Is Rectal Bleeding During Bowel Movements a Sign of Anal Fissures?

Constipation and blood in the stool: Is it anal fissure?

Hello Doctor: I have previously experienced rectal bleeding during bowel movements, but after applying Mentholatum ointment, the issue improved within a few days.
In the past two weeks, I had bowel movements on 4/11, 4/15, 4/17, and 4/20.
On 4/15, I noticed bleeding from the anus during a bowel movement; the amount was not significant and stopped after one application of the ointment.
I believe that day I hadn't had a bowel movement for three days, and the stool was hard.
Each time I experience bleeding, I become very anxious and quickly apply the Mentholatum ointment.
On 4/17, I experienced bleeding again and applied the ointment once more.
Today, on 4/20, I initially passed small pellets without any bleeding, but later, when passing larger, harder stools, I experienced bleeding again.
What should I do now? Thank you, Doctor.

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

Dr. Ke Fangxu reply Surgery

Generally, pain during bowel movements accompanied by a small amount of bleeding indicates an anal fissure, while painless bowel movements with significant bleeding suggest hemorrhoids.
Based on your description, it seems more likely that you are experiencing hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is advisable to avoid constipation during this period and to shorten the time spent on the toilet.
Warm sitz baths may also help alleviate symptoms.
You can purchase over-the-counter hemorrhoidal suppositories for relief.
It is best to avoid using stool softeners indiscriminately; at your age, increasing your intake of dietary fiber and fluids should be sufficient.
If bleeding persists, it is recommended to consult a physician for further evaluation.

Reply Date: 2016/04/20

More Info

Rectal bleeding during bowel movements can indeed be a sign of anal fissures, especially when accompanied by hard stools and discomfort during defecation. Anal fissures are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to sharp pain and bleeding during or after bowel movements. Given your history of experiencing bleeding during bowel movements, it is plausible that you may be dealing with this condition.

In your case, it seems that the bleeding occurs primarily when you have hard stools, which aligns with the typical presentation of anal fissures. The fact that you have been applying a topical ointment, such as Mentholatum, suggests that you are taking steps to soothe the area, which can be beneficial. However, it is important to address the underlying issue of stool consistency to prevent further episodes of bleeding.

Here are some recommendations to help manage your symptoms and promote better bowel health:
1. Increase Fiber Intake: Consuming a diet high in fiber can help soften your stools and make them easier to pass. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Aim for at least 25-30 grams of fiber per day.

2. Stay Hydrated: Drinking plenty of water is crucial for maintaining stool consistency. Aim for at least 8-10 glasses of water a day, as adequate hydration helps prevent constipation.

3. Regular Bowel Habits: Try to establish a regular bowel routine. Set aside time each day to sit on the toilet, even if you don’t feel the urge to go. This can help train your body to have regular bowel movements.

4. Avoid Straining: Straining during bowel movements can exacerbate fissures. If you find yourself straining, consider using a stool softener or a fiber supplement to help ease the passage of stools.

5. Warm Sitz Baths: Taking warm sitz baths can help soothe the anal area and promote healing. Soaking for 10-15 minutes several times a day can provide relief from pain and discomfort.

6. Topical Treatments: Continue using topical ointments or creams that can help soothe the area. Over-the-counter options may include hydrocortisone creams or other soothing agents. However, consult with a healthcare provider before starting any new treatments.

7. Monitor Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, as well as any associated pain. If the bleeding persists or worsens, or if you experience significant pain, it is important to seek medical attention.

8. Consult a Healthcare Provider: If you continue to experience rectal bleeding, it is advisable to consult with a healthcare professional. They may recommend further evaluation, such as a physical examination or possibly a colonoscopy, to rule out other potential causes of bleeding, such as hemorrhoids, polyps, or other gastrointestinal issues.

In summary, while rectal bleeding during bowel movements can be indicative of anal fissures, it is essential to address the underlying causes, such as hard stools and straining. By implementing dietary changes, maintaining hydration, and practicing good bowel habits, you can help manage your symptoms and reduce the likelihood of future bleeding episodes. If symptoms persist, do not hesitate to seek medical advice for a thorough evaluation and appropriate treatment.

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