Rectal Bleeding: Causes and When to Seek Help

Blood in stool

Hello Dr.
Ke, I would like to inquire about experiencing bleeding during bowel movements.
I have done some preliminary research and have had a negative fecal occult blood test.
My bowel movements occur approximately every 3 to 5 days.
I eat very little, and my intake of fruits and vegetables is low.
I notice fresh blood, but there is almost always a "premonitory" feeling, like a slight urge to have a bowel movement or a feeling of fullness.
Sometimes, fresh blood appears before I can have a bowel movement, and then I no longer feel the urge, or I may only pass a small amount with fresh blood.
Even when I feel that my bowel movement is smooth, there can still be fresh blood.
Occasionally, the bleeding is jet-like or quite significant (estimated to be similar to a nosebleed, but perhaps slightly less?).
However, there is no pain associated with it.
Should I urgently arrange for more detailed examinations? Thank you, doctor.

Jingjing, 20~29 year old female. Ask Date: 2016/04/27

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility 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 your age, increasing dietary fiber and hydration should be sufficient.
If bleeding persists, it is advisable to consult a physician.
To be honest, your bowel habits are not ideal, so before seeking medical assistance, you might want to start with self-improvement measures.

Reply Date: 2016/04/27

More Info

Rectal bleeding can be a concerning symptom, and understanding its causes is crucial for determining the appropriate course of action. Based on your description, it appears that you are experiencing rectal bleeding during bowel movements, which can manifest in various ways, including bright red blood, sometimes in significant amounts, without accompanying pain.

Possible Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of rectal bleeding, especially if the blood is bright red and appears on the toilet paper or in the toilet bowl. Hemorrhoids can be internal or external and are often associated with straining during bowel movements, which can occur if you have infrequent bowel habits or a low-fiber diet.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to bleeding and may be accompanied by discomfort during bowel movements.

3. Diverticular Disease: Diverticulosis can lead to diverticulitis, which may cause bleeding. This condition is more common in older adults and can be exacerbated by a low-fiber diet.

4. Polyps or Colorectal Cancer: While less common, polyps can bleed, and colorectal cancer can present with rectal bleeding, especially in individuals over 50 or those with a family history of colorectal cancer.

5. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause rectal bleeding, often accompanied by other symptoms such as diarrhea, abdominal pain, or weight loss.

6. Infections: Certain infections can lead to inflammation and bleeding in the gastrointestinal tract.

When to Seek Medical Help
Given your symptoms, it is advisable to seek medical attention, especially since you are experiencing significant bleeding. Here are some guidelines on when to consult a healthcare provider:
- If the bleeding is persistent: If you notice blood during bowel movements consistently over several days, it warrants further investigation.

- If the amount of blood increases: If you experience a sudden increase in the volume of blood, especially if it resembles a "jet" or is more than just a few drops, you should seek immediate medical attention.

- If you experience other symptoms: While you mentioned no pain, if you start experiencing abdominal pain, changes in bowel habits, weight loss, or fatigue, these could indicate a more serious condition.

- If you have a family history of gastrointestinal diseases: If there is a history of colorectal cancer or other gastrointestinal diseases in your family, it is prudent to get checked.

Recommended Next Steps
1. Dietary Changes: Increasing your intake of fiber-rich foods (fruits, vegetables, whole grains) can help soften stools and reduce straining during bowel movements, which may alleviate some symptoms.

2. Hydration: Ensure you are drinking enough fluids, as this can also help with stool consistency.

3. Medical Evaluation: Schedule an appointment with a gastroenterologist for a thorough evaluation. They may recommend diagnostic tests such as a colonoscopy, which can help visualize the colon and rectum to identify any abnormalities.

4. Monitoring Symptoms: Keep a record of your symptoms, including the frequency and amount of bleeding, any associated symptoms, and dietary habits. This information can be helpful for your healthcare provider.

In conclusion, while rectal bleeding can often be attributed to benign causes such as hemorrhoids or fissures, it is essential to take it seriously, especially given the potential for more serious underlying conditions. Seeking medical advice and undergoing appropriate evaluations will help ensure that any necessary treatment is initiated promptly.

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