Persistent Red Mucus Blood After Colonoscopy: What to Do Next?

After a colonoscopy, there is persistent blood in the stool with red mucous blood clots?

Hello Doctor: I am 26 years old.
In early August of this year, I experienced significant bleeding in the toilet during bowel movements and noticed red mucus in my stool.
After one or two weeks without improvement, I went to Mackay Memorial Hospital in mid-September for my first colonoscopy (it was free except for the registration fee).
The biopsy revealed that polyps were removed, and there were ulcers and inflammation.
However, several weeks later, I continued to have persistent bleeding with red mucus and blood clots.
In mid-November, I was referred to the largest hospital in the north (Tai x Hospital) for a second colonoscopy (self-paid).
During the procedure, the nurse informed my family that polyps had been removed, but when I followed up with the doctor to ask if any polyps were removed during the colonoscopy, the doctor surprisingly told me that there were no polyps, only biopsies (I was speechless and unsure of the truth).
The doctor stated that the report only indicated intestinal inflammation and ulcers.
After returning home, two to three weeks later, I still experienced persistent bleeding with red mucus and blood clots, and my stool color was dark brown.
I would like to ask the doctor, after having two colonoscopies and with no improvement after several months, what should I do? Should I wait a few more weeks to see if there is any improvement, or should I undergo further examinations like an endoscopy or X-ray? I am currently at a loss and would appreciate any advice from the doctor.
Thank you!

Hua, 20~29 year old female. Ask Date: 2016/12/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
I suggest that you consolidate the examination reports and pathology reports from both hospitals, choose one of them, and proceed with the examinations/medications while maintaining long-term follow-up.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2016/12/02

More Info

It sounds like you are experiencing a concerning and persistent issue with rectal bleeding and mucus after undergoing two colonoscopies. Given your age and the symptoms you've described, it's essential to approach this situation carefully and methodically.

Firstly, it's important to understand that the presence of red mucus blood in your stool can be indicative of several conditions, including hemorrhoids, anal fissures, inflammatory bowel disease (IBD), or even complications from the procedures you've undergone. The fact that you have had two colonoscopies, and both indicated inflammation and ulcers, suggests that there may be an underlying issue that needs to be addressed.

Since you have already undergone two colonoscopies, it would be prudent to gather all the reports and findings from both hospitals. This includes the pathology reports from any biopsies taken during the procedures. Having a comprehensive view of your medical history and findings will be crucial for any healthcare provider you consult next.

Here are some steps you can consider taking:
1. Follow-Up with a Gastroenterologist: It may be beneficial to schedule a follow-up appointment with a gastroenterologist who can review all your previous tests and findings. They may recommend further diagnostic tests, such as imaging studies (like a CT scan) or even a capsule endoscopy, which can help visualize areas of the small intestine that might not be accessible through a standard colonoscopy.

2. Consider Dietary Changes: Sometimes, dietary factors can exacerbate gastrointestinal issues. Keeping a food diary to track what you eat and any associated symptoms may help identify potential triggers. A diet low in irritants (like spicy foods, caffeine, and alcohol) and high in fiber may help improve your bowel health.

3. Medication Review: If you are on any medications, including over-the-counter supplements, review these with your doctor. Some medications can cause gastrointestinal bleeding or exacerbate existing conditions.

4. Monitor Symptoms: Keep a close eye on your symptoms. If you notice any changes, such as increased bleeding, severe abdominal pain, or changes in bowel habits, seek medical attention promptly.

5. Consider a Second Opinion: If you feel uncertain about the information provided by your current healthcare providers, seeking a second opinion from another gastroenterologist may provide additional insights or alternative treatment options.

6. Lifestyle Modifications: Ensure you are staying hydrated and maintaining a balanced diet. Regular exercise can also promote healthy digestion and bowel function.

7. Psychological Support: Chronic health issues can be stressful and may lead to anxiety or depression. Consider speaking with a mental health professional if you find that your symptoms are affecting your emotional well-being.

In conclusion, persistent rectal bleeding and mucus after colonoscopy warrant further investigation. It is essential to work closely with a healthcare provider who can guide you through the next steps based on your specific situation. Do not hesitate to advocate for your health and seek the answers you need to feel better.

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