Lower Abdominal Pain and Bright Red Stool: When to Seek Help

Lower abdominal pain and the presence of bright red blood in the stool?

Hello doctor, I have been experiencing irregular lower abdominal pain for the past three years.
The pain occurs with abdominal contractions and feels dull, affecting both sides but more on the left.
Initially, it mostly happened between two menstrual periods, lasting for about two days.
I thought it was discomfort related to ovulation.
Over the past year, the pain has become more random; sometimes it occurs after menstruation, sometimes around ovulation, and occasionally before menstruation, primarily in the left lower abdomen, about the size of a palm below the navel.
The pain feels dull and bloated with abdominal contractions or pressure.
This year, my menstrual flow has been lighter, only requiring regular pads for the first day and a half, and I haven't used overnight pads for over a year.
For the last three days, I have noticed bright red blood and white mucus during bowel movements.
I was initially unsure if it was coming from the vagina or the anus, but when wiping with toilet paper, there was noticeable bright red blood near the anus.
The mucus has disappeared, but the bright red blood has persisted for three days.
My diet and bowel movements have been regular, with daily bowel movements that are formed, brown to black in color, and without any discomfort from hard stools.
Which specialist should I see for these issues?

Ms. Chen, 20~29 year old female. Ask Date: 2016/08/29

Dr. Wu Huixiong reply Family Medicine

Hello, in principle, I hope you return to the obstetrics and gynecology department, as many issues require further examination to understand.

Reply Date: 2016/08/29

More Info

When experiencing lower abdominal pain and bright red stool, it is essential to understand the potential causes and when to seek medical help. Your symptoms, which include recurrent left lower abdominal pain, changes in menstrual flow, and the presence of bright red blood near the anus, warrant a thorough evaluation.

Understanding Your Symptoms
1. Lower Abdominal Pain: The recurrent nature of your abdominal pain, particularly its correlation with your menstrual cycle, suggests a possible gynecological issue. Conditions such as ovarian cysts, endometriosis, or pelvic inflammatory disease could be contributing to your symptoms. The left-sided predominance of pain may indicate issues related to the left ovary or other structures in the pelvic region.

2. Changes in Menstrual Flow: The decrease in menstrual flow and the irregularity of your cycles could also be linked to hormonal imbalances, which can be influenced by stress, weight changes, or underlying health conditions. It is crucial to monitor these changes, as they can provide valuable information to your healthcare provider.

3. Bright Red Stool: The presence of bright red blood in your stool is concerning and could indicate several conditions, ranging from hemorrhoids to more serious issues like diverticular disease or colorectal polyps. The fact that you have noted this blood in conjunction with your bowel movements, and that it has persisted for three days, necessitates further investigation.

When to Seek Help
Given the combination of your symptoms, it is advisable to seek medical attention promptly. Here are some guidelines on when to see a doctor:
- Persistent or Worsening Symptoms: If your abdominal pain becomes more severe or persistent, or if you experience additional symptoms such as fever, vomiting, or significant changes in bowel habits, you should seek immediate medical care.

- Bright Red Blood: The presence of bright red blood in your stool, especially if it continues for more than a couple of days, should be evaluated by a healthcare professional. This could indicate bleeding from the lower gastrointestinal tract, which may require diagnostic procedures such as a colonoscopy.

Which Specialist to See
Based on your symptoms, you may want to consider seeing the following specialists:
1. Gynecologist: Since your symptoms are closely related to your menstrual cycle, a gynecologist can evaluate for any reproductive health issues, including ovarian cysts, endometriosis, or other gynecological conditions.

2. Gastroenterologist: If the bright red blood in your stool persists, a gastroenterologist would be the appropriate specialist to assess your gastrointestinal health. They can perform necessary tests to determine the source of the bleeding and recommend appropriate treatment.

Conclusion
In summary, your symptoms of lower abdominal pain, changes in menstrual flow, and bright red stool are concerning and should not be ignored. It is essential to seek medical evaluation to determine the underlying causes and receive appropriate treatment. Early intervention can lead to better outcomes, especially if there are any serious underlying conditions. Remember to provide your healthcare provider with a complete history of your symptoms, including the duration, frequency, and any associated changes in your health, to facilitate an accurate diagnosis.

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