Rectal Pressure: Symptoms and When to Seek Specialist Care

Anal heaviness

Hello Doctor, about two months ago I experienced a single episode of rectal bleeding (bright red blood, painless), after which I became particularly sensitive regarding my gastrointestinal health.
Here are the main symptoms and test results from the past two months: (1) I have a bowel movement every morning, no constipation, and my stools are generally soft and somewhat loose.
(2) After the first episode of rectal bleeding, I have tested for occult blood several times, all of which returned negative results.
However, a few days ago, I noticed a significant amount of blood on the toilet paper after wiping, although I did not see any blood in the stool.
(3) I have a sensation of fullness in the anal area, often feeling sore with a foreign body sensation, which is intermittent and more pronounced at night or after meals, causing me considerable distress.
(4) I occasionally experience bloating (I already have a history of gastroesophageal reflux).
(5) I consulted a non-specialist doctor in the U.S.
who performed a digital examination and a small anal scope, and they did not find any internal hemorrhoids but suspected an anal fissure (the doctor was uncertain).
Since I have doubts about the non-specialist doctors here (and it would take two months to see a specialist), I would like to ask if it is necessary to return to Taiwan for a self-paid colonoscopy.
Thank you.

Niming, 30~39 year old female. Ask Date: 2017/05/18

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
With a negative occult blood test and being under 50 years old, your risk is low, and you may simply continue with follow-up.
If you still feel unwell or have concerns, you can visit a gastroenterology clinic for an examination when you return to Taiwan.
Changhua Hospital cares about your health.
Chen Shih-Dian.

Reply Date: 2017/05/18

More Info

It sounds like you've been experiencing a range of concerning gastrointestinal symptoms, particularly following an episode of rectal bleeding. Your symptoms, including the sensation of rectal pressure, soft stools, and intermittent blood on toilet paper, warrant careful consideration and further evaluation.
Firstly, it's important to understand that rectal bleeding can arise from various causes, some benign and others more serious. Given that you experienced a significant episode of bright red blood in your stool without accompanying pain, it could suggest several possibilities, including hemorrhoids, anal fissures, or even more serious conditions like diverticular disease or colorectal polyps. The fact that subsequent tests for occult blood were negative is reassuring, but it does not completely rule out the presence of a more serious issue.

The sensation of rectal fullness or pressure, along with the intermittent discomfort, could indeed be related to conditions such as hemorrhoids or anal fissures, which can cause discomfort and bleeding, especially during bowel movements. However, the intermittent nature of your symptoms and the fact that you have a history of gastroesophageal reflux disease (GERD) could also indicate a more complex gastrointestinal issue, possibly involving the lower gastrointestinal tract.

Given your concerns and the fact that you are experiencing persistent symptoms, it is advisable to seek further evaluation from a specialist, such as a gastroenterologist. While you mentioned that you have already consulted with non-specialist physicians, their assessments may not have been comprehensive enough to address your concerns fully. A gastroenterologist can perform a thorough examination, including a flexible sigmoidoscopy or colonoscopy, which would allow for direct visualization of the rectum and colon. This procedure is particularly important given your history of rectal bleeding and the ongoing symptoms you are experiencing.

In terms of your question about whether to return to Taiwan for a colonoscopy, it is essential to weigh the urgency of your symptoms against the potential wait time for a specialist appointment in your current location. If your symptoms are significantly impacting your quality of life or if you have any new symptoms (such as weight loss, changes in appetite, or severe abdominal pain), it would be prudent to pursue a colonoscopy sooner rather than later, regardless of the location.

Additionally, managing your gastrointestinal symptoms may involve dietary adjustments, such as increasing fiber intake to help regulate bowel movements and reduce the risk of straining during defecation, which can exacerbate conditions like hemorrhoids and fissures. Staying hydrated and avoiding irritants such as caffeine and spicy foods may also be beneficial.

In summary, while some of your symptoms may be benign, the presence of rectal bleeding, especially following an episode of bright red blood, necessitates further investigation. Consulting with a gastroenterologist for a thorough evaluation, including a possible colonoscopy, is highly recommended to rule out any serious underlying conditions and to provide you with peace of mind. Your health is paramount, and addressing these symptoms promptly can lead to better outcomes and improved quality of life.

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