Mild Anemia: Causes and Gastrointestinal Concerns - Gastroenterology and Hepatology

Acute mild anemia

Hello Doctor: In 2013, my hemoglobin was 16.4 during a health check, and in 2015, it was 15.7.
However, in 2016, my hemoglobin dropped to 12.7, and during a blood donation in March 2017, it was found to be 12.6.
In April 2017, a hospital check showed my hemoglobin at 12.9, but my previously normal GOT/GPT levels were slightly elevated at 49.
My family physician suggested that it appears to be iron deficiency anemia and recommended checking my gastrointestinal system.
An abdominal ultrasound indicated fatty liver, and I was advised to continue monitoring.
In 2010, I experienced diarrhea, and in 2015, I had a stool that was flat, which led to a colonoscopy that showed normal results with no polyps found.
In 2015, the doctor noted the presence of an anal fissure.
Earlier this year, I experienced anal pain during bowel movements and noticed a small, red, painful, and itchy growth at the anal opening.
After using warm water to clean myself for a few days and attempting to push it inward, I felt more comfortable.
Recently, I have observed that my stools are flat, but if I eat a lot of vegetables the day before, they are more regular and take on a cylindrical shape, though they are always yellow.
I would like to ask the doctor: 1) If the results from 2015 were normal, is there still a possibility of developing polyps or other issues? 2) Given that in 2004 I had fresh blood after bowel movements and the doctor diagnosed internal hemorrhoids, could the previous anal pain and itching be related to hemorrhoids? Is it possible for internal hemorrhoids to heal on their own if there has been no bleeding in recent years? 3) If I have mild iron deficiency anemia, could it be caused by hemorrhoids or liver issues? Do I still need to undergo a colonoscopy? Thank you!

JACK, 40~49 year old female. Ask Date: 2017/05/03

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Please first visit a colorectal surgeon.

Reply Date: 2017/05/03

More Info

Understanding mild anemia and its potential gastrointestinal concerns is crucial for maintaining overall health. Based on your medical history and the symptoms you've described, let's break down your questions and concerns.

1. Possibility of Polyps or Other Issues After a Normal Colonoscopy: It is indeed possible for polyps or other abnormalities to develop after a normal colonoscopy. While the risk of developing colorectal polyps increases with age, factors such as diet, lifestyle, and genetic predisposition can also play a role. Regular screenings are essential, especially if you have a history of gastrointestinal issues. If your last colonoscopy was normal, it doesn't completely rule out the possibility of new growths, but it does provide a baseline for comparison. It is generally recommended to follow up with your healthcare provider regarding the appropriate timing for your next colonoscopy based on your risk factors.

2. Anal Pain and Potential Hemorrhoids: The symptoms you describe, including pain and itching around the anal area, could indeed be indicative of hemorrhoids. Internal hemorrhoids can cause discomfort and may not always lead to visible bleeding, especially if they are not prolapsed. The fact that you have experienced anal pain and a "red bump" could suggest the presence of hemorrhoids or possibly a thrombosed hemorrhoid, which can be quite painful. If you have not experienced bleeding recently, it is possible for hemorrhoids to resolve on their own, especially with lifestyle changes such as increased fiber intake and hydration. However, if the symptoms persist or worsen, it would be wise to consult a healthcare professional for further evaluation.

3. Connection Between Mild Iron Deficiency Anemia and Hemorrhoids or Liver Issues: Mild iron deficiency anemia can have various causes, including dietary insufficiency, chronic blood loss, or malabsorption issues. If you have a history of gastrointestinal bleeding, even if it was years ago, it is essential to consider that as a potential contributing factor to your anemia. Hemorrhoids can cause minor bleeding, which might contribute to iron deficiency over time, especially if the bleeding is chronic. Additionally, liver issues, such as fatty liver disease, can affect overall metabolism and nutrient absorption, potentially leading to anemia. It is crucial to investigate the underlying cause of your anemia further, as it may require dietary adjustments, iron supplementation, or more extensive gastrointestinal evaluation.

Regarding the need for another colonoscopy, given your history of gastrointestinal symptoms and the recent development of anemia, it may be prudent to discuss this with your healthcare provider. They may recommend further testing, such as a repeat colonoscopy, especially if there are any changes in your bowel habits, such as persistent changes in stool shape or consistency, or if you experience any new symptoms.

In summary, while mild anemia can be multifactorial, it is essential to consider your gastrointestinal health in conjunction with your anemia. Regular follow-ups with your healthcare provider, maintaining a balanced diet rich in iron, and monitoring any changes in your symptoms will be vital in managing your health effectively. If you have any further questions or concerns, don't hesitate to reach out to your healthcare provider for personalized advice and management.

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