Dark Red Blood in Stool: When to Seek Further Evaluation

Dark red, sticky blood in stool?

Hello Dr.
Ke:
In early January, I went to Mackay Memorial Hospital's colorectal surgery department due to bright red blood in my stool.
After a digital rectal exam and a colonoscopy, I was informed that I had internal hemorrhoids and a mild anal fissure.
After using medication and suppositories, my symptoms improved.
However, I have been experiencing intermittent left lower abdominal pain, so in early March, I went to a health check clinic for a painless colonoscopy (with sedation).
The results indicated that a 0.2 cm polyp in the rectum was removed and sent for pathological examination, which confirmed it as a hyperplastic polyp.
On April 20, 2017, I experienced bright red blood in my stool again, both on toilet paper and on the surface of the stool, and I thought it was a recurrence of the internal hemorrhoids.
On May 9, 2017, after using the restroom, I felt the urge to defecate again and passed a stool approximately 3 cm in diameter and 7 cm long, which had dark red, thick blood on it (similar to dark red mucus).
On May 10, 2017, I had another bowel movement and visually did not see any blood, but I still frequently feel left lower abdominal pain.
I would like to ask:
1.
If there is a tumor in the intestine that could potentially cause bleeding, is it possible that it would not be detected during a colonoscopy?
2.
Should I arrange for another colonoscopy?
3.
Would you recommend a CEA blood test?
For additional context, I have no family history of colorectal cancer, I work rotating shifts, and my BMI is 28.
I often eat out.

Jovie, 20~29 year old female. Ask Date: 2017/05/13

Dr. Ke Fangxu reply Surgery

1.
No, a colonoscopy will not overlook such tumors.

2.
Not necessary.

3.
Not necessary; tumor markers are only valuable for reference before and after surgery, and smokers may also have elevated levels.

Reply Date: 2017/05/13

More Info

When it comes to the presence of dark red blood in stool, it is essential to understand the potential causes and when to seek further evaluation. Based on your history of rectal bleeding, previous diagnoses of hemorrhoids and anal fissures, and the recent episodes of blood in your stool, it is crucial to approach this situation with caution.

1. Understanding the Symptoms: The presence of bright red blood on toilet paper or mixed with stool often indicates bleeding from the lower gastrointestinal tract, which can be due to hemorrhoids, anal fissures, or more serious conditions such as polyps or colorectal cancer. Dark red or maroon-colored blood can suggest bleeding from higher up in the colon. Given your history of rectal issues, it is possible that your symptoms are related to hemorrhoids or fissures, especially if the bleeding is intermittent and associated with bowel movements.

2. Previous Colonoscopy Findings: You mentioned that a colonoscopy revealed a small polyp that was benign (hyperplastic). While polyps can bleed, the fact that you have had a colonoscopy recently and that the polyp was benign is reassuring. However, it is important to note that not all lesions may be detected during a colonoscopy, especially if they are small or located in difficult-to-reach areas. If there is a concern about a new growth or lesion, a repeat colonoscopy may be warranted.

3. When to Seek Further Evaluation: Given your ongoing symptoms of left lower abdominal pain and the recurrence of blood in your stool, it is advisable to seek further evaluation. You should consider scheduling another colonoscopy, especially since you have experienced a change in your symptoms. Additionally, if you notice any changes in your bowel habits, such as persistent diarrhea or constipation, or if the blood becomes more frequent or changes in color, these are also indications to seek medical attention.

4. CEA Blood Test: The Carcinoembryonic Antigen (CEA) test is a blood test that can be used as a tumor marker for certain types of cancer, including colorectal cancer. However, it is not specific and can be elevated in other conditions, including inflammatory bowel disease, pancreatitis, and even in smokers. If there is a suspicion of malignancy based on your symptoms or findings, discussing the CEA test with your healthcare provider may be appropriate.

5. Lifestyle Considerations: Your BMI of 28 indicates that you are in the overweight category, which can increase the risk of various health issues, including colorectal cancer. Maintaining a healthy diet rich in fiber, staying hydrated, and regular exercise can help improve bowel health and potentially reduce the risk of developing further complications.

In conclusion, while your previous evaluations have shown benign findings, the recurrence of blood in your stool and abdominal pain warrants further investigation. It is essential to communicate openly with your healthcare provider about your symptoms and concerns. They may recommend a repeat colonoscopy, additional imaging studies, or laboratory tests to rule out any serious conditions. Early detection and intervention are key to managing gastrointestinal health effectively.

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