Blood in Stool: Is It Hemorrhoids or Anal Fissures?

Blood in stool with blood clots?

Hello Doctor: I have a constitution that tends to have a weaker gastrointestinal system.
I had a peptic ulcer during high school, which was treated.
Recently, I noticed blood on the toilet paper after wiping following a bowel movement; it was bright red.
However, after wiping a couple of times, the bleeding seemed to stop.
Later, when I went to urinate and stood up from the toilet, I noticed bleeding again.
There were two days without symptoms (I still had bowel movements during those days), but today the bleeding returned, and there were also blood clots (separate from the stool).
After wiping a couple of times, the bleeding stopped again.
After using the toilet and wiping, I feel a warm, tingling sensation around the external anal sphincter.
I would like to ask the doctor if this is hemorrhoids or a typical anal fissure? But can anal fissures recur repeatedly? Thank you for your help.
QAQ

Jie Yu, 20~29 year old female. Ask Date: 2017/04/04

Dr. Lin Minghui reply Gastroenterology and Hepatology

Blood clots during bowel movements can commonly be caused by hemorrhoids or anal fissures.
Anal fissures may recur and occur when straining during bowel movements.
It is advisable to consult a colorectal specialist for diagnosis and treatment.

Reply Date: 2017/04/04

More Info

When it comes to understanding the presence of blood in stool, it's essential to differentiate between various potential causes, such as hemorrhoids, anal fissures, or other gastrointestinal issues. Based on your description, it seems you are experiencing fresh red blood on toilet paper after bowel movements, which can be alarming and warrants further investigation.

Understanding Blood in Stool
1. Types of Blood in Stool:
- Bright Red Blood: This typically indicates bleeding from the lower gastrointestinal tract, such as the rectum or anus. Common causes include hemorrhoids or anal fissures.

- Dark Red or Black Stool: This may suggest bleeding from higher up in the gastrointestinal tract, such as the stomach or small intestine, and could indicate more serious conditions like ulcers or tumors.

2. Hemorrhoids vs. Anal Fissures:
- Hemorrhoids: These are swollen veins in the rectal area that can cause bright red blood during bowel movements. They may also cause discomfort, itching, or a feeling of fullness. Blood from hemorrhoids usually appears on the surface of the stool or on toilet paper.

- Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can also lead to bright red blood and may be accompanied by sharp pain during and after bowel movements. The pain can be significant and may cause individuals to avoid bowel movements, leading to constipation and worsening the fissure.

Your Symptoms
Given your symptoms of bright red blood on toilet paper, along with a sensation of heat or stinging around the anal area, it is plausible that you may be dealing with either hemorrhoids or anal fissures. The intermittent nature of your symptoms, where you experience bleeding on some days and not others, can occur with both conditions.
- Recurrent Symptoms: It is not uncommon for anal fissures to recur, especially if there are underlying issues such as constipation or straining during bowel movements. Hemorrhoids can also flare up and down based on factors like diet, hydration, and bowel habits.

Recommendations
1. Dietary Changes: Ensure you are consuming a high-fiber diet to soften stools and reduce straining. This includes fruits, vegetables, whole grains, and plenty of fluids.

2. Over-the-Counter Treatments: You may consider using topical treatments for hemorrhoids, such as creams or ointments that contain hydrocortisone or witch hazel, which can help reduce inflammation and discomfort.

3. Warm Sitz Baths: Taking warm baths can soothe the anal area and promote healing if you have fissures or hemorrhoids.

4. Consult a Healthcare Provider: Since you have a history of gastrointestinal issues and are currently experiencing these symptoms, it is advisable to consult a healthcare provider. They may recommend a physical examination, possibly including a digital rectal exam or anoscopy, to assess the situation accurately.

5. Monitoring Symptoms: Keep track of your symptoms, including the frequency of bleeding, any associated pain, and changes in bowel habits. This information will be valuable for your healthcare provider.

Conclusion
While your symptoms may suggest hemorrhoids or anal fissures, it is crucial to have a thorough evaluation by a healthcare professional to rule out any serious conditions. Early diagnosis and treatment can prevent complications and improve your quality of life. If you experience significant pain, persistent bleeding, or changes in your bowel habits, seek medical attention promptly.

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