Midnight Abdominal Pain and Blood on Toilet Paper: What to Do?

Q: Midnight Abdominal Pain and Blood on Toilet Paper: What to Do?

Hello： If there is bright red blood on most of the toilet paper and the stool color is normal, it may indicate anal fissures or hemorrhoids. <br>However, if there are changes in bowel habits along with ongoing bleeding, it is advisable to consult a gastroenterologist or a colorec

Abdominal pain at midnight, and the next day there is blood when wiping after using the bathroom?

Hello Doctor, I am 32 years old and I do not smoke or drink alcohol.
Occasionally, I stay up late on weekends, and I usually eat home-cooked meals due to my irritable bowel syndrome, which often causes me to run to the bathroom.
A few days ago, I suddenly woke up in the middle of the night with severe abdominal pain, feeling like I had gas.
I spent a long time in the bathroom before I could have a bowel movement.
Initially, my stool was normal, but it later turned into diarrhea.
In the morning, I went to the bathroom three times; although I felt some diarrhea, the stool color was normal.
However, in the afternoon at work, when I wiped after using the bathroom, I noticed bright red blood on the toilet paper, even though my stool appeared normal.
I previously had a colonoscopy that showed internal hemorrhoids and polyps.
Should I go to the hospital for an examination? Thank you for taking the time to respond.

Yǒnghéng de jìntóu, 30~39 year old female. Ask Date: 2016/08/16

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: If there is bright red blood on most of the toilet paper and the stool color is normal, it may indicate anal fissures or hemorrhoids.
However, if there are changes in bowel habits along with ongoing bleeding, it is advisable to consult a gastroenterologist or a colorectal specialist.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2016/08/16

More Info

Experiencing abdominal pain and finding blood on toilet paper can be alarming, especially when it occurs suddenly and without a clear explanation. Based on your description, it seems that you have a history of irritable bowel syndrome (IBS), which can lead to various gastrointestinal symptoms, including abdominal pain and changes in bowel habits. However, the presence of fresh red blood on toilet paper raises concerns that should not be overlooked.

First and foremost, it is essential to understand that blood in the stool or on toilet paper can originate from various sources within the gastrointestinal tract. The fact that your stool appears normal in color while you notice blood on the toilet paper suggests that the bleeding may be occurring in the lower part of the digestive tract, such as the rectum or anus. Common causes of such bleeding include:
1. Hemorrhoids: Given your previous diagnosis of internal hemorrhoids, this is a likely culprit. Hemorrhoids can become inflamed or irritated, especially during episodes of diarrhea or straining during bowel movements, leading to bright red blood on toilet paper.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to passing hard stools or straining. They can cause sharp pain and bleeding during bowel movements.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon, can sometimes lead to diverticulitis, where these pouches become inflamed or infected, causing abdominal pain and bleeding.

4. Polyps or Colorectal Cancer: Although less common, especially in younger individuals, the presence of polyps (which you have previously had) can lead to bleeding. It’s essential to monitor any changes in your bowel habits or the appearance of blood.

5. Gastrointestinal Infections: Infections can lead to diarrhea and may cause inflammation or irritation of the intestinal lining, potentially resulting in bleeding.

Given your symptoms and medical history, it is advisable to seek medical attention promptly. A healthcare professional may recommend further evaluation, which could include:
- A thorough physical examination: This may involve a digital rectal exam to assess for hemorrhoids or fissures.

- Repeat colonoscopy: Since you have a history of polyps, a repeat colonoscopy may be warranted to rule out any new growths or changes in your colon.

- Stool tests: These can help identify infections or other abnormalities.

- Imaging studies: In some cases, imaging such as a CT scan may be necessary to evaluate the abdominal organs.

In the meantime, it is crucial to monitor your symptoms closely. If you experience severe abdominal pain, significant changes in bowel habits, or if the bleeding persists or worsens, do not hesitate to seek emergency medical care.
In conclusion, while hemorrhoids and anal fissures are common causes of the symptoms you are experiencing, it is essential to rule out more serious conditions, especially given your history of gastrointestinal issues. Early intervention can lead to better outcomes and peace of mind. Always prioritize your health and consult with a healthcare provider when you notice concerning symptoms.

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