Blood in Stool: Causes, Symptoms, and Treatments - Gastroenterology and Hepatology

Blood in the stool?

Hello Doctor, I have been experiencing blood (bright red) on toilet paper after bowel movements for the past 10 days.
It is quite painful when the stool is passing through the anus (I usually have softer stools).
I visited a colorectal specialist who performed a digital examination and a flexible sigmoidoscopy, and found that I have both hemorrhoids and an anal fissure.
They performed a hemorrhoid ligation and prescribed stool softeners, hemostatic medication, and ointment.
The day after returning home, I had a bowel movement (soft and narrow), and on the first day, there was no blood on the toilet paper.
However, four days later, I had another bowel movement (soft and narrow) in the morning, and again there was blood (bright red) on the toilet paper, with one drop of blood in the toilet.

I would like to ask the doctor:
1.
Can having consistently narrow or soft stools cause anal fissures?
2.
Normally, after hemorrhoid ligation, there shouldn't be any bleeding, but it has been five days, and I still see blood on the toilet paper after bowel movements (sometimes with a drop of blood in the toilet).

3.
I still feel pain in the anus when the stool is about to come out, despite using ointment and taking warm sitz baths.

4.
I only have a bowel movement once every morning, but I continue to see blood (bright red) on the toilet paper and experience anal pain with soft stools.
Could this be rectal cancer? Thank you!

A-Ming, 40~49 year old female. Ask Date: 2016/04/09

Dr. Lin Minghui reply Gastroenterology and Hepatology

1.
It is recommended to follow up with a colorectal specialist.
2.
Straining during bowel movements, including hard stools, can exacerbate hemorrhoids and anal fissures, with severe anal fissures potentially causing bleeding.
3.
After hemorrhoid ligation, there may be slight bleeding for 7-10 days following the detachment of the hemorrhoidal tissue.
4.
If rectal bleeding persists, it is advisable to undergo a sigmoidoscopy and colonoscopy.
Wishing you good health.

Reply Date: 2016/04/09

More Info

Understanding blood in stool can be a concerning issue, and it’s important to address the symptoms and potential causes thoroughly. Based on your description, it seems that you have already consulted with a colorectal specialist who diagnosed you with hemorrhoids (internal piles) and anal fissures. These conditions can indeed lead to the symptoms you are experiencing, such as bright red blood on toilet paper and pain during bowel movements.

1. Causes of Blood in Stool: Blood in the stool can arise from various sources within the gastrointestinal tract. Common causes include hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease (IBD), and colorectal cancer. In your case, the presence of hemorrhoids and anal fissures is likely the primary reason for the blood. Hemorrhoids can become engorged and bleed, especially during bowel movements, while anal fissures can cause sharp pain and bleeding when passing stool.

2. Impact of Stool Consistency: You mentioned that your stools are often soft and narrow. While soft stools are generally less likely to cause trauma to the anal area, if they are consistently narrow (like a pencil), it could indicate an underlying issue that may need further evaluation. However, soft stools alone are not typically a direct cause of anal fissures. It’s essential to maintain a balanced diet rich in fiber to promote healthy bowel movements and prevent straining.

3. Post-Surgery Symptoms: After undergoing a procedure for hemorrhoids, it is expected that there may be some residual bleeding, especially if the area is still healing. However, if you continue to see blood five days post-surgery, it’s crucial to monitor the situation closely. While some bleeding can be normal, persistent bleeding should be evaluated by your doctor to rule out any complications or additional issues.

4. Pain During Bowel Movements: The pain you are experiencing during bowel movements could be attributed to the healing process of the anal fissure and the irritation from hemorrhoids. The use of topical medications and sitz baths can help alleviate discomfort. If the pain persists or worsens, it’s advisable to follow up with your healthcare provider.

5. Concerns About Colorectal Cancer: While your symptoms could be alarming, especially with the presence of blood, it’s important to note that hemorrhoids and anal fissures are much more common causes of blood in the stool than colorectal cancer, particularly in younger individuals. However, if you have risk factors for colorectal cancer or if your symptoms change (such as a change in bowel habits, weight loss, or persistent abdominal pain), further investigation may be warranted.

In summary, while your symptoms are concerning, they are more likely related to hemorrhoids and anal fissures rather than colorectal cancer. It is essential to continue following your doctor's advice, maintain a high-fiber diet, and stay hydrated to promote regular bowel movements. If symptoms persist or worsen, do not hesitate to seek further medical evaluation. Regular check-ups and open communication with your healthcare provider are key to managing your condition effectively.

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