Rectal Bleeding: Causes and Solutions for Constipation

Rectal bleeding

Hello Doctor, I have been experiencing constipation, sometimes having a bowel movement every two to three days, and other times every three to four days.
My bowel movements tend to be more frequent before my menstrual period.
Previously, I felt that my stools were very hard, and I had to strain a lot to pass them, which caused a sensation of tearing in the anal area.
As a result, there was some slight bleeding when wiping, but there was no blood in the toilet.
However, during my most recent bowel movement, although I felt a slight tearing sensation, it wasn't as painful, but I did notice some blood in the toilet this time.
When wiping, I also noticed more blood than before, and it was slightly wetter and more than what I experienced with the previous tears.
After using the toilet, there was no pain in my anal area, and everything felt normal.
That evening, I took a stool softener, and the next day, my bowel movement was similar (I have never taken a stool softener before; this was my first time).
I usually drink water, but not in large amounts.
I would like to know how I can improve this situation.
Thank you.

Ms. Chen, 20~29 year old female. Ask Date: 2016/06/03

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be an anal fissure.
The typical symptoms include pain during bowel movements accompanied by slight bleeding.
The causes of anal fissures are often due to hard stools, but diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is recommended to improve bowel habits and to take warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2016/06/03

More Info

Rectal bleeding can be concerning, especially when associated with constipation and hard stools. Based on your description, it seems that you are experiencing a combination of constipation and minor rectal bleeding, likely due to small tears in the anal tissue (often referred to as anal fissures) caused by straining during bowel movements. Here’s a comprehensive overview of potential causes, solutions, and preventive measures for your situation.

Causes of Rectal Bleeding with Constipation
1. Anal Fissures: These are small tears in the lining of the anus that can occur when passing hard stools. They can cause pain and bleeding, especially during bowel movements. The blood is usually bright red, indicating that it is fresh and comes from the lower gastrointestinal tract.

2. Hemorrhoids: Swollen blood vessels in the rectal area can also lead to bleeding. They may not always be painful but can cause discomfort and bleeding, especially during bowel movements.

3. Constipation: Hard stools can lead to straining, which increases the risk of developing fissures or aggravating hemorrhoids. The longer stool remains in the colon, the harder it becomes, making it more difficult to pass.

4. Dietary Factors: A low-fiber diet can contribute to constipation. Insufficient fluid intake can also lead to harder stools.

Solutions and Management
1. Increase Fiber Intake: Aim for a diet rich in fruits, vegetables, whole grains, and legumes. Fiber helps to soften stools and promote regular bowel movements. The recommended daily intake of fiber is about 25-30 grams for adults.

2. Hydration: Drink plenty of fluids, particularly water. Aim for at least 8-10 cups of water daily. Proper hydration helps to keep stools soft and easier to pass.

3. Use of Stool Softeners: As you mentioned using a stool softener for the first time, this can be beneficial. Stool softeners like docusate sodium can help make bowel movements less painful by softening the stool.

4. Regular Bowel Habits: Try to establish a regular schedule for bowel movements. Don’t ignore the urge to go, as delaying can lead to harder stools.

5. Avoid Straining: When you feel the urge to have a bowel movement, try to relax and avoid straining. If you find it difficult to pass stools, consider using a footstool to elevate your feet while sitting on the toilet, which can help align the rectum for easier passage.

6. Warm Baths: Taking warm baths can help soothe the anal area and promote relaxation, which may help with discomfort from fissures or hemorrhoids.

7. Topical Treatments: Over-the-counter creams or ointments can provide relief from pain and itching associated with hemorrhoids or fissures. Look for products containing hydrocortisone or witch hazel.

When to Seek Medical Attention
If you notice persistent bleeding, significant pain, or if the bleeding increases, it is essential to consult a healthcare provider. They may perform a physical examination and possibly recommend further tests to rule out other conditions, such as gastrointestinal disorders.

Recovery and Prevention
With appropriate dietary changes and lifestyle modifications, many individuals can significantly improve their bowel habits and reduce the occurrence of rectal bleeding. It may take some time to see improvements, but consistency is key. If symptoms persist despite these changes, further evaluation by a gastroenterologist or a colorectal specialist may be warranted.

In summary, addressing constipation through dietary changes, hydration, and the use of stool softeners can help alleviate symptoms and prevent further episodes of rectal bleeding. Always consult with a healthcare professional for personalized advice and treatment options tailored to your specific situation.

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