to monitor the function of other organs. Sometimes veterinarians may recommend abdominal radiographs or ultrasound to look for other causes of gastrointestinal signs. Management of IBD is a lifelong process that may need to be modified as the disease progresses. Initial dietary management without medication is recommended because many of the medications used to treat IBD can cause unwanted side effects and may not be needed. Considering the role of the intestinal microbiome in IBD pathogenesis, prebiotics and probiotics have been theorized to be useful in the treatment of IBD, and trials are ongoing to prove the efficacy of selected strains in managing IBD. Anecdotal reports suggest that some dogs with mild to moderate signs of IBD may respond well to commercially available therapeutic gastrointestinal diets used with or without gastrointestinal medications.

2.4. Colorectal Polyps and Tumors

Benign colorectal polyps in the mucosa and submucosa of the rectum and distal colon of dogs can range in size (less than 2 cm). Dogs with colonic polyps are usually unaware of the problem, but the disease has clinical significance, as they are prone to rectal bleeding. These polyps can be retrieved by rectal palpation or cytology, but definitive diagnoses are generally based on histopathology. In contrast, colorectal tumors are less common, although sporadic data is available on their prevalence. These tumors typically have similar clinical signs to polyps, and unfortunately, many of these are malignant. Proper evaluation of the mucosal and submucosal pathology acquired by endoscopy typically provides insights into the relative importance of gastrointestinal clinical problems and gastrointestinal bleeding.

The most common macroscopic clinical symptoms of benign and malignant lesions are metastases to regional lymph nodes, liver, and/or lungs, with the exception of a subset of benign leiomyomas and leiomyomas of the muscularis. Dogs with colorectal polyps and colorectal cancers may have signs of chronic colitis. In general, owners bring older dogs with a suspected pruritic problem, who have had significant hematochezia for weeks or more, to the emergency room, but after careful testing with rectal palpation or biopsy, the presence of the lesion is confirmed. The appearance of tumors and the selection of surgery depend on information obtained from staging gastrointestinal endoscopy and other nonsurgical modalities. Polyp removal requires patient monitoring even though the polyps are benign in nature. Furthermore, dogs with carcinomas undergo more primary treatments than dogs with polyps.

3. Diagnostic Approaches

While evaluating a dog with hematochezia, one should first confirm that it can actually defecate. A complete physical examination remains an essential component of the initial workup, and it needs to be complemented by a detailed dietary and medication history. A logical diagnostic approach to the dog with hematochezia starts with fecal analysis and progresses to laboratory testing of blood and feces, followed by imaging. If clinicians follow a logical diagnostic plan, they will make a correct diagnosis and efficiently manage the patient.

In dogs with hematochezia, there are just a few key tests to prioritize in order to arrive at a quick diagnosis. The first priority is a complete blood count in any patient with bloody stool because anemia is the single best prognostic indicator for all causes of bloody stools. Although hematochezia suggests colitis, which usually has normal other hematologic and serum chemistry abnormalities, anemia often develops gradually over many days. Secondly, perform a saline fecal flotation using two randomly selected one-gram samples, as large blood losses and occult blood loss can frequently cause parasite ova to be excreted. In most cases, follow up these tests with a commercial in-clinic or reference laboratory pancreatic lipase immunoenzymometric assay, as dogs and cats that receive large whole blood transfusions may have falsely elevated serum lipase levels from the lipase in the donated blood. Ultrasonography is very useful for determining if there are abdominal masses or fragmented calculus in the colon and if there is retroperitoneal or external pelvic bleeding into some portions of the colon. Very few truly lateral oblique colon radiography studies can be helpful. Standard ventral (or dorsal) and left lateral (or right lateral) decubitus contrast radiography is best for determining if a patient has hemorrhagic colitis. After abdominal radiography, abdominal ultrasonography has the highest diagnostic accuracy for determining which patients have inflamed rectal and colonic walls.

3.1. Physical Examination and History

In the veterinary visit, the most important part of the diagnostic process is the review of the animal during the clinical examination at the time of the visit. It is critical that all the systems of the body be briefly reviewed to collect all relevant patient medical information given in the examination room by the pet owner, as well as visual and olfactory data collected by the veterinary caregiver. During the physical examination, a thorough oral examination to evaluate the teeth, gums, and surrounding oral cavity should be performed. Dogs with chronic or recurrent intermittent hematochezia often have concurrent vomiting, diarrhea, or both. Such dogs may have been guarded or more insular by their pet owners. They may excessively lick the anus, vocalize during attempts to defecate, or be reluctant to defecate in a normal location.

There are three major components to diagnosis: the review of the history to look for predisposing factors or clues that may define the nature of the bleed, the localizing or etiologic factors, and the tissue of origin. An animal with a changing dietary history has a higher likelihood of a dietary issue than a dog with a consistent or long-term diet that is not changing. A history of garbage ingestion or exposure to toxins, drugs, or plants that could damage the canine or feline gastrointestinal mucosa is absolutely essential to gather. The role of the history in bleeding abnormalities is critical in the review of the management process. For it is pet owners who observe the animal's behaviors and give the pet caretaker information that will expedite the comprehensive management and care that the animal receives. Early recognition is the key to resolving clinical problems.

3.2. Fecal Analysis

Fecal analysis is frequently suggested during the diagnostic workup for hematochezia in dogs. Dogs generally require little or no encouragement to defecate on an examination table. Fresh stool samples should be collected into clean, labeled containers. Samples may be refrigerated if not examined within a few hours of defecation. Samples for bacterial culture should be refrigerated rather than frozen for optimal results. Feces are subjectively classified as soft, formed, or hard. An objective assessment of fecal moisture can also be performed through the use of gravimetric testing.

A sample is tested for the presence of internal parasites, with the most common test being passive dispersion flotation. Positive results should be quantified. Microscopic examination can also reveal intestinal cells, blood, mucus, and dietary items. A fresh fecal smear should be examined first, followed by a gram stain and trichrome stain. The key benefit of negative fecal results is that they indicate that the cause of the hematochezia lies above the cecum or in the stomach or small intestine. Help in ruling in or out parasites, as well as the amount of shedding present, are the two primary roles of quantitative fecal examinations. The fecal flotation and smear, as well as saline sedimentation, provide qualitative evaluations of the feces. Veterinarians will suggest doing these tests first, followed by additional, more targeted testing if these tests are negative. There are several issues with this approach. Positive results may indicate a variety of diseases, including parasitism, dietary indiscretion, obstruction, or enzyme deficiencies. The very best approach to interpreting quantitative results is in context with the animal's fecal quality and the remainder of the examination findings. Clearly discussing the significance of increasing shedding with a pet owner is also important because some amount of shedding is normal. Quantitation needs to be made over an interval of time, simply because fecal shedding can wax and wane. For persistent shedders, a treatment interval that is short enough to capitalize on information on the kinetics of shedding needs to be established. For all infected animals, keeping them fecal negative during the duration of their treatment serves as a reinforcement for owner compliance with rechecks or confirmatory diagnostic tests. The most critical value in decoding quantitative results as compared to qualitative results is that where negative results have been found, based on the veterinarian's clinical suspicion or signs, one should dialogue with the pet owner about the need to pursue further investigative studies. And for acute hematochezia, this will be zinc oxide fecal flotation, which is specifically looking for canine whipworm eggs but also developmental stages, as the false negative results in centrifuge to passive flotation range from 50 to 90% and will require that the pet owner keeps the animal in the hospital until they can do the test that looks for whipworms. Clearly, this needs to be done in consultation with the pet owner before they leave the clinic, as many pet owners won’t expect that or expect that this is the reason they are still suffering hematochezia. New intestinal parasites are coming to light, and veterinarians need to keep themselves updated on relevant test methods. The combination of the different tests remains important, with each test adding a higher diagnostic probability for identifying potential parasites.

3.3. Blood Tests

Blood testing that is helpful in dogs with hematochezia (bloody feces) can be broken down into two categories: blood tests that help to diagnose the actual cause of the hematochezia and blood tests that are used to assess systemic disorders contributing to the gastrointestinal bleeding. Hematochezia blood tests When trying to diagnose the underlying cause of hematochezia, veterinarians often recommend general blood testing for a complete blood cell count (CBC) and a biochemistry profile. Complete blood cell count testing is beneficial because it can identify an infection, an elevated white blood cell count, or anemia, a relatively common cause of gastrointestinal bleeding. Biochemistry profiles help by detecting systemic disorders, some of which may contribute to hemorrhagic diarrhea. However, values are often normal in many hematochezia cases. Furthermore, the in-house testing might not be sensitive enough to identify abnormalities. Additional CBC parameters that should be investigated in dogs with hematochezia and no obvious signs of systemic illness include coagulation times, fibrinogen, and D-dimers, platelet numbers, and parasites. Serum biochemical abnormalities do not appear to be more common in dogs with hematochezia compared with those that have either mixed or melena diarrhea, but mild increases in BUN, creatinine, and liver enzymes can be seen. Serum biochemistry is rarely necessary for diagnosing hematochezia, but in some cases, biochemistry can be required as a secondary aid to support the other clinicopathological findings. The best results can be gained quickly, and the timing of the blood sampling should be taken at the time when the clinical signs are still present or, at the latest, on the following day because most blood samples should be tested immediately, and not all parasitic conditions can be identified with a smear result. Shift changes could be explored further in some of the larger labs if tests are frequently run in batches. If blood counts reveal marked leukocytosis, neutropenia, eosinophilia, microcytosis, non-regenerative anemia, thrombocytosis, thrombocytopenia, or platelet anisocytosis, additional diagnostic procedures such as bone marrow aspiration, bone marrow biopsy, or Coomb's test should be considered. There may be an overlap in parameters, and hence it is usually necessary to factor in other biochemistry results such as albumin, calcium, or ketosis to minimize unnecessary parasite testing on a case-by-case basis.

3.4. Imaging Techniques

Imaging is essential to evaluate the loss of blood from the rectum and the lower part of the gastrointestinal tract as the blood is not present in every stool sample due to reduced retention time in the large intestine. Physical examination often does not reveal structural abnormalities in the gastrointestinal tract to warrant further workup with advanced imaging techniques. Radiography, ultrasonography, a CT scan, and a barium study to outline the bowel lumen are performed to locate the cause of bleeding and rectal discharge within the gastrointestinal tract. The entire gastrointestinal tract has been damaged during episodes of hematochezia in patients with typhlitis, especially if gastrointestinal signs of vomiting and diarrhea are present. Radiography is useful to investigate the abdomen and the chest at a low cost. Ultrasonography, including endorectal ultrasonography, is an excellent technique to visualize pancreatic tumors, rectal tumors, and mesenteric lymph nodes. The CT scan combined with bi-planar or multi-planar reformatted images is the preferred technique to visualize a foreign body and describe the exact location in the bowel and peritoneal contamination. If no radiographic abnormalities are detected, a low-dose single-slice CT spiral scanner can be used to confirm these findings due to its cost-effectiveness. The CT scan allows an entire medical workup from the initial diagnosis to the prognosis to reduce the cost per examination. The CT scan images must be viewed in combination with the gray soft tissue window and the lung-tissue window. The CT scan helps assess the resectability of a tumor positive at endorectal ultrasound.

4. Treatment and Management

In many cases, dietary modifications are one of the most important components of managing hematochezia. Certain options, such as a limited-ingredient diet, often work well to step toward better understanding what components of their diet could be exacerbating their clinical signs. Additionally, fiber supplements also increase gastrointestinal health, and modifying diets through canned dog food instead of kibble may produce softer stools, which may lead the fecal blood to be less apparent. Medications may be used to alleviate clinical signs of hematochezia and also treat some of the underlying causes of gastrointestinal bleeding. Options include antacids to provide gastrointestinal comfort for a dog in a similar way it can for people. Other options may include anti-diarrheal medications, antihistamines, and supplements. Ultimately, many cases would benefit from the inclusion of prescriptive medications, whether they be antibiotics, antiparasitics, antidiarrheals, or other more efficacious medications. It is vital to have your veterinarian in the decision-making process of whether to include those medications in their treatment plan, as they most often should know the specifics of the case.

There are more serious occasions where a dog may have bleeding into their gastrointestinal tract, and the owner will not hesitate to contact their veterinarian or bring their pets into a facility. The main medical and surgical management options in this case may include endoscopy, surgical adeptness, and referral to a specialist in gastrointestinal diseases. Supportive care and hospitalization may be required in more extenuating cases, possibly to keep a pet hydrated or until some more serious primary issues are under control. This should include intravenous fluids and electrolytes and the necessity of blood or blood component transfusions in some cases of severe hemorrhage. Other dietary supplements, such as probiotics, are mentioned in such cases but should be used in combination with other techniques and with veterinarians' guidance. Many cases of hematochezia have a good prognosis with a good deal of various combinations of management strategies. There could be a per-acute approach, where a pet is not seen for a couple of days, and the owners start a more at-home kind of plan, including restricting feedings, feeding an easily digestible diet, and more frequent but smaller meals. Any food allergies may develop after experimenting with different main ingredients. In many cases, though, more advanced diagnostics and an immediate and more involved medical intervention will be necessary to bring about a positive result. Over time, many of these patients will still require some sort of advanced medical interventions, as the classic sign of hematochezia persists. Case-by-case evaluation is strongly recommended. Finally, it is important to ensure that dog owners' treatments provide relief from the onset sign cited as hematochezia. This might require getting into early diagnostics, perhaps starting with some more at-home strategies on a case-by-case basis. The path to making that selection starts by answering those follow-up, diagnostic, and medical questions.

4.1. Dietary Changes

Dietary Changes. One of the key components of managing hematochezia is changing the diet. The diet should be formulated to prevent continued diarrhea, one of the causes of straining that leads to the passage of blood, while providing a balanced diet that is also easily digestible and will support the healing of the damaged gut. Some dogs are also sensitive to specific ingredients or may have developed an allergy to a commonly used dog food ingredient. Feeding these dogs a home-prepared recipe that does not contain the allergen can help to reduce the ongoing inflammation. The diet should generally be moderately low in fat and free of lactose and certain proteins (common allergens such as beef, chicken, pork, soy, eggs, wheat, cow's milk) and coloring agents. Fresh vegetables such as carrots, yams, snap peas, or zucchini are ideal as they are low in calories, well digested, and are non-allergenic. Brown rice, pumpkin, potato, and oatmeal are also useful for promoting absorptive colon health. Fibers that support the healthy growth of beneficial bacteria that help transform food into the stool use glucomannan as the transport device to get the phytoestrogens to the colon. Barley and powdered psyllium hulls are very useful in controlling frequent bloody diarrhea. Turkey, lamb, and fish are all excellent muscle protein sources as they are low in proteins that cause inflammation, are also non-allergenic to dogs, and are also lower in fat.

Foods that may be good also include diets that would include Milo and cowpea based diet, Green Tripe, Hounds & Gatos chicken with a single amino acid source of plantain, and pork and/or duck canned food. By avoiding these ingredients, one may be able to somewhat quiet down the dog's immune system. Feed a moderate fiber food that promotes healthy colon function and a good stool. Diets with a highly digestible protein source allow the gut to heal, while an additional vitamin and mineral supplement will help support healing. Much like any dog transitioning from one food to another, a dog transitioning to a natural homemade diet should start with small amounts of a new food source and slowly increase over a week. Gently adding small amounts of a new food into the diet is important because it helps the stomach get used to the novel food. However, in dogs, this is especially important because the allergen or food irritant may result in unhappy colonic tissue, as evidenced by hematochezia. Thus, starting slowly for a week when transitioning from a commercial to a homemade diet is a good idea. Proper attention should be placed when making recommendations, particularly to advise clients that all recommendations should be approved by their veterinarian who is experienced in handling this condition in that unique animal. You should also advise them that over time, the results of this treatment could take several days to start to be evaluated. Additionally, homemade recipes that might be a consideration for these dogs are occasionally published by groups or veterinarians who work with a larger volume of pets.

4.2. Medications

Medications are often used for the treatment of hematochezia in veterinary patients. Medications can have anti-inflammatory, antidiarrheal, antimicrobial, antiemetic, and analgesic properties. Therefore, medications often serve other purposes that are not just treatment of hemorrhagic diarrhea. The main use of pharmacologic treatment of hematochezia is reduction of colon inflammation. Other medications, such as antimicrobials, may be prescribed to patients with concerns of infection in more severe or chronic cases. Evidence of infection in the colon is not as common as inflammation. Efficacy of any medication is only as good as compliance of the client. It is important for clients to recognize that medications prescribed are meant for the symptoms their dog is experiencing, and that after the symptoms resolve, the underlying disease may still exist. Regular veterinary care is a critical factor in the successful treatment of sporadic hematochezia. Many times, veterinarians may suggest additional measures to treat the underlying factors contributing to hematochezia.

Medications used for the quick reduction of inflammation include prednisone. It is often used initially to reduce profuse gut inflammation; it may be coupled with concurrent immunosuppressive medications such as cyclosporine. Sulfasalazine may be used for some of the anti-inflammatory effects; however, it is not an effective anti-inflammatory agent in itself. In dogs with large bowel diarrhea, bismuth sub-salicylate is often used as an antidiarrheal agent by veterinarians, especially in dogs with chronic idiopathic forms of large bowel diarrhea. Most patients respond to some form of medication. Veterinarian discretion and consideration of other medications used by the patient are necessary as some of the previously mentioned medications may interact or potentiate other forms of treatment as well. It is important to monitor progress and response to any pharmacologic treatment. There may be side effects and drug-drug interactions that are a consequence of using medications to manage hematochezia. As mentioned before, the potential adverse effects and efficacy of drugs may not outweigh the benefits in some patients. Regular and consistent veterinary cooperation is vital for a positive treatment outcome.

4.3. Surgical Interventions

When medical therapy does not effectively manage the underlying cause of hematochezia or your pet is experiencing a more dire issue like a foreign body, tumor, or chronic inflammation, surgical intervention may be indicated. There are many different diseases that will necessitate surgical evaluation. A list of some of the more common reasons is listed below. • Tumors • Chronic severe straining • Foreign body • Chronic inflammation seen on blood tests or by intestinal biopsy • Structural issues not seen on endoscopy Prior to doing any surgical procedure, it is important that the veterinarian has the opportunity to assess the patient, including an evaluation of its history, a complete physical exam, and necessary testing to more accurately determine the surgical risk and to offer a more accurate assessment of how serious the condition may be. This may involve blood tests, X-rays, and/or ultrasound. Patients that are initially placed on medications or have a change in diet may need to be rechecked with blood work and other testing to determine if the medical therapy is effective or if additional diagnostics are necessary. There are several forms of surgery that may be performed to address each of the above issues, but some of the more common ones include: • Central polypectomy • Large bowel polypectomy • Surgical resection for cancer Surgery in animals is done in much the same way it is in humans; however, there is no pretreatment to allay fear before the procedure. After the completion of surgery, the animal is monitored closely until full recovery from the anesthetic. Once the patient is fully awake, food is usually withheld until normal eating can be performed. Rehabilitative therapy and dietary modification may continue after the post-operative examination, which varies based on the needs of the pet. Although generally well tolerated, any surgical procedure involving anesthesia carries some risk. Given this, it is important to note the potential complications from surgery. Post-operative infection, changes in the stool, changes in appetite or energy level, or any other issues should be reported to the veterinarian. Some pets may need medication or other post-operative care, including hospitalization after the procedure. For animals that may have been nourished through the placement of a feeding tube prior to surgery, steps may be instituted to begin weaning the pet off of the tube feedings. Depending on the type and progression of the disease, additional surgeries may be necessary for management of the condition, as a permanent cure may not be possible. In some instances, medications can be given to stunt the growth or further the progress of a cancer while the pet continues therapeutic discussions with an oncologist to lessen the problem organ and disease, and to extend the quality of life for the pet. In these cases, surgery can still be very effective as part of an overall medical plan.

5. Preventive Measures and Conclusion

Preventive Measures - Dogs should be seen regularly by a veterinarian to detect diseases in the early stages before the damage becomes severe. Even when no diseases are present, check-ups are key to detecting and preventing any potential problems. - Puppies require a series of vaccinations starting at 6-8 weeks of age. - Diets should be balanced between protein, carbohydrates, and fats. Dogs do well when provided with a consistent diet they can tolerate. - Establish a feeding routine and avoid sudden changes in diet or feeding habits. - With exotic foods becoming popular, it is unknown if our domestic dogs are consuming too much of a nutritional allergen. - An educated pet owner is ideal. Owners should be monitoring for any changes in their pet’s overall appearance and habits, especially after routine examinations. - Puppies and young adult dogs are at the highest risk for internal parasites such as roundworms, hookworms, whipworms, and coccidia. By keeping them on a parasite prevention program through adulthood, their health is unlikely to be compromised. Conclusion Hematochezia should not be overlooked, since it can be a commonly confused and misrepresented symptom for veterinarians with an array of potential causes. Although dogs affected with hematochezia may appear unwell, there is a promising prognosis when the conditions are properly addressed. Understanding the findings from presented studies conducted by veterinarians practicing in real clinical settings is a valuable aspect of enhanced education in preventing, diagnosing, and appropriately controlling hematochezia present in our patient populations. By increasing awareness in the understanding of individual pet disease risk factors and influencing pet owner decisions, appropriate counseling becomes more ethical and practical. Enhancing practical approaches toward proper patient care leads to encouraging new steps in becoming a responsible pet owner and promoting the right use of knowledge in the veterinary spectrum.

References:

Test, S. I. P. T., 2022. Assessing the Physical Properties of Fecal Matter. Low-Cost Veterinary Clinical Diagnostics. [HTML]

Spies, K. E. & Slovak, J. E., 2020. Pilot study of the effect of gastrointestinal diets on fecal occult blood testing in cats. Journal of feline medicine and surgery. sagepub.com

Bonfanti, U., 2020. Intestines and rectum. Veterinary Cytology. [HTML]

Ruaux, C. and Milovancev, M., 2020. Rectoanal Diseases–Medical and Surgical Management. Clinical Small Animal Internal Medicine, pp.609-620. [HTML]

Cervone, M., Hugonnard, M., Bourdoiseau, G., Chabanne, L., Krafft, E. and Cadoré, J.L., 2024. Clinical and Diagnostic Findings in Dogs Infected with Trichuris vulpis: A Retrospective Study. Veterinary Sciences, 11(7), p.306. mdpi.com

Mehra, J.M., Tolbert, M.K., Guadiano, P., Steiner, J.M., Moore, G.E. and Lewis, M.J., 2023. Double‐blinded placebo‐controlled clinical trial of prophylactic omeprazole in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion. Journal of Veterinary Internal Medicine, 37(2), pp.586-597. wiley.com

Šmit, I., Potočnjak, D., Matijatko, V., Torti, M., Jović, I., Grden, D., Crnogaj, M. and Beck, R., 2023. The Influence of Giardia duodenalis on the Occurrence of Clinical Signs in Dogs. Veterinary sciences, 10(12), p.694. mdpi.com

Branco, I. D. L. O., 2024. Old enemies, new differentials: canine leishmaniosis as a cause of refractory enteritis. utl.pt