Rectal Bleeding: Hemorrhoids or Anal Fissures?

Rectal bleeding

Hello, doctor.
I previously had issues with constipation, where I would go up to three days without a bowel movement.
Typically, I have a bowel movement once every one or two days, and I do eat fruits regularly.
However, my stools are still somewhat hard.
Recently, I have been experiencing pain in the anus during bowel movements, and there are some traces of blood on the toilet paper and in the toilet bowl.
The blood is bright red.
Could this be hemorrhoids or an anal fissure?

Miss Chen, 10~19 year old female. Ask Date: 2016/10/27

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be a typical case of anal fissure.
The classic symptoms include 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; however, 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 advisable to consult a physician for further evaluation to identify the underlying issue.

Reply Date: 2016/10/27

More Info

Rectal bleeding can be a concerning symptom, and it's important to understand the potential causes and their implications. Based on your description, it sounds like you may be experiencing either hemorrhoids or anal fissures, both of which are common conditions that can lead to rectal bleeding, especially in the context of constipation and hard stools.

Hemorrhoids are swollen veins in the lower rectum or anus, similar to varicose veins. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms often include painless bleeding during bowel movements, itching, and discomfort. The blood is usually bright red and may be seen on toilet paper or in the toilet bowl. Hemorrhoids can be caused by straining during bowel movements, prolonged sitting, or increased pressure during pregnancy.

Anal fissures, on the other hand, are small tears in the lining of the anus, often resulting from passing hard or large stools. They can cause sharp pain during and after bowel movements, and the bleeding is typically bright red. The pain can be severe, leading to a fear of bowel movements, which can exacerbate constipation.

Given your history of constipation and hard stools, it is quite possible that either condition could be responsible for your symptoms. The presence of bright red blood on toilet paper and in the toilet bowl is characteristic of both hemorrhoids and anal fissures. However, the pain you describe during bowel movements is more indicative of an anal fissure, especially if the pain is sharp and intense.

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

2. Over-the-Counter Remedies: You may consider using topical treatments such as hydrocortisone creams for hemorrhoids or soothing ointments for fissures. Sitz baths (soaking the anal area in warm water) can also provide relief.

3. Avoid Straining: Try to avoid straining during bowel movements. If you feel the urge to go, don’t delay, as this can lead to harder stools.

4. Consult a Healthcare Provider: If your symptoms persist, worsen, or if you experience significant pain or other concerning symptoms (such as fever or significant changes in bowel habits), it is important to consult a healthcare provider. They may perform a physical examination and possibly recommend further tests to rule out other conditions.

5. Follow-Up Care: If diagnosed with hemorrhoids or fissures, follow-up care may be necessary to monitor your condition and ensure proper healing. In some cases, if conservative measures fail, medical procedures may be needed.

When to Seek Immediate Care: If you experience heavy bleeding (more than a small amount), signs of infection (such as fever or increased pain), or if you have any other concerning symptoms, seek medical attention promptly.

In summary, while hemorrhoids and anal fissures are common causes of rectal bleeding, proper evaluation and management are essential to ensure effective treatment and prevent complications. Making dietary adjustments, using over-the-counter treatments, and consulting a healthcare provider if symptoms persist are key steps in addressing your concerns.

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