Blood in Stool: When to Seek Further Evaluation

There is a large amount of bright red blood in the stool?

Hello, Dr.
Ke.
I have noticed a significant amount of bright red blood in my stool, to the point where I can't see the color of the feces at all.
I visited a clinic, and the doctor said that since I am only 25 years old, he wouldn't allow me to have a colonoscopy because it's not covered by insurance.
I thought there were provisions for this? I found information online that suggests otherwise, and isn't it true that there are cases of colorectal cancer in young people? Many people also have polyps, right? Later, he examined me and said it was a mild hemorrhoid, attributing it to my poor lifestyle.
However, my eating habits are normal with three meals a day, and I don't eat late-night snacks.
I occasionally consume drinks and fried foods, but only when I have takeout.
I usually go to bed around midnight, which is a bit late, but how can there be so much bleeding if it's mild? The doctor prescribed a hemorrhoid cream and told me to apply it only when I have bleeding, and not to use it otherwise.
Is it true that hemorrhoids will heal on their own without treatment? I asked him if it would be better to remove the hemorrhoids while they are still mild, but he said to wait until they get bigger before considering surgery...
(I can't tell if he was joking or serious).
He then told me I could leave.

Hao, 20~29 year old female. Ask Date: 2017/04/22

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
Warm sitz baths may help alleviate symptoms, and you can also purchase over-the-counter hemorrhoid suppositories.
It is best to avoid taking stool softeners indiscriminately.
If bleeding persists, it is advisable to consult a physician.
At this age, a colonoscopy is not necessary, but if you insist, the doctor will arrange it for you.
Surgical removal of hemorrhoids is not very effective when they are too small, and if there is no pain or bleeding, surgical removal is not the first-line treatment option.

Reply Date: 2017/04/22

More Info

When it comes to the presence of bright red blood in your stool, it is essential to take this symptom seriously, regardless of your age. While the doctor you consulted suggested that it might be due to mild hemorrhoids and did not recommend a colonoscopy, it is crucial to understand that rectal bleeding can have various causes, some of which may require further evaluation.

Firstly, the bright red color of the blood typically indicates that the bleeding is occurring in the lower gastrointestinal tract, such as the rectum or anus. Common causes of rectal bleeding include hemorrhoids, anal fissures, diverticular disease, and colorectal polyps, as well as more serious conditions like colorectal cancer. While hemorrhoids are indeed a common cause of rectal bleeding, especially in younger individuals, it is not the only possibility.
You mentioned that the doctor prescribed a topical treatment for hemorrhoids and advised you to use it only when bleeding occurs. While this may provide relief for mild cases, it does not address the underlying issue, especially given the significant amount of blood you reported. It is important to note that even mild hemorrhoids can cause substantial bleeding, but the volume of blood you described warrants further investigation to rule out other potential causes.

Regarding your concerns about colorectal cancer, it is true that while the risk increases with age, younger individuals can also develop this condition. The presence of polyps, which can be precursors to cancer, is also a possibility. In fact, guidelines suggest that individuals with a family history of colorectal cancer or other risk factors may need to begin screening earlier than the standard age of 45.

If you feel that your symptoms are not being adequately addressed, it is within your rights to seek a second opinion. A gastroenterologist can provide a more thorough evaluation, which may include a colonoscopy, especially given your symptoms. A colonoscopy is a safe and effective procedure that allows for direct visualization of the colon and rectum, and it can also facilitate the removal of polyps if they are found.

In terms of lifestyle, while maintaining a healthy diet and regular exercise can help prevent constipation and reduce the risk of hemorrhoids, they do not eliminate the need for medical evaluation when symptoms arise. If your bleeding persists or worsens, or if you experience other concerning symptoms such as weight loss, changes in bowel habits, or abdominal pain, it is crucial to seek medical attention promptly.

In summary, while your doctor may have suggested that your symptoms are due to mild hemorrhoids, the significant amount of blood you are experiencing should not be overlooked. It is advisable to pursue further evaluation, potentially through a gastroenterologist, to ensure that any serious conditions are ruled out. Your health is paramount, and advocating for yourself in the face of concerning symptoms is essential.

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