Persistent Lower Abdominal Pain: When to Consider a Colonoscopy

Persistent mild lower abdominal pain?

I have been experiencing a dull pain in my lower abdomen for the past few days, specifically in the area just below my navel.
The pain is not unbearable.
My bowel habits have remained relatively unchanged over the years, typically having a bowel movement every two days, with occasional constipation.
The stool varies in thickness and sometimes appears in small, hard pieces.
Last week, I noticed blood in my stool, which was bright red and dripped into the toilet.
While it is more likely to be hemorrhoids or a rupture of blood vessels near the anus, I am concerned about the lower abdominal pain and whether it could be cancer.
Should I undergo a colonoscopy? Thank you, doctor.

Xiao Hou, 20~29 year old female. Ask Date: 2017/03/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

1) Abdominal pain can be merely a functional disorder, and the most likely cause of blood in the stool is hemorrhoids.
2) Lower abdominal pain is not necessarily related to blood in the stool.
3) You may consult a colorectal surgeon.

Reply Date: 2017/03/17

More Info

Persistent lower abdominal pain can be concerning, especially when accompanied by changes in bowel habits or rectal bleeding. Your symptoms, including the dull pain in the lower abdomen and the presence of fresh blood in your stool, warrant careful consideration and evaluation.

Firstly, it's important to understand that lower abdominal pain can arise from various causes, including gastrointestinal issues, gynecological conditions, urinary tract problems, or even musculoskeletal issues. Given your history of bowel irregularities, such as alternating between normal and constipated stools, and the recent occurrence of blood in your stool, a thorough evaluation is necessary.

The presence of fresh blood in the stool, particularly if it is bright red, often suggests that the source of bleeding is in the lower gastrointestinal tract, which could include conditions such as hemorrhoids, anal fissures, diverticular disease, or even more serious conditions like colorectal cancer. While hemorrhoids are a common cause of rectal bleeding, especially in individuals with a history of constipation, it is crucial not to dismiss the possibility of more serious conditions, particularly given your concerns about cancer.

In your case, the combination of persistent lower abdominal pain, changes in bowel habits, and rectal bleeding strongly suggests that a colonoscopy may be warranted. A colonoscopy is a diagnostic procedure that allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as polyps, inflammation, or tumors. It is also a procedure that allows for biopsy if any suspicious lesions are found.

Given your symptoms and the potential risks associated with them, it is advisable to consult with a gastroenterologist. They can assess your symptoms in detail, review your medical history, and determine whether a colonoscopy is appropriate. In general, guidelines suggest that individuals over the age of 45, or those with concerning symptoms like yours, should undergo screening for colorectal cancer, which includes a colonoscopy.

Additionally, while waiting for your appointment, it may be beneficial to keep a symptom diary. Note the frequency and characteristics of your bowel movements, any associated symptoms (such as weight loss, changes in appetite, or fever), and the nature of your abdominal pain. This information can be invaluable for your healthcare provider in making an accurate diagnosis.

In summary, while your symptoms could be due to benign conditions such as hemorrhoids or functional bowel issues, the presence of rectal bleeding and persistent abdominal pain necessitates further investigation. A colonoscopy is a reasonable next step to rule out serious conditions and ensure appropriate management. Please do not hesitate to seek medical attention promptly, as early diagnosis and intervention can significantly improve outcomes.

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