Blood in Stool: Should You Worry About Colon Cancer?

Blood in the stool suspected to be colorectal cancer?

Hello Doctor: I have no family history of colorectal cancer.
I am a 28-year-old male, and I have bowel movements about two to three times a day, with somewhat irregular shapes.
Two weeks ago, I noticed that my stool had a brown color with dark red streaks.
On the same day, about an hour later, I had a second bowel movement, and the stool was loose with only a small amount, but it contained some deep red blood streaks.
When I wiped, the toilet paper showed a light red stain resembling blood.
A week later, during one bowel movement, the stool was almost entirely dark red, but the next morning, it returned to a normal yellow-brown color.
Until this afternoon, my stool was yellow-brown with a slight dark red tint at the front, and the latter part was somewhat sticky and glossy, almost entirely dark red.
Here is the image: http://666kb.com/i/d80udcjwiqustm43d.jpg.

I would like to ask the doctor if I should undergo another colonoscopy.
I am very worried about the possibility of colorectal cancer because I had my first colonoscopy three and a half years ago and a second one two and a half years ago, both of which were normal with no polyps, only mild internal hemorrhoids.
However, given my current bowel movement symptoms, what is the likelihood of developing cancer? I have heard that dark red blood in the stool is often associated with colorectal cancer rather than hemorrhoid symptoms.
I am very concerned and would appreciate your clarification.
Thank you~~~

Cheng, 20~29 year old female. Ask Date: 2016/04/12

Dr. Ke Fangxu reply Surgery

If there are not three or more family members, or two first-degree relatives with colorectal cancer, it cannot be classified as hereditary colorectal cancer.
It is generally recommended to undergo fecal occult blood testing every two years.
If abnormalities are found, a colonoscopy should be performed.
Based on your description, it seems more like hemorrhoidal bleeding.
It is advisable to maintain a light diet and good lifestyle habits.
If symptoms persist without improvement, you may ask your physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can also be arranged.

Reply Date: 2016/04/12

More Info

When it comes to the presence of blood in stool, it can understandably cause significant concern, especially with a family history of colorectal cancer. However, it's important to approach this situation with a clear understanding of the potential causes and the appropriate steps to take.

Based on your description, you are experiencing intermittent episodes of blood in your stool, with varying colors and consistency. The presence of dark red blood, especially if it appears mixed with stool or as streaks, can be alarming. However, it is crucial to consider several factors before jumping to conclusions about the possibility of colorectal cancer.

1. Age and Risk Factors: At 28 years old, you are generally considered to be at a lower risk for colorectal cancer, especially if you have no family history of the disease. Most colorectal cancers occur in individuals over the age of 50, although it is not impossible for younger individuals to be affected. Your previous colonoscopies, which were normal, also reduce the likelihood of cancer significantly.

2. Possible Causes of Blood in Stool: Blood in the stool can arise from various sources within the gastrointestinal tract. Common causes include:
- Hemorrhoids: Given your history of mild internal hemorrhoids, this could be a likely source of the bleeding. Hemorrhoids can cause bright red blood on the toilet paper or in the stool, especially after straining during bowel movements.

- Anal Fissures: These small tears in the lining of the anus can also lead to bleeding, particularly if you are experiencing hard or difficult bowel movements.

- Diverticular Disease: This condition, which involves small pouches forming in the colon, can lead to bleeding as well.

- Gastrointestinal Infections or Inflammation: Conditions like colitis or infections can cause changes in stool color and the presence of blood.

3. Color of Blood: The color of the blood can provide clues about its source. Bright red blood typically indicates bleeding from the lower gastrointestinal tract (such as hemorrhoids or fissures), while darker blood may suggest bleeding from higher up in the GI tract. However, the presence of dark red blood does not automatically indicate cancer.

4. Dietary Factors: You mentioned changes in your diet, including increased consumption of fried foods. Diet can significantly affect bowel habits and stool appearance. Foods can sometimes cause temporary changes in stool color, and if you have been experiencing irregular bowel movements, it may be worth examining your diet and hydration levels.

5. When to Seek Further Evaluation: Given your previous normal colonoscopies and the fact that you have a mild case of hemorrhoids, it may not be necessary to undergo another colonoscopy immediately. However, if the bleeding persists, worsens, or is accompanied by other symptoms such as significant abdominal pain, weight loss, or changes in bowel habits, it would be prudent to consult with a gastroenterologist for further evaluation. A stool test for occult blood could also be a useful initial step to assess for hidden bleeding.

In summary, while the presence of blood in your stool is concerning, it is essential to consider the broader context, including your age, medical history, and potential benign causes. Monitoring your symptoms and maintaining open communication with your healthcare provider will be key in addressing your concerns and ensuring your gastrointestinal health. If you remain anxious or if symptoms persist, do not hesitate to seek further medical advice.

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