Rectal Bleeding: Causes and When to Seek Help

Rectal bleeding

Hello, Dr.
Ko: Recently, I have noticed red blood stains on the toilet paper after wiping my bottom following a bowel movement.
There was one occasion when fresh blood even flowed out (but that time it occurred about a minute after I had finished and was still sitting on the toilet).
For the past few days, there have been no blood stains on the toilet paper, but there is fresh red blood attached to the front (or possibly the back, I'm not sure) of the stool.
This only occurs on one end, and if I pass several pieces at once, only one will have blood on one end.
Most of the stool is brownish-yellow and shaped, with a small portion being loose.
This morning, I noticed red blood again at the front of the stool, accompanied by one or two white strands (again, only one end had blood).
Sometimes, after a bowel movement, I experience a little pain in the anal area, but it goes away quickly.
I have been drinking less water; my bowel movements occur 1 to 2 times a day.
The bleeding started shortly after I had been constipated (I had to strain quite a bit to pass the stool).
I am overweight and have endometriosis.
Could this be related to hemorrhoids, or is it irritable bowel syndrome (I eat a lot but have poor digestion, I prefer bland food but love spicy dishes), or could it be a symptom of colon cancer that requires a colonoscopy? I have an important exam in July, and I'm a bit anxious.
Would it be too late to seek medical attention if I wait until after July? Thank you, doctor!

Niming, 20~29 year old female. Ask Date: 2016/05/26

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, but it is best not to take stool softeners indiscriminately.
At this age, increasing dietary fiber and hydration should be sufficient.
Although the risk of developing colorectal cancer at the age of 25 is not zero, it is generally very low.
It is advisable to maintain a light diet and a healthy lifestyle.
If symptoms persist without improvement, you may consult a physician for medication.
If there is still no improvement or if you are very concerned, you can arrange for a colonoscopy.
Modern colonoscopies are quick and safe, typically taking 2-3 days from the appointment to completion, or up to 1-2 weeks at most.
It is better to complete the procedure early for peace of mind, and it is fine to wait until after July to do so.

Reply Date: 2016/05/26

More Info

Rectal bleeding can be a concerning symptom, and it’s important to understand its potential causes and when to seek medical help. Based on your description, there are several possibilities that could explain the presence of bright red blood on your stool and toilet paper after bowel movements.

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 on the stool itself, is hemorrhoids. These are swollen veins in the rectal area that can become inflamed and bleed, particularly during bowel movements, especially if you are straining due to constipation. Given that you mentioned experiencing constipation and having to exert effort to pass stool, this could indeed be a contributing factor.

2. Anal Fissures: Another possibility is an anal fissure, which is a small tear in the lining of the anus. This can occur due to passing hard stools and can cause sharp pain during and after bowel movements, along with bleeding. The blood from a fissure is typically bright red and may be seen on the stool or toilet paper.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can also lead to bleeding. This is more common in older adults, but it’s worth considering if you have any other gastrointestinal symptoms.

4. Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease or ulcerative colitis can cause rectal bleeding, along with other symptoms like abdominal pain, diarrhea, and weight loss. If you have a history of gastrointestinal issues, this could be a consideration.

5. Colorectal Cancer: While less common in younger individuals, rectal bleeding can be a symptom of colorectal cancer. It’s essential to be vigilant, especially if you have risk factors or if the bleeding persists.

Given your concerns about your weight, dietary habits, and the presence of a chocolate cyst (endometriosis-related), it’s crucial to address these factors as they may contribute to gastrointestinal symptoms. Stress and anxiety, particularly with upcoming exams, can also exacerbate gastrointestinal issues, including irritable bowel syndrome (IBS), which may cause changes in bowel habits and discomfort.

When to Seek Help
You should seek medical attention if:
- The bleeding persists or worsens.

- You experience significant pain or discomfort.

- You notice changes in your bowel habits, such as diarrhea or constipation lasting more than a few days.

- You experience other symptoms like weight loss, fatigue, or changes in appetite.

Recommended Actions
1. Hydration and Diet: Increase your fluid intake and consider a high-fiber diet to help prevent constipation. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

2. Avoid Straining: Try to avoid straining during bowel movements. If you are constipated, consider using over-the-counter stool softeners or laxatives, but consult with a healthcare provider before starting any new medication.

3. Medical Evaluation: Given your symptoms and concerns, it would be prudent to schedule an appointment with a healthcare provider. They may recommend a physical examination, and possibly a colonoscopy, especially if the bleeding continues or if there are any alarming symptoms.

4. Stress Management: Since you mentioned stress related to exams, consider incorporating stress-reducing techniques such as mindfulness, meditation, or gentle exercise into your routine.

In conclusion, while hemorrhoids and anal fissures are common causes of rectal bleeding, it’s essential to rule out more serious conditions. Don’t hesitate to seek medical advice sooner rather than later, especially if your symptoms persist. Early intervention can lead to better outcomes and peace of mind.

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