Rectal Bleeding: Causes, Symptoms, and Treatment Options

Rectal bleeding

Hello Dr.
Ke: I would like to ask you about a situation where I feel a slight stinging sensation in my anus just as I am about to have a bowel movement.
After I finish, there is fresh blood at the end of the stool.
Initially, there was blood, but after more than a month, it did not recur.
However, since the beginning of this year, it has been happening frequently.
I have used ointment for several days, and after applying it, there were about a few days without bleeding and no stinging sensation.
But yesterday, I felt a slight stinging in my anus during a bowel movement, although there was no bleeding.
This morning, the same stinging occurred, and there was bleeding again, with the situation consistently happening at the end of the stool.
This condition has been recurring for about six months, with more than ten episodes of bleeding, which makes me quite worried about the possibility of colorectal cancer.
Sometimes, my stool color resembles dark coffee, and at other times it turns dark yellow.
Each time I wipe, I pay attention to whether there are any streaks of blood or blood in the stool, but I have not seen any.
Could you please help clarify whether this is hemorrhoids, anal fissures, or something else? How can I soften my stool (I drink about 2000-3000 cc of water daily, but I sweat it all out)? What fruits and vegetables should I eat to improve this? Can I eat guava, red guava, or apples?

Ayou, 30~39 year old female. Ask Date: 2016/06/30

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.
If there is concurrent bleeding from hemorrhoids, the amount of blood may be greater.
The primary cause of anal fissures is usually hard stools; however, 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 without improvement, you may consult a physician for medication.
Although the risk of developing colorectal cancer at the age of 31 is still relatively low, if you are concerned, you can ask your doctor to arrange for a colonoscopy.

Reply Date: 2016/06/30

More Info

Understanding rectal bleeding can be concerning, especially when it becomes a recurring issue. Based on your description, it seems you are experiencing symptoms that could be related to either hemorrhoids (commonly known as piles) or anal fissures. Both conditions can cause bleeding during bowel movements, particularly when straining or passing hard stools.

Causes of Rectal Bleeding
1. Hemorrhoids: These are swollen veins in the lower rectum or anus. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms often include painless bleeding during bowel movements, itching, and discomfort.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard or large stools. Symptoms typically include sharp pain during and after bowel movements, along with bleeding.

3. Other Causes: While hemorrhoids and fissures are the most common causes of rectal bleeding, other potential causes include diverticular disease, inflammatory bowel disease (IBD), and in rare cases, colorectal cancer. Given your concern about colorectal cancer, it’s essential to consult a healthcare provider for a thorough evaluation.

Symptoms to Monitor
- Pain: The sharp pain you experience during bowel movements is more indicative of an anal fissure, while hemorrhoids may cause discomfort but not necessarily sharp pain.

- Bleeding: The presence of bright red blood on the toilet paper or in the stool is common with both conditions. Darker blood or changes in stool color could indicate other issues and should be evaluated by a doctor.

- Changes in Bowel Habits: Any significant changes in your bowel habits, such as persistent diarrhea or constipation, should be discussed with a healthcare professional.

Treatment Options
1. Dietary Changes: To soften your stools and prevent straining, consider increasing your intake of fiber-rich foods. Foods such as fruits (like apples and pears), vegetables, whole grains, and legumes can help. Guava and red guava are also good options as they are high in fiber. Aim for at least 25-30 grams of fiber daily.

2. Hydration: Continue drinking plenty of water, as you mentioned consuming 2000-3000 cc daily. This is crucial for maintaining stool softness.

3. Over-the-Counter Remedies: You may consider using stool softeners or fiber supplements (like psyllium husk) to help with bowel movements. Topical treatments for hemorrhoids, such as creams or ointments, can provide relief from discomfort.

4. Warm Baths: Soaking in a warm bath can help soothe the area and promote healing.

5. Avoid Straining: When using the bathroom, try to relax and avoid straining, which can exacerbate both hemorrhoids and fissures.

When to See a Doctor
Given that you have experienced this issue for several months and it has recurred multiple times, it is advisable to consult a healthcare provider. They may perform a physical examination and possibly recommend further tests, such as a colonoscopy, to rule out any serious conditions, including colorectal cancer.

Conclusion
While hemorrhoids and anal fissures are common and often treatable conditions, persistent rectal bleeding should not be ignored. It is essential to maintain a healthy diet, stay hydrated, and seek medical advice to ensure proper diagnosis and treatment. Your health is paramount, and addressing these symptoms early can lead to better outcomes and peace of mind.

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