Rectal Bleeding: Causes and Concerns After Bowel Movements

Blood in stool (not present in the first bowel movement of the day, but occurs after the second)?

It has been three to four days since I started experiencing significant rectal bleeding during bowel movements.
The toilet bowl is often stained with blood, and I need to use tissue two or three times before the bleeding stops.
The blood is mostly bright red (there is both stool and blood on the tissue).
After bowel movements, I feel pain around the anal area.
The stool is generally of normal color, but I noticed a small streak of blood on one occasion.
The key point is that the first bowel movement of the day is fine, but the bleeding occurs during the second bowel movement.
Could you please explain why this is happening? Thank you.

A-Hui, 40~49 year old female. Ask Date: 2016/12/04

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase over-the-counter hemorrhoidal suppositories, but it is best not to take laxatives indiscriminately.
At this age, increasing the intake of dietary fiber and fluids should be sufficient.
If bleeding persists, it is advisable to consult a physician.
It is also appropriate to schedule a colonoscopy at this age.

Reply Date: 2016/12/04

More Info

Rectal bleeding can be a concerning symptom, especially when it occurs frequently or in significant amounts. Based on the information you've provided, it seems that you are experiencing bright red blood in your stool, particularly after your second bowel movement of the day, along with some pain around the anal area. Let's break down the potential causes and considerations regarding your situation.

Potential Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of rectal bleeding is hemorrhoids, which are swollen veins in the lower rectum or anus. They can be internal or external and may cause bleeding, especially during bowel movements. The blood is typically bright red and may be seen on toilet paper or in the toilet bowl.

2. Anal Fissures: Another possible cause is an anal fissure, which is a small tear in the lining of the anus. This can occur due to passing hard stools or straining during bowel movements. Fissures often cause sharp pain during and after bowel movements, and you may notice bright red blood on the toilet paper.

3. Diverticular Disease: Given your history of bowel surgery, diverticulosis (the presence of small pouches in the colon) could also be a factor. If these pouches become inflamed or infected (diverticulitis), they can cause bleeding.

4. Post-Surgical Changes: Since you have undergone significant bowel surgery, changes in bowel habits and the anatomy of your digestive tract could contribute to bleeding. Surgical alterations can lead to increased pressure or strain during bowel movements, potentially leading to issues like hemorrhoids or fissures.

5. Infections or Inflammatory Conditions: Conditions such as inflammatory bowel disease (IBD) or infections can also cause rectal bleeding. These conditions often present with additional symptoms like abdominal pain, diarrhea, or changes in bowel habits.

Recommendations for Management
1. Hydration and Diet: Ensure you are drinking plenty of fluids and consuming a high-fiber diet to help soften your stools. This can reduce straining during bowel movements, which may alleviate some of the bleeding and pain.

2. Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote healing if you have an anal fissure or hemorrhoids.

3. Over-the-Counter Treatments: You might consider using over-the-counter topical treatments for hemorrhoids or fissures, which can provide relief from pain and discomfort.

4. Avoid Straining: Try to avoid straining during bowel movements. If you feel the urge to go, don’t delay, as this can lead to harder stools.

5. Medical Evaluation: Given that you have experienced significant bleeding and pain, it is crucial to seek medical evaluation. A healthcare provider can perform a thorough examination, possibly including a colonoscopy, to determine the exact cause of your bleeding and recommend appropriate treatment.

When to Seek Immediate Care
You should seek immediate medical attention if you experience any of the following:
- Heavy bleeding (more than a small amount on toilet paper)
- Severe pain that does not improve
- Symptoms of anemia (such as dizziness, weakness, or shortness of breath)
- Changes in bowel habits that persist or worsen
In conclusion, while there are several potential causes for your rectal bleeding, it is essential to consult with a healthcare professional for a proper diagnosis and treatment plan. Your history of bowel surgery may complicate the situation, making it even more important to get a thorough evaluation.

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