Recurring Rectal Bleeding: Causes and Solutions

Recurrent rectal bleeding?

Hello Doctor: I have been experiencing rectal bleeding (I had an episode two years ago).
After a significant amount of bleeding in January this year, which turned the toilet bowl red, I consulted a doctor.
After performing a digital rectal examination, the doctor diagnosed me with hemorrhoids, noting that the blood was bright red and there was no mucus.
I was prescribed an ointment to apply, but I still experience bleeding every 5-6 days.
After diligently using the medication, I went a month without bleeding, but today I experienced it again! The blood is bright red, and it occurred after a bowel movement.
I usually check for blood after I finish, and today it was similar to blood coming out after passing gas.
What could be the cause of this recurring bleeding? My bowel movements are irregular; I go when I feel the urge.
My weight has not decreased, my appetite is good, and there is no family history of colorectal cancer.

Nìmíng, 30~39 year old female. Ask Date: 2017/03/27

Dr. Ke Fangxu reply Surgery

Hemorrhoidal bleeding is a recurring phenomenon, especially if dietary and bowel habits are not maintained properly.
It is normal for the bleeding to fluctuate between better and worse.
Although the risk of developing colorectal cancer at the age of 36 is not zero, it is generally considered relatively low.
Based on your description, it seems more likely to be hemorrhoids.
It is recommended to follow a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided.
If symptoms persist without improvement, you should consult a physician for medication.

Reply Date: 2017/03/27

More Info

Recurring rectal bleeding can be concerning, and it’s important to understand the potential causes and solutions. Based on your description, it seems that you have been experiencing intermittent rectal bleeding, which has been attributed to hemorrhoids by your physician. Hemorrhoids are swollen veins in the lower rectum or anus that can cause discomfort and bleeding, especially during bowel movements.

The fact that you are noticing bright red blood, particularly after bowel movements, is typical for hemorrhoids. This is because the blood comes from the lower part of the gastrointestinal tract, which is why it appears bright red. The absence of mucus and the nature of the bleeding you described further support this diagnosis. However, it’s crucial to monitor the situation closely, as recurrent bleeding can sometimes indicate other underlying conditions.

Here are some common causes of rectal bleeding:
1. Hemorrhoids: As mentioned, these are the most common cause of bright red blood in the stool. They can be internal or external and may cause itching, pain, and bleeding.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain and bleeding during bowel movements.

3. Diverticular Disease: This condition involves the formation of small pouches in the colon wall that can become inflamed or infected, leading to bleeding.

4. Polyps or Colorectal Cancer: While less common, polyps can bleed, and in some cases, they can be precursors to colorectal cancer. Given your family history, this is a consideration, although you mentioned no family history of colorectal cancer.

5. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause rectal bleeding, along with other gastrointestinal symptoms.

Given that you have experienced this bleeding multiple times, it is advisable to follow up with your healthcare provider. They may recommend further evaluation, such as a colonoscopy, to rule out any serious conditions and to assess the extent of your hemorrhoids or any other potential issues.

In terms of management and prevention of recurring rectal bleeding, here are some strategies:
1. Dietary Changes: Increasing your fiber intake can help soften stools and reduce straining during bowel movements, which can alleviate pressure on hemorrhoids. Foods high in fiber include fruits, vegetables, whole grains, and legumes.

2. Hydration: Drinking plenty of water can also help prevent constipation and promote regular bowel movements.

3. Regular Bowel Habits: Establishing a routine for bowel movements can help. Try to go at the same time each day and avoid delaying the urge to go.

4. Topical Treatments: Over-the-counter creams or ointments for hemorrhoids can provide relief from symptoms. If your current treatment isn’t effective, discuss alternatives with your doctor.

5. Sitz Baths: Soaking in warm water can help soothe the area and promote healing.

6. Avoid Straining: When using the bathroom, try to relax and avoid straining, as this can exacerbate hemorrhoids.

7. Exercise: Regular physical activity can help maintain bowel regularity and reduce the risk of constipation.

If your symptoms persist despite these measures, or if you notice any changes in the nature of the bleeding (such as darker blood or blood mixed with stool), it is essential to seek medical attention promptly. Your healthcare provider can conduct a thorough evaluation and determine the best course of action for your situation.

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