Prolonged Bleeding from Hemorrhoids: Causes and Solutions

Rectal bleeding

Hello Doctor: I have been experiencing issues with hemorrhoids.
After using the restroom, they protrude and cannot be pushed back in, but after resting for 1 to 2 hours, they retract (sometimes they swell and are painful, making it impossible to retract).
I also have anal fissures; recently, I had a fissure that bled for about three days due to incomplete bowel movements.
A few days later, I noticed blood in my stool along with blood clots approximately 2 to 3 centimeters long, which lasted for about 3 to 4 days (the amount of blood decreased each day).
After that, I stopped bleeding for a couple of days, but then after using the restroom, the hemorrhoids suddenly retracted forcefully into the anus, and the next day I started bleeding again for two days.
After a day without bleeding, I bled again, but the amount was not significant.
My bowel habits have not changed; I typically have a bowel movement once a day at around the same time.
I would like to know if hemorrhoid-related bleeding can last for several days.

Niming, 30~39 year old female. Ask Date: 2016/09/21

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be a typical case of anal fissure, which is characterized by pain during bowel movements accompanied by slight bleeding.
If there is concurrent bleeding from 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 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 conservative treatment does not yield satisfactory results, surgical intervention may be considered.
If symptoms persist for more than a week without improvement, it is important to consult a physician to identify the underlying issue, and a colonoscopy may be arranged if necessary.

Reply Date: 2016/09/21

More Info

Prolonged bleeding from hemorrhoids can be a concerning issue, especially when accompanied by symptoms such as pain, swelling, and the presence of blood clots. Hemorrhoids, which are swollen veins in the lower rectum and anus, can lead to various complications, including bleeding, particularly during bowel movements. In your case, it seems that you are experiencing a combination of hemorrhoids and anal fissures, which can exacerbate the bleeding and discomfort.

Causes of Prolonged Bleeding from Hemorrhoids
1. Straining During Bowel Movements: Straining can increase pressure on the veins in the rectal area, leading to the formation of hemorrhoids or aggravating existing ones. This can cause bleeding, especially if there are fissures present.

2. Chronic Constipation or Diarrhea: Both conditions can lead to increased straining or irritation of the anal area, contributing to hemorrhoid formation and bleeding.

3. Inflammation and Infection: Hemorrhoids can become inflamed or infected, leading to increased bleeding. This is particularly true if there are fissures that can become infected.

4. Poor Dietary Habits: A diet low in fiber can lead to constipation, which in turn can exacerbate hemorrhoids and lead to bleeding.

5. Physical Activity: Heavy lifting or strenuous exercise can increase abdominal pressure, which may aggravate hemorrhoids.

Solutions and Management
1. Dietary Changes: Increasing your fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

2. Over-the-Counter Treatments: There are various topical treatments available that can help reduce inflammation and pain associated with hemorrhoids. These may include creams or ointments containing hydrocortisone or witch hazel.

3. Warm Sitz Baths: Soaking in warm water can help relieve discomfort and promote healing. This can be done several times a day, especially after bowel movements.

4. Avoid Straining: Try to avoid prolonged sitting on the toilet and straining during bowel movements. If you feel the urge to go, respond promptly rather than waiting.

5. Medical Intervention: If bleeding persists or worsens, it is essential to consult a healthcare provider. They may recommend procedures such as rubber band ligation, sclerotherapy, or even surgical options in severe cases.

6. Monitor Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, as well as any changes in bowel habits. This information can be helpful for your healthcare provider in determining the best course of action.

When to Seek Medical Attention
You should seek medical attention if:
- The bleeding is heavy or persistent.

- You experience severe pain or swelling.

- There are changes in bowel habits, such as diarrhea or constipation.

- You notice any signs of infection, such as fever or increased redness and swelling around the anus.

Conclusion
In summary, while hemorrhoids can cause prolonged bleeding, it is essential to address the underlying causes and manage symptoms effectively. Making dietary changes, using over-the-counter treatments, and practicing good bowel habits can significantly help. However, if symptoms persist or worsen, consulting a healthcare professional is crucial to rule out other potential causes and to receive appropriate treatment. Remember, early intervention can prevent complications and improve your quality of life.

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