Rectal Bleeding and Weight Loss: Key Concerns for Young Adults

In mid-January, there was blood in the stool?

1.
Regarding your question, after experiencing bright red blood in your stool in mid-January, you promptly consulted a colorectal specialist who performed a flexible sigmoidoscopy and diagnosed you with a mild anal fissure.
Following that, you did not experience any further bleeding for two to three days.
Can a flexible sigmoidoscopy effectively rule out rectal pathologies?
2.
As for your weight issue, you have noticed a downward trend in your weight over the past three to four months, dropping from 80 kg to currently 69 kg.
You have also consulted a psychiatrist who mentioned that you are experiencing anxiety, autonomic nervous system dysregulation, and emotional instability.
You have been maintaining a balanced diet and exercising at least once a week, with increased frequency in basketball recently.
Could this be a contributing factor to your weight loss? You have also scheduled a colonoscopy for tomorrow, which is causing you anxiety.
This month, your weight has fluctuated between 70 and 71 kg, but due to a low-residue diet in preparation for the examination, it has dropped to 69 kg.
Is it common for individuals with symptoms of colorectal cancer to experience continuous weight loss without any increase?
3.
Additionally, your thyroid and diabetes screenings have returned normal results, along with abdominal ultrasound, stool tests, urinalysis, and blood tests.
There is no family history of colorectal cancer, and you are 24 years old.
Given these factors, what is the likelihood of developing colorectal cancer?

Luo Kai-Ren, 20~29 year old female. Ask Date: 2017/03/21

Dr. Ke Fangxu reply Surgery

The anoscope, as you described, is a method for examining the anus and does not cover the rectal area.
Since a colonoscopy has already been scheduled, there is no need to dwell on it.
You likely already know the results when you saw the email response.
It is true that patients with advanced colorectal cancer may experience weight loss, although the likelihood is not zero.
If any abnormalities are found during the colonoscopy, further treatment can be pursued.

Reply Date: 2017/03/21

More Info

When it comes to rectal bleeding and weight loss, especially in young adults, there are several important factors to consider. Your situation involves a recent episode of bright red blood during bowel movements, which was diagnosed as a mild anal fissure, and a significant weight loss of approximately 11 kg over the past few months. Let's break down your concerns systematically.

1. Rectal Bleeding and Diagnostic Procedures: The fact that you underwent a flexible sigmoidoscopy (or anoscopy) and were diagnosed with a mild anal fissure is a positive sign. Anal fissures are common and often result from straining during bowel movements, which can occur due to constipation or hard stools. This type of bleeding is usually not indicative of more serious conditions like colorectal cancer, especially if it resolves quickly and is associated with pain during bowel movements. However, while a flexible sigmoidoscopy can help rule out some rectal pathologies, it does not completely exclude the possibility of other issues in the colon or rectum. Therefore, your decision to pursue a colonoscopy is prudent, especially given your symptoms and weight loss.

2. Weight Loss Concerns: A weight loss of 11 kg over a few months is significant, particularly if it is unintentional. While anxiety and stress can lead to changes in appetite and weight, it is essential to consider other potential causes. In young adults, unexplained weight loss can sometimes be associated with gastrointestinal disorders, metabolic issues, or even malignancies. However, given your normal thyroid function tests, abdominal ultrasound, and other routine checks, the likelihood of a serious underlying condition decreases. It is also worth noting that regular physical activity, such as playing basketball, can contribute to weight loss, especially if your caloric intake has not adjusted accordingly.

3. Concerns About Colorectal Cancer: The symptoms of colorectal cancer can vary widely, but common signs include a change in bowel habits, blood in the stool, and unexplained weight loss. However, your age (24 years old), lack of family history, and normal results from various tests significantly lower your risk for colorectal cancer. Most colorectal cancers are diagnosed in older adults, and the incidence in young adults is relatively low. Nevertheless, it is crucial to remain vigilant and follow up with your healthcare provider regarding your colonoscopy results.

4. Anxiety and Its Impact: Anxiety can manifest physically, leading to symptoms such as changes in appetite, gastrointestinal discomfort, and even weight fluctuations. Managing anxiety through counseling, therapy, or medication can help stabilize your emotional state and may also positively impact your physical health.

In summary, while your symptoms warrant further investigation, the combination of a mild anal fissure and significant weight loss does not immediately suggest a high risk for colorectal cancer, especially given your age and normal test results. It is essential to follow through with your scheduled colonoscopy for peace of mind and to rule out any other potential issues. Additionally, addressing your anxiety and ensuring a balanced diet can help manage your weight and overall well-being. Always consult with your healthcare provider for personalized advice and treatment options based on your specific situation.

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