Blood in Stool: Causes and When to Seek Further Testing - Gastroenterology and Hepatology

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When interpreting blood in stool, it’s essential to understand the potential causes and the appropriate steps to take for further evaluation. In your case, you have experienced abdominal discomfort, changes in bowel habits, and the presence of bright red blood in your stool. These symptoms can be concerning and warrant a thorough investigation.

From your description, it seems you have already undergone several evaluations, including an upper endoscopy (gastroscopy) and a flexible sigmoidoscopy. The findings from the sigmoidoscopy indicated that you have a fissure (anal fissure) causing the bleeding, which is a common condition that can occur due to trauma to the anal canal, often from passing hard stools. However, you mentioned that you do not experience constipation or hard stools, which raises questions about the diagnosis.

The presence of bright red blood in the stool typically indicates that the bleeding is occurring in the lower gastrointestinal tract, such as the rectum or anus. This is consistent with your diagnosis of an anal fissure. However, it is also important to consider other potential causes of rectal bleeding, including hemorrhoids, diverticular disease, inflammatory bowel disease (IBD), or even colorectal polyps or cancer, especially if you have persistent symptoms.

Your ongoing symptoms of abdominal pain and the sensation of incomplete bowel movements could suggest a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), which can coexist with other conditions. IBS can cause symptoms like bloating, gas, and changes in bowel habits, including urgency and difficulty in passing stool.

Given your situation, here are some recommendations:
1. Follow-Up with a Specialist: Since you have already seen a colorectal surgeon, it may be beneficial to follow up with a gastroenterologist for a comprehensive evaluation. They can assess your symptoms in the context of your previous findings and may recommend a full colonoscopy to rule out any other underlying conditions.

2. Monitor Symptoms: Keep track of your symptoms, including the frequency and appearance of blood in your stool, any changes in bowel habits, and the nature of your abdominal pain. This information will be valuable for your healthcare provider.

3. Dietary Adjustments: Consider dietary changes that may help alleviate your symptoms. Increasing fiber intake can help soften stools and reduce the risk of fissures. Staying hydrated is also crucial.

4. Pain Management: If you are experiencing significant abdominal pain, discuss pain management options with your healthcare provider. They may recommend medications or lifestyle changes to help alleviate discomfort.

5. Consider Psychological Factors: Since you mentioned stress and anxiety related to your symptoms, it may be helpful to explore stress management techniques or speak with a mental health professional. Stress can exacerbate gastrointestinal symptoms.

6. Further Testing: If your symptoms persist or worsen, or if you develop new symptoms (such as weight loss, changes in appetite, or severe pain), it would be prudent to undergo further testing, including a full colonoscopy.

In summary, while your current diagnosis of an anal fissure may explain the blood in your stool, it is essential to remain vigilant and seek further evaluation if your symptoms do not improve or if you have concerns about other potential gastrointestinal issues. Your health is paramount, and addressing these symptoms with the appropriate medical professionals will help ensure that you receive the care you need.