Blood in Stool: Causes and Insights from a Colonoscopy

Blood in the stool?

Hello, doctor.
Previously, I experienced a feeling of discomfort and pain in my abdomen, sometimes sharp like a needle or knife.
My stomach would also make noises and feel bloated, and I would pass gas frequently, which was loud and accompanied by a lot of gas.
Eventually, I noticed some blood in my stool (not much) and mucus with traces of blood (the front part of the stool was harder, while the middle and end were softer).
When wiping, there was no blood on the toilet paper.
So, I went to the hospital for an examination and was scheduled for a colonoscopy, which showed normal results with no polyps or tumors.

Since the colonoscopy nearly a month ago, I still have a feeling of discomfort, but it has improved compared to before.
Occasionally, my stool has streaks or traces of blood and mucus with blood.
When I consulted the doctor again, he mentioned that the previous colonoscopy results were fine and that the discomfort might be neuropathic pain.
He prescribed me a muscle relaxant and said that the blood in my stool could be due to irritation of the intestinal wall, which is not serious.

Recently, I still notice blood traces in my stool.
The front part of my stool appears pellet-like, consisting of several larger pieces (the pellet-like surface has blood traces), followed by normal stool (sometimes also with streaks or traces of blood).
Once, while taking the subway, I had abdominal pain and had diarrhea in the subway restroom (squat toilet), where the stool was loose and had mucus with blood traces.

I am aware that I have external hemorrhoids, but during this period, there has been no significant swelling or pain.
I am careful not to wipe too hard and gently push the anal area inward with my finger.
Before each bowel movement, I apply petroleum jelly to the inside of the anal area to help the stool pass more easily.
Sometimes, after a bowel movement, there is slight discomfort (not significant) at the anal area.

By the way, the doctor mentioned that during the colonoscopy, there were a few small hemorrhoids; are these internal hemorrhoids? Could you please help me understand what my overall condition might indicate?

Xiao Tai Yang, 40~49 year old female. Ask Date: 2016/05/29

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like irritable bowel syndrome combined with hemorrhoidal bleeding.
It is recommended to start with a light diet and maintain a good lifestyle.
If the symptoms persist without improvement, you may ask a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be performed to rule out the possibility of malignancy.
Most remaining issues are likely functional gastrointestinal problems, which do not require excessive worry.

Reply Date: 2016/05/29

More Info

Understanding blood in stool can be concerning, and it’s important to approach this issue with careful consideration of the symptoms and findings from medical evaluations, such as a colonoscopy. Based on your description, it seems that you have been experiencing a range of gastrointestinal symptoms, including abdominal pain, changes in stool consistency, and the presence of blood and mucus in your stool.

Firstly, the presence of blood in your stool can arise from several potential causes. Given that your colonoscopy results were normal, ruling out serious conditions like polyps or colorectal cancer, it is likely that your symptoms are related to functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), or possibly hemorrhoids (痔瘡). IBS is characterized by symptoms like abdominal pain, bloating, and changes in bowel habits, which can include diarrhea and constipation. The fact that you have experienced hard, pellet-like stools (often referred to as "sheep feces") suggests that constipation may be a contributing factor, which can lead to straining during bowel movements and potentially cause minor bleeding from the anal area or rectal mucosa.

The blood you are observing, especially if it is bright red and appears on the surface of the stool or on toilet paper, is often indicative of bleeding from the lower gastrointestinal tract, such as from hemorrhoids or anal fissures. Hemorrhoids can become irritated and bleed, particularly if there is straining during bowel movements or if the stool is hard. The presence of mucus and blood streaks can also suggest irritation of the intestinal lining, which can occur with IBS or other inflammatory conditions.

Your doctor’s suggestion that the blood might be due to friction against the intestinal wall is plausible, especially if you are experiencing changes in stool consistency. The use of petroleum jelly to ease bowel movements is a common practice for individuals who experience discomfort during defecation, but it’s essential to ensure that you are also addressing the underlying issues, such as dietary habits and hydration.

In terms of management, it is advisable to focus on dietary modifications that promote softer stools. Increasing fiber intake through fruits, vegetables, and whole grains can help, as well as ensuring adequate hydration. Drinking plenty of water (aiming for 1,000 to 1,500 cc daily) can also assist in softening stools and reducing the likelihood of straining. Additionally, regular physical activity can promote healthy bowel function.

If your symptoms persist or worsen, or if you continue to see blood in your stool, it is crucial to follow up with your healthcare provider. They may recommend further evaluations or treatments, such as medications to manage IBS symptoms or topical treatments for hemorrhoids. In some cases, a referral to a gastroenterologist may be warranted for more specialized care.

In conclusion, while the presence of blood in your stool can be alarming, the combination of your colonoscopy results and the nature of your symptoms suggests that you may be dealing with functional gastrointestinal issues, possibly exacerbated by dietary factors and hemorrhoids. Maintaining a balanced diet, staying hydrated, and monitoring your symptoms closely will be key in managing your condition. Always consult with your healthcare provider for personalized advice and treatment options.

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