Blood in Stool: Differentiating Between Hemorrhoids and Polyps

Rectal bleeding

Hello Doctor,
I would like to update you on my situation.
In 2017, my colonoscopy results indicated that I had occasional blood in my stool in 2013, but it was only on the surface of the stool.
During a digital rectal exam at that time, internal hemorrhoids were found.
In 2014, a colonoscopy revealed three polyps, which were subsequently removed.
A follow-up examination in 2015 showed normal results.

In 2017, I experienced blood in my stool again after feeling a strong urge to defecate but being unable to find a restroom, which led me to hold it in.
After finally using the bathroom, I noticed a significant amount of blood in my stool, and there were streaks of blood on the toilet paper, but this resolved after a few days.
This has happened twice, but during normal bowel movements, there has been no blood.
The doctor suggested another colonoscopy for confirmation, and after the examination, I was informed that there were no polyps.

Since there are no polyps, it is possible that my symptoms are caused by the internal hemorrhoids.
My concern is how to differentiate between bleeding due to polyps and bleeding caused by internal hemorrhoids if it happens again, whether it is a small amount or a significant amount.
Each time I see blood, I worry about the possibility of polyps.
I have been trying to eat more vegetables for convenience.

P.S.
Currently, my diet has reduced meat and is lighter; I avoid spicy foods and have limited fried foods.
I also make sure to sleep before midnight.
Thank you.

Mr. Hong, 30~39 year old female. Ask Date: 2017/04/13

Dr. Ke Fangxu reply Surgery

In fact, colorectal polyps rarely cause visible bleeding; most cases of visible fresh blood are due to hemorrhoidal bleeding.
The occurrence of polyps is related to individual constitution and may not have a direct correlation with dietary habits or lifestyle.
If polyps have been previously detected, it is generally recommended to undergo a colonoscopy every one to two years to remove the polyps early and prevent malignant transformation.

Reply Date: 2017/04/13

More Info

When it comes to differentiating between hemorrhoids and polyps as potential causes of blood in the stool, it’s essential to understand the characteristics of each condition, as well as the nature of the bleeding itself.
Hemorrhoids are swollen veins in the lower rectum or anus, and they can be either internal or external. The bleeding associated with hemorrhoids is typically bright red and may be seen on the toilet paper, in the toilet bowl, or coating the stool. This bleeding often occurs during bowel movements, especially if there is straining involved. Patients may also experience discomfort, itching, or a feeling of fullness in the anal area.
On the other hand, polyps are growths on the lining of the colon or rectum, and while they are often benign, some can develop into colorectal cancer over time. The bleeding from polyps can vary in color; it may be bright red or darker, depending on the location of the polyp. Unlike hemorrhoids, bleeding from polyps may not be associated with pain or discomfort, and it can occur without any visible signs on the stool itself.
In your case, you mentioned that the blood was sometimes attached to the surface of the stool and that you experienced a significant amount of blood after straining during a bowel movement. This pattern is more consistent with hemorrhoidal bleeding, especially since you have a history of internal hemorrhoids. However, the presence of blood in the stool, regardless of the amount, should always be taken seriously, particularly given your history of polyps.

To differentiate between the two conditions in the future, consider the following:
1. Color and Amount of Blood: Bright red blood that appears on the toilet paper or in the toilet bowl after a bowel movement is more indicative of hemorrhoids. Darker blood or blood mixed with stool may suggest a more serious condition, including polyps or other gastrointestinal issues.

2. Associated Symptoms: If you experience pain, itching, or discomfort in the anal area, it is more likely to be hemorrhoids. If there are no associated symptoms and the bleeding is intermittent, it may warrant further investigation for polyps.

3. Bowel Habits: Straining during bowel movements can exacerbate hemorrhoids. If you notice that blood appears after straining, it may be related to hemorrhoids. Conversely, if blood appears without straining and is accompanied by changes in bowel habits (such as diarrhea or constipation), it may be more concerning.

4. Follow-Up Care: Given your history of polyps and the recent colonoscopy that showed no polyps, it is crucial to maintain regular follow-up appointments with your healthcare provider. If you experience any recurrence of bleeding, it is advisable to undergo another colonoscopy for evaluation.

5. Diet and Lifestyle: You mentioned making dietary changes to include more vegetables and reduce meat intake. This is beneficial, as a high-fiber diet can help prevent constipation and reduce straining during bowel movements, which can alleviate symptoms of hemorrhoids. Staying hydrated and maintaining regular physical activity are also important.

In conclusion, while your current symptoms may suggest hemorrhoids, any occurrence of blood in the stool should prompt a discussion with your healthcare provider. They may recommend further diagnostic testing, such as a colonoscopy, to rule out any serious conditions, especially given your history. Always prioritize your health and seek medical advice whenever you notice changes in your bowel habits or experience concerning symptoms.

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