Rectal Bleeding: Causes and When to Seek Help - Internal Medicine

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Rectal bleeding can be a concerning symptom, and understanding its causes is essential for determining when to seek medical help. Based on your description, it seems you have experienced intermittent rectal bleeding, primarily noted on toilet paper after wiping, with the blood appearing bright red. This type of bleeding is often associated with conditions affecting the lower gastrointestinal tract, particularly the rectum and anus.


Common Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of bright red blood on toilet paper is hemorrhoids, which are swollen veins in the rectum or anus. They can be internal or external and may cause bleeding, especially during bowel movements. Straining during defecation, prolonged sitting on the toilet, or constipation can exacerbate this condition.

2. Anal Fissures: An anal fissure is a small tear in the lining of the anus, often resulting from passing hard stools or prolonged straining. This can lead to sharp pain during bowel movements and bright red bleeding, typically seen on toilet paper or in the toilet bowl.

3. Diverticular Disease: Diverticulosis, the presence of small pouches in the colon, can lead to diverticulitis, which may cause bleeding. However, this is usually accompanied by other symptoms like abdominal pain or changes in bowel habits.

4. Colorectal Polyps or Cancer: While less common, polyps or colorectal cancer can also present with rectal bleeding. This is particularly concerning if the bleeding is persistent, accompanied by changes in bowel habits, weight loss, or abdominal pain.

5. Other Conditions: Conditions such as inflammatory bowel disease (IBD), infections, or even certain medications can lead to rectal bleeding.


When to Seek Medical Help
Given that you have experienced a recurrence of bleeding after a period of improvement, it is advisable to consult a healthcare professional, especially since this episode differs from your previous experiences. Here are some guidelines on when to seek help:
- Persistent Bleeding: If the bleeding continues or worsens, it is essential to seek medical attention.

- Accompanying Symptoms: If you experience additional symptoms such as severe abdominal pain, changes in bowel habits, weight loss, or fatigue, you should see a doctor promptly.

- Frequency of Episodes: If you notice that the bleeding becomes more frequent or occurs without an obvious cause, it is crucial to get evaluated.


Diagnostic Approach
When you visit a healthcare provider, they may perform a physical examination, including a digital rectal exam, and may recommend further tests such as:
- Colonoscopy: This procedure allows direct visualization of the colon and rectum to identify any abnormalities, such as polyps or fissures.

- Anoscopy: A specialized examination of the anal canal may help diagnose hemorrhoids or fissures.

- Blood Tests: To check for anemia or other underlying conditions.


Management and Prevention
In the meantime, you can take some steps to manage your symptoms and prevent future occurrences:
- Dietary Changes: Increase fiber intake through fruits, vegetables, and whole grains to promote regular bowel movements and prevent constipation.

- Hydration: Drink plenty of water to help soften stools.

- Avoid Straining: Try not to strain during bowel movements, and consider using a stool softener if necessary.

- Regular Exercise: Physical activity can help maintain bowel regularity.


Conclusion
While occasional rectal bleeding can be benign, it is essential to monitor your symptoms closely. Given the changes in your bleeding pattern and the potential for conditions like hemorrhoids or anal fissures, consulting a healthcare professional is the best course of action. They can provide a thorough evaluation and appropriate management to ensure your health and well-being.