Blood in Stool: Possible Causes and Concerns

Blood in the stool?

Hello doctor, my younger sister has been living away from home for six months and her diet has been irregular.
She has had constipation since childhood, which improved as she grew older.
However, two weeks ago she had the flu and took medication, and she thought the bleeding during bowel movements was a side effect.
At first, it was just a few drops, but after recovering from the cold, the bleeding has increased in the last three bowel movements.
Her flatulence has a noticeable odor.
Could this be related to her colon, or could it be due to internal hemorrhoids? (Her stools are harder, larger, and a dark brown color.)

Xiao Mei, 10~19 year old female. Ask Date: 2016/04/15

Dr. Ke Fangxu reply Surgery

This situation is likely indicative of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase over-the-counter hemorrhoidal suppositories for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and fluid intake should be sufficient.
If bleeding persists, it is advisable to consult a physician for evaluation.

Reply Date: 2016/04/15

More Info

Understanding blood in stool can be a concerning symptom, and it is essential to approach it with careful consideration of potential causes and underlying conditions. In your case, the presence of blood in the stool, especially after a period of irregular eating habits and a history of constipation, raises several possibilities that should be explored further.

Firstly, it is important to note that blood in the stool can originate from various parts of the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, colon, and rectum. The color and consistency of the blood can provide clues about its source. For instance, bright red blood typically indicates bleeding from the lower GI tract, such as hemorrhoids or anal fissures, while darker blood or "coffee ground" appearance suggests bleeding from the upper GI tract.

Given your description of having hard stools and the possibility of hemorrhoids, it is plausible that the blood you are observing could be related to this condition. Hemorrhoids are swollen veins in the rectum or anus that can become inflamed and bleed, especially during bowel movements. They are often associated with straining, which can occur due to constipation. The fact that you have experienced constipation in the past and have been eating irregularly could contribute to the development of hemorrhoids.

Another potential cause of blood in the stool could be anal fissures, which are small tears in the lining of the anus that can occur due to passing hard stools. These can also lead to pain and bleeding during bowel movements.
However, it is crucial to consider other more serious conditions that could cause blood in the stool, such as diverticulosis, inflammatory bowel disease (IBD), or even colorectal polyps or cancer, especially if the bleeding persists or is accompanied by other symptoms like significant abdominal pain, weight loss, or changes in bowel habits.

The presence of a foul odor when passing gas might suggest an underlying digestive issue, such as malabsorption or an imbalance in gut bacteria, which could be exacerbated by dietary changes.
Given these considerations, it is highly advisable to consult a healthcare professional for a thorough evaluation. They may recommend a physical examination, a digital rectal exam, and possibly further diagnostic tests such as a colonoscopy or imaging studies to determine the exact cause of the bleeding.
In summary, while hemorrhoids or anal fissures could be the likely culprits given your symptoms, it is essential to rule out more serious conditions. Maintaining a healthy diet, staying hydrated, and managing constipation through dietary fiber and possibly stool softeners can help alleviate some symptoms. However, a medical evaluation is crucial to ensure proper diagnosis and treatment.

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