Managing Persistent Rectal Bleeding: Solutions for Hemorrhoids and Diverticulitis

Rectal bleeding?

Dear, I have had issues with hemorrhoids and diverticulitis.
Previously, I experienced continuous bleeding during bowel movements, and when I strained, the bleeding worsened.
I went to the colorectal surgeon at Cathay General Hospital in Taipei, where my hemoglobin dropped to 5, and I urgently needed a blood transfusion.
The doctor did not recommend surgery for the hemorrhoids, stating that I have difficulty with bleeding control, and my hemorrhoids do not cause pain; they just bleed continuously during bowel movements.
This has led to both bowel issues and ongoing bleeding problems.
The doctor performed a hemorrhoidal banding procedure, but within two weeks, the bleeding resumed.
When I returned to see the doctor, he only suggested repeating the banding procedure.
The constant bleeding makes me afraid to have bowel movements, which is very distressing.
Is there any way to resolve this?

Xiao Yu, 30~39 year old female. Ask Date: 2016/11/03

Dr. Ke Fangxu reply Surgery

The main indication for hemorrhoid surgery is severe bleeding.
Given your condition, you should consider undergoing hemorrhoidectomy.
Although there are concerns about postoperative pain, this procedure provides the best hemostatic effect among all treatment options.
Additionally, it is important to avoid constipation and shorten the time spent during bowel movements to prevent rebleeding.
Otherwise, the recurrence of significant bleeding could pose a life-threatening risk.

Reply Date: 2016/11/03

More Info

Managing persistent rectal bleeding, especially when associated with hemorrhoids and diverticulitis, can be quite challenging and distressing. Your situation, where you have a history of hemorrhoids and diverticulitis, combined with significant blood loss leading to a hemoglobin level of 5, indicates a serious condition that requires careful management.

Understanding Your Condition
1. Hemorrhoids: These are swollen veins in the lower rectum and anus that can cause bleeding, especially during bowel movements. The bleeding is often bright red and can be alarming, but it is usually not life-threatening. However, persistent bleeding can lead to anemia, as you've experienced.

2. Diverticulitis: This condition occurs when diverticula (small pouches that can form in the walls of the colon) become inflamed or infected. It can also lead to bleeding, though this is typically less common than with hemorrhoids.

Current Management Strategies
Given your history and the treatments you've undergone, including the endoscopic procedures for hemorrhoid treatment, it seems that the bleeding has not been adequately controlled. Here are some potential management strategies and considerations:
1. Dietary Modifications: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which can exacerbate hemorrhoids. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

2. Medications: Over-the-counter stool softeners or laxatives may help ease bowel movements. If you are experiencing significant pain or discomfort, topical treatments for hemorrhoids (like hydrocortisone creams) may provide relief.

3. Surgical Options: If conservative measures fail, surgical intervention may be necessary. Options include:
- Hemorrhoidectomy: This is the surgical removal of hemorrhoids and may be indicated if your bleeding is primarily due to hemorrhoids.

- Sclerotherapy or Rubber Band Ligation: These are less invasive procedures that can be performed in an outpatient setting to treat hemorrhoids.

- Diverticulitis Management: If diverticulitis is contributing to your symptoms, your doctor may recommend antibiotics or, in severe cases, surgery to remove the affected portion of the colon.

4. Follow-Up Care: Regular follow-ups with your gastroenterologist or colorectal surgeon are essential. They can monitor your hemoglobin levels and overall health, adjusting your treatment plan as necessary.

5. Psychological Support: The fear of bowel movements due to pain or bleeding can lead to constipation and further complications. Consider speaking with a mental health professional or a support group to help manage anxiety related to your condition.

When to Seek Immediate Care
If you experience any of the following, seek immediate medical attention:
- Severe abdominal pain
- A significant increase in bleeding
- Signs of infection (fever, chills)
- Changes in bowel habits (such as severe constipation or diarrhea)

Conclusion
Persistent rectal bleeding can be a complex issue, especially with underlying conditions like hemorrhoids and diverticulitis. It is crucial to work closely with your healthcare provider to develop a comprehensive management plan tailored to your specific needs. Don't hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Remember, effective management is possible, and with the right approach, you can improve your quality of life and reduce the fear associated with bowel movements.

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