Abdominal Pain and Blood in Stool: When to Seek Colonoscopy?

Abdominal pain with blood in the stool?

Hello Doctor: Over the past month, I have frequently experienced abdominal pain and often pass gas.
The pain is not localized and does not feel like the kind that makes me want to rush to the bathroom.
Additionally, my stools are somewhat soft, and I often notice food remnants in them.
I previously consulted a gastroenterologist who suggested that my symptoms might be due to stress and prescribed medication.
After taking it a few times, I felt some improvement, but the symptoms recurred after a week.
Recently, I noticed bright red, watery blood when wiping after a bowel movement, usually present the first time I wipe but not the second.
Upon close inspection of my stool, I can also see a streak of blood.
I have experienced this occasionally in the past but dismissed it as anal fissures.
Doctor, do you think I need to undergo a colonoscopy? (My grandmother had colon cancer.) P.S.
I was recently diagnosed with Kikuchi disease, a lymphatic system disorder, and my doctor mentioned that it would resolve on its own, believing that my gastrointestinal issues are unrelated to my lymphatic condition.

c, 20~29 year old female. Ask Date: 2016/11/30

Dr. Chen Jiaming reply Surgery

Medical care does not have a standard answer; it varies based on each individual's clinical condition and concerns.
Looking purely at the changes in bowel habits this month, whether in frequency or the presence of blood, since you are worried about the possibility of colorectal cancer, I don't think any physician would guarantee the exclusion of that possibility.
Therefore, it would be advisable to schedule a colonoscopy for confirmation.
If the results can rule it out, I believe you will feel much more at ease.^^

Reply Date: 2016/11/30

More Info

When experiencing abdominal pain and blood in the stool, it is crucial to understand the potential underlying causes and when to seek further medical evaluation, such as a colonoscopy. Your symptoms, including recurrent abdominal pain, soft stools with food remnants, and the presence of bright red blood, warrant careful consideration.

Firstly, the presence of blood in the stool can arise from various sources within the gastrointestinal tract. In your case, the bright red blood observed when wiping could indicate a lower gastrointestinal issue, potentially related to hemorrhoids, anal fissures, or other conditions affecting the rectum or lower colon. However, given your family history of colorectal cancer, it is essential to take these symptoms seriously.

The abdominal pain you describe as non-specific and not associated with urgent bowel movements may suggest a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), which can be exacerbated by stress. However, the recurrence of symptoms and the new onset of blood in the stool should prompt further investigation. While your doctor initially attributed your symptoms to stress, the persistence and change in your symptoms, especially with the family history of colorectal cancer, necessitate a more thorough evaluation.

A colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum, enabling the identification of abnormalities such as polyps, inflammation, or tumors. Given your symptoms and family history, a colonoscopy is advisable. It can help rule out serious conditions, including colorectal cancer, and provide peace of mind. The American College of Gastroenterology recommends that individuals with a family history of colorectal cancer begin screening at an earlier age than the general population, typically 10 years before the age at which their relative was diagnosed.

Regarding your recent diagnosis of Kikuchi disease, while it is primarily a lymphadenopathy condition and generally self-limiting, it is unlikely to be directly related to your gastrointestinal symptoms. However, the stress associated with managing a chronic illness can contribute to gastrointestinal distress.

In summary, based on your symptoms and family history, I strongly recommend that you consult with a gastroenterologist for a comprehensive evaluation, including the possibility of a colonoscopy. Early detection of any potential issues is crucial, especially given your family history. Additionally, managing stress through lifestyle changes, counseling, or medication may also help alleviate some of your gastrointestinal symptoms. Remember, it is always better to err on the side of caution when it comes to your health, especially with concerning symptoms like blood in the stool.

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