Blood on Toilet Paper: Causes and Solutions for Rectal Issues

Blood on toilet paper after a bowel movement?

Hello, Doctor: Since I discovered that I have frequent flatulence symptoms last November, various gastrointestinal issues have emerged.
In mid-March of this year, I first noticed a small amount of blood on the toilet paper after having a bowel movement.
However, it was not much, and it only appeared when I was almost done wiping.
At that time, I did not feel any particular discomfort in the anal area.
By late April to early May, the amount of bleeding gradually changed; although it still appeared when I was almost done wiping, in the last month or two, I often see blood mixed with stool when wiping, and I also feel significant pain at the anal opening during bowel movements.
Due to my poor gastrointestinal health, I have been regularly following up with a gastroenterologist.
During my last visit at the end of July, I mentioned this situation to my attending physician, who prescribed an ointment for me.
Later, due to my concerns, I visited a proctologist in early August.
The doctor performed a digital rectal exam and indicated that I had a minor anal fissure and hemorrhoids, but they were very mild and advised me not to worry.
He also recommended that I avoid using toilet paper and instead wash with water.
This morning, when I went to the bathroom, I noticed that a small portion of my stool was purplish-red (about the size of a 50 NT dollar coin), and there was also some blood when wiping.
This has caused me to worry, even though I had a colonoscopy two years ago.
This situation makes me wonder if I need to undergo another one...
Here are a few questions: 1.
After being diagnosed by the proctologist with an anal fissure, can anal fissures heal completely? 2.
What methods can improve the ease of bowel movements? Currently, I eat at least two types of vegetables and two types of fruits daily, and I drink about 2000 cc of water.
When I first sit on the toilet, my bowel movements are very smooth, but I always feel like I haven't fully emptied my bowels, and after sitting for another 10 minutes, a small amount of stool is still expelled.
3.
Regarding the purplish-red stool I noticed this morning, which is the small amount of stool mentioned in question 2, I immediately went to see a proctologist, but the doctor said it was not a concern and that I did not need a colonoscopy.
However, I am still quite worried...
Thank you!

Yi Wei Lu Ren, 20~29 year old female. Ask Date: 2016/08/28

Dr. Ke Fangxu reply Surgery

1.
Based on your description, it seems you are experiencing typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
If there is bleeding associated with hemorrhoids, the amount of blood may be more significant.
The primary cause of anal fissures is usually hard stools, but diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is advisable to improve your bowel habits and take warm sitz baths to alleviate symptoms.
You may also use topical ointments and suppositories for treatment.
If symptoms persist for more than a week without improvement, you should consult a physician to identify the underlying issue.
2.
Spending too much time on the toilet may be the root cause of your anal issues.
It is recommended to keep bowel movements brief, ideally under 10 minutes.
Prolonged sitting can lead to swelling and frequent contractions of the anal area, exacerbating symptoms of fissures and hemorrhoids.
3.
I also believe there is no issue; however, if you are truly concerned, you may consider undergoing another colonoscopy.
4.
The presence of food particles in your stool may relate to the nature of the food itself, but not chewing thoroughly while eating is also an important factor.
I recommend improving your eating habits and observing any changes.

Reply Date: 2016/08/28

More Info

Understanding blood on toilet paper can be concerning, especially when it becomes a recurring issue. Based on your description, it seems you have been experiencing rectal bleeding, which has progressed from minor spotting to more noticeable blood mixed with stool, accompanied by pain during bowel movements. This situation can arise from several causes, and it’s essential to address it appropriately.

Possible Causes of Rectal Bleeding
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain and bleeding during bowel movements. Given your history of constipation and the pain you described, this is a likely cause.

2. Hemorrhoids: These are swollen veins in the rectal area that can cause bleeding, especially during bowel movements. The fact that your doctor noted mild hemorrhoids aligns with this possibility.

3. Diverticular Disease: This condition involves the formation of small pouches in the colon wall, which can become inflamed or infected, leading to bleeding.

4. Colorectal Polyps or Cancer: While less common, especially in younger individuals, these can also cause rectal bleeding. Your previous colonoscopy would have likely ruled out significant issues, but it’s something to keep in mind.

5. Gastrointestinal Infections: Certain infections can lead to bloody stools, but these are usually accompanied by other symptoms like diarrhea or fever.

Addressing Your Concerns
1. Can Anal Fissures Heal?: Yes, anal fissures can heal with proper care. Treatment typically involves dietary changes to soften stools, topical medications to relieve pain and promote healing, and sometimes sitz baths to soothe the area. If fissures are chronic, more advanced treatments may be necessary, but many cases resolve with conservative management.

2. Improving Bowel Regularity: To enhance stool consistency and promote regular bowel movements, consider the following strategies:
- Dietary Fiber: Continue consuming a variety of fruits and vegetables. Aim for at least 25-30 grams of fiber daily. Foods high in fiber include whole grains, legumes, and nuts.

- Hydration: Drinking adequate water is crucial. You mentioned consuming about 2000cc, which is good, but ensure you’re drinking enough to keep stools soft.

- Regular Exercise: Physical activity can stimulate bowel function. Aim for at least 30 minutes of moderate exercise most days.

- Routine: Establish a regular time for bowel movements, allowing yourself enough time to relax and not rush.

3. Concerns About Purple-Red Stools: The appearance of purple-red stools can be alarming. This could be due to bleeding from the lower gastrointestinal tract, possibly related to the fissures or hemorrhoids. However, if your doctor has evaluated you and deemed it not concerning, it may be related to the food you consume or the way your body processes certain nutrients. If the bleeding persists or worsens, or if you experience additional symptoms like significant pain, changes in bowel habits, or weight loss, further evaluation may be warranted.

When to Seek Further Help
If you continue to experience rectal bleeding, especially if it becomes more frequent or severe, or if you develop new symptoms, it’s essential to follow up with your healthcare provider. While your previous evaluations have been reassuring, persistent symptoms warrant further investigation, such as a repeat colonoscopy, especially if there are changes in your bowel habits or stool characteristics.

In summary, while rectal bleeding can be distressing, many causes are manageable with lifestyle changes and medical treatment. Keep an open line of communication with your healthcare provider, and don’t hesitate to seek further evaluation if your symptoms change or worsen.

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