Blood in Stool: Causes and When to Seek Medical Attention

Blood in the stool?

Hello Doctor, I have experienced two instances of blood in my stool over the past month.
The first time occurred after having diarrhea three times in one day, where I noticed a few drops of blood mixed in with watery stool.
The second instance, about three weeks later, involved a stool that was normal to slightly soft; the front part was normal, but the back part also had a few drops of blood.
Both times, the stool color ranged from golden to coffee, and the blood was on the surface of the stool, not mixed in, although it seemed to be accompanied by a bit of mucus.
After each bowel movement, I experienced some pain in the anal area; the first time was due to multiple episodes of diarrhea, while the second time was after passing a hard stool, although the stool itself felt moderately soft.

Additionally, I would like to mention two points: since my gallbladder was removed last year, my bowel frequency has increased, currently averaging about 1-3 times a day, with a higher likelihood of soft stools.
I understand that post-cholecystectomy, diarrhea can be a common issue, but I had expected improvement after more than six months, which has not been the case.
After consuming greasy or cold foods, I notice significant gastrointestinal motility, leading to watery stools, and sometimes mucus is present.
In the past six months, I have visited a colorectal surgeon twice due to blood in my stool and shape issues.
During those visits, the doctor performed a digital rectal exam and used an anoscope to examine me, concluding that I have internal hemorrhoids but no other significant issues.
After using suppositories and taking sitz baths, I had no further symptoms, aside from the previously mentioned tendency to have diarrhea, until the recent two instances of bleeding.
I would like to ask about the possible causes of the recent two episodes of bleeding and any recommendations for follow-up.
Is it necessary to schedule a colonoscopy immediately? Thank you.

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

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like hemorrhoidal bleeding caused by diarrhea after gallbladder removal.
It is recommended to start with a light diet and maintain a good daily routine.
If the symptoms persist without improvement, you may consult a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.

Reply Date: 2016/06/30

More Info

When it comes to the presence of blood in the stool, it is essential to understand that this symptom can arise from various causes, some of which may be benign while others could indicate more serious conditions. Based on your description, you have experienced two episodes of blood in your stool over the past month, with the blood appearing on the surface rather than being mixed in with the stool. Additionally, you have a history of gallbladder removal, which can lead to changes in bowel habits, including increased frequency and softer stools.

The fact that you have been diagnosed with hemorrhoids (internal hemorrhoids) in the past could explain the blood you are seeing, especially if you have experienced straining during bowel movements. Hemorrhoids can cause bleeding, particularly when there is increased pressure during defecation, which can lead to pain and discomfort. The pain you described after your bowel movements, particularly after passing hard stools, could also be attributed to hemorrhoids.

However, given that you have experienced two episodes of bleeding in a relatively short time frame, it is prudent to consider other potential causes. Some possible reasons for blood in the stool include:
1. Hemorrhoids: As mentioned, these are a common cause of rectal bleeding and can cause blood to appear on the surface of the stool or on toilet paper.

2. Anal fissures: These are small tears in the lining of the anus that can occur due to passing hard stools and can cause pain and bleeding.

3. Gastrointestinal conditions: Conditions such as diverticulosis, inflammatory bowel disease (IBD), or colorectal polyps can also lead to bleeding.

4. Infections: Certain gastrointestinal infections can cause diarrhea and may lead to blood in the stool.

5. Malignancies: Although less common, colorectal cancer can present with rectal bleeding, especially in individuals over the age of 50 or those with risk factors.

Given your history of gallbladder removal and the changes in your bowel habits, it is essential to monitor your symptoms closely. The fact that you have had two episodes of bleeding, along with the pain associated with bowel movements, warrants further investigation.
Recommendations:
1. Consult a Gastroenterologist: Given your symptoms and history, it would be advisable to schedule an appointment with a gastroenterologist. They may recommend a colonoscopy to evaluate the source of the bleeding, especially since you have had previous episodes and have a history of gastrointestinal issues.

2. Keep a Symptom Diary: Document any changes in your bowel habits, the characteristics of your stools, and any associated symptoms such as pain, changes in appetite, or weight loss. This information can be valuable for your healthcare provider.

3. Dietary Adjustments: Since you mentioned that greasy or cold foods exacerbate your symptoms, consider adjusting your diet to see if it helps alleviate your gastrointestinal discomfort. Increasing fiber intake can also help with stool consistency and may reduce straining during bowel movements.

4. Hydration: Ensure you are well-hydrated, as this can help with stool consistency and may reduce the likelihood of constipation and straining.

5. Follow-Up: If you experience any worsening symptoms, such as increased bleeding, severe abdominal pain, or changes in your overall health, seek medical attention promptly.

In conclusion, while hemorrhoids may be the likely cause of your symptoms, it is essential to rule out other potential causes through appropriate medical evaluation. A proactive approach, including consulting with a specialist and monitoring your symptoms, will help ensure that any underlying issues are addressed promptly.

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