Rectal Bleeding: Causes and Concerns for Patients

Rectal bleeding

Hello Doctor, in 2013, I experienced occasional blood in my stool, but it was only on the surface of the stool.
A digital rectal exam at that time revealed an internal hemorrhoid.
In 2014, a colonoscopy found three polyps, which were removed.
A follow-up in 2015 was normal.
In 2017, I noticed blood again; I felt an urgent need to have a bowel movement but couldn't find a restroom, so I held it in.
After finally using the toilet, I found blood in my stool, and there was a significant amount.
When wiping, there were streaks of blood on the toilet paper, but this resolved after a few days.
This happened twice, but during normal bowel movements (complete stools), there was no bleeding.
The doctor recommended another colonoscopy.
My questions are: 1.
Does holding in a bowel movement when feeling an urgent need easily lead to bleeding? 2.
If the bleeding is caused by polyps, why does it only occur during bowel movements?

Mr. Hong, 30~39 year old female. Ask Date: 2017/04/09

Dr. Ke Fangxu reply Surgery

1.
Yes, holding in bowel movements can lead to increased pressure in the anal area, which over time can easily cause hemorrhoidal bleeding.

2.
Based on your description, it seems more like irritable bowel syndrome.
I recommend starting with a light diet and maintaining a good daily routine.
Spicy, irritating, and greasy foods should be avoided.
If symptoms persist without improvement, you may want to consult a physician for medication or to undergo a colonoscopy.

Reply Date: 2017/04/09

More Info

Rectal bleeding can be a concerning symptom for many patients, and understanding its causes is crucial for appropriate management and treatment. In your case, it appears that you have experienced rectal bleeding intermittently since 2013, with a history of hemorrhoids and polyps. Let's delve into your questions and concerns regarding this issue.

1. Causes of Rectal Bleeding: Rectal bleeding can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease (IBD), and colorectal polyps or cancer. Given your history of hemorrhoids and polyps, these could be potential culprits for your bleeding episodes. Hemorrhoids, in particular, are swollen blood vessels in the rectal area that can bleed, especially during bowel movements. They can be exacerbated by straining, which is often the case when one is unable to find a restroom and holds in a bowel movement.

2. Straining and Its Effects: Straining during bowel movements can indeed lead to rectal bleeding. When you hold in a bowel movement, the pressure increases in the rectal area, which can cause existing hemorrhoids to bleed or lead to the formation of anal fissures. Fissures are small tears in the lining of the anus that can occur due to the passage of hard stools or excessive straining. This is why you may have noticed blood on the toilet paper or on the stool itself after such episodes.

3. Polyp-Related Bleeding: You mentioned that your bleeding episodes seem to coincide with times when you feel the urge to have a bowel movement but cannot find a restroom. While polyps can cause bleeding, it is often more associated with changes in bowel habits or the presence of larger polyps. If the bleeding is primarily occurring during straining or when you are constipated, it may be more related to hemorrhoids or fissures rather than polyps. However, it is essential to rule out any significant pathology, especially since you have a history of polyps.

4. Recommendations for Management: Given your history and the intermittent nature of your bleeding, it is advisable to follow up with your healthcare provider for a thorough evaluation. A repeat colonoscopy may be warranted to assess for any new polyps or other abnormalities in the colon. Additionally, maintaining a high-fiber diet, staying hydrated, and using stool softeners can help prevent constipation and reduce the need for straining during bowel movements. If hemorrhoids are a recurrent issue, treatments such as topical medications, rubber band ligation, or other minimally invasive procedures may be considered.

5. When to Seek Immediate Care: If you experience significant bleeding (more than a small amount), changes in your bowel habits, or any other concerning symptoms such as weight loss or abdominal pain, it is crucial to seek medical attention promptly. These could be signs of more serious conditions that require immediate evaluation.

In summary, while straining during bowel movements can lead to rectal bleeding, it is essential to consider all potential causes, including hemorrhoids and polyps. Regular follow-ups with your healthcare provider and appropriate screening can help manage your symptoms and ensure your gastrointestinal health.

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