Blood After Wiping: Is It Hemorrhoids or Anal Fissures?

Blood on toilet paper after wiping can indicate several potential issues, such as hemorrhoids, anal fissures, or gastrointestinal bleeding?

I experienced my first episode of constipation with blood during my senior year of high school, and since then, I have had occasional hard stools for several months, which resulted in blood when wiping, but it usually stopped after a few wipes.
Today, I experienced the same situation, but after several hours, there was still blood when I wiped, although it was decreasing.
However, when I pressed on a certain spot with toilet paper, there was still blood.
Occasionally, I feel a sharp pain in my anus, similar to the sensation of not having fully emptied my bowels.
I haven't eaten much vegetables or fruits in the past few days.
Could this be hemorrhoids or an anal fissure? What should I do? A few months ago, I was concerned and went to a large hospital for a stool test, but there was no sign of bleeding.

Amy, 10~19 year old female. Ask Date: 2016/03/23

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be an anal fissure.
The typical symptoms include pain during bowel movements accompanied by slight bleeding.
The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is advisable to improve bowel habits and take warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is important to consult a physician to identify the underlying issue.

Reply Date: 2016/03/23

More Info

It sounds like you're experiencing some concerning symptoms related to your bowel movements, specifically the presence of blood after wiping and occasional pain. Based on your description, it could be indicative of either hemorrhoids or anal fissures, both of which are common conditions that can occur due to constipation and straining during bowel movements.

Hemorrhoids are swollen veins in the lower rectum or anus, similar to varicose veins. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms of hemorrhoids can include painless bleeding during bowel movements, itching, and discomfort. The blood is usually bright red and may be seen on the toilet paper or in the toilet bowl.

Anal fissures, on the other hand, are small tears in the lining of the anus, often caused by passing hard or large stools. Symptoms typically include sharp pain during and after bowel movements, as well as bleeding, which may appear as bright red blood on the toilet paper or on the stool. The pain can be quite intense and may lead to a fear of having bowel movements, which can perpetuate the cycle of constipation.

Given that you've experienced blood after wiping, especially following hard stools, it’s quite possible that you may have either condition. The fact that the bleeding seems to lessen after a few wipes is more characteristic of hemorrhoids, but the presence of pain could suggest an anal fissure.

Recommendations:
1. Dietary Changes: Since you mentioned not eating much in the way of fruits and vegetables recently, it’s crucial to increase your fiber intake. A diet high in fiber can help soften stools and make them easier to pass, reducing the risk of both hemorrhoids and fissures. Aim for a variety of fruits, vegetables, whole grains, and legumes.
2. Hydration: Drink plenty of water throughout the day. Staying hydrated helps keep stools soft.

3. Regular Bowel Habits: Try to establish a regular schedule for bowel movements. Don’t ignore the urge to go, and avoid straining during bowel movements.

4. Over-the-Counter Treatments: You might consider using over-the-counter topical treatments for hemorrhoids, which can help alleviate discomfort and reduce swelling. If you suspect a fissure, topical anesthetics or hydrocortisone creams can also provide relief.

5. Warm Baths: Soaking in a warm bath (sitz bath) can help soothe the area and promote healing.

6. Avoiding Strain: When you feel the urge to have a bowel movement, try to relax and avoid straining. If you find it difficult to pass stools, consider using a stool softener or a fiber supplement.

7. Consult a Healthcare Provider: Since you have had these symptoms for several months, it would be wise to consult a healthcare provider for a thorough examination. They can provide a definitive diagnosis and recommend appropriate treatment. If necessary, they may perform a physical examination or other tests to rule out more serious conditions.

Conclusion:
While hemorrhoids and anal fissures are common and often manageable with lifestyle changes and home treatments, persistent symptoms warrant a professional evaluation to ensure there are no underlying issues. Your health and comfort are important, so don’t hesitate to seek medical advice if your symptoms continue or worsen.

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