Blood in Stool: Causes of Blood During Constipation

Q: Blood in Stool: Causes of Blood During Constipation

Hello： Blood after a bowel movement, with normal stool color, is mostly caused by anal fissures or hemorrhoids. <br>However, there are also rare possibilities of polyps, tumors, or chronic inflammation. <br>If the situation persists, you may consider consulting a gastroenterologi

What could be the reason for having a small amount of blood at the front of the stool when straining during constipation?

What could be the cause of having a small amount of blood on the front end of my stool when I strain during constipation? A few days ago, after not having a bowel movement for three days, I went to the bathroom and had to exert a lot of effort to pass a long, hard stool that had a coffee-brown color and a small amount of blood on the surface.
Subsequent stools have been golden yellow.
Last year, I underwent a fecal occult blood test at Chang Gung Memorial Hospital in the gastroenterology department, which was negative and did not detect any blood.
However, sometimes during bowel movements, I notice bright red or dark red streaks mixed in with my stool, making it difficult to determine if it's blood or undigested food residue.
I am wondering if the fecal occult blood test I had last year, where I visually inspected the stool for obvious blood and then used a swab for testing, is accurate.
Should I go back to Chang Gung Memorial Hospital for another examination?

A-Rong, 40~49 year old female. Ask Date: 2017/01/27

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Blood after a bowel movement, with normal stool color, is mostly caused by anal fissures or hemorrhoids.
However, there are also rare possibilities of polyps, tumors, or chronic inflammation.
If the situation persists, you may consider consulting a gastroenterologist or a colorectal specialist.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2017/01/27

More Info

When experiencing blood in the stool, especially during constipation, it is essential to understand the potential causes and implications. The presence of blood can be alarming, and while it may not always indicate a severe condition, it is crucial to investigate further to rule out any underlying issues.

In your case, the blood observed on the surface of the stool, particularly after straining during a bowel movement, is often associated with hemorrhoids or anal fissures. These conditions are common, especially when one is constipated and exerts significant pressure to pass hard stools. Hemorrhoids are swollen veins in the rectal area that can bleed when irritated, while anal fissures are small tears in the lining of the anus that can occur due to passing hard stools. Both conditions can lead to bright red blood on the stool or toilet paper.

The fact that your stool was hard and coffee-colored suggests that it may have been impacted, which can lead to straining and subsequently cause these issues. The subsequent yellow stools you mentioned indicate a return to normal bowel function, which is a positive sign. However, the presence of fresh red or dark red blood in your stool, even if intermittent, warrants further investigation.

You mentioned that you had a fecal occult blood test (FOBT) last year, which returned negative. This test is designed to detect hidden blood in the stool that may not be visible to the naked eye. While the test is generally reliable, it is not infallible, and false negatives can occur, especially if the bleeding is intermittent or if the sample collected did not contain blood.

Given your symptoms, it would be prudent to consult with a gastroenterologist again, especially since you are experiencing ongoing changes in your stool and occasional blood. A repeat examination may include a more comprehensive evaluation, such as a colonoscopy, which allows for direct visualization of the colon and rectum. This procedure can help identify any abnormalities, such as polyps, diverticula, or other lesions that could be causing the bleeding.

In terms of the accuracy of the FOBT, while it is a useful screening tool, it is not definitive. The method of collecting the sample can influence the results, and sometimes, a more thorough investigation is necessary to ensure that no significant pathology is present.

In summary, while the blood you observed may be due to benign causes such as hemorrhoids or fissures, it is essential to follow up with your healthcare provider for a thorough evaluation. They may recommend further testing to rule out any serious conditions, especially if the bleeding persists or if you experience any other concerning symptoms, such as changes in bowel habits, weight loss, or abdominal pain. Taking these steps will help ensure your health and peace of mind.

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