Prolonged Rectal Bleeding and Associated Symptoms in Young Adults

Bleeding during bowel movements has persisted for 2-3 months?

Female, 21 years old, has lost 10 kg over the past 2-3 months.
Adequate water intake and a high vegetable consumption (healthy diet + detox drinks).
Has never undergone any gynecological, endocrinological, or gastrointestinal examinations and has rarely been ill, maintaining good health.
However, during this period, she has experienced persistent constipation, with bowel movements occurring every 2-3 days, recently improving to once a day.
After bowel movements, there is a small amount of blood on the tissue, but no blood in the stool or toilet.
Most bowel movements feel large and require significant effort to pass, with stool primarily deep brown in color.
There is a sensation of incomplete evacuation, occasionally accompanied by clear, white mucus or dark brown, almost black secretions (similar to paste, difficult to break apart).
Occasionally, bowel movements resemble diarrhea, with the diarrhea being deep yellow-brown.
Recently, symptoms of anemia have appeared, such as dizziness and nausea, especially in poorly ventilated environments (I am a blood donor and usually maintain a hemoglobin level of 13, but it has dropped to 11).
My feet are particularly prone to feeling cold.
Recently, I have experienced a dull sensation in the lower abdomen, with occasional severe abdominal pain that varies in duration.
All these symptoms are overwhelming, resembling acne but possibly indicating something else.
Thank you for your assistance.

Záluàn de tóuxù, 20~29 year old female. Ask Date: 2017/05/27

Dr. Chen Jiaming reply Surgery

There are many ways to lose weight, and many people encounter bowel issues during the process (though this is often not discussed).
Increasing fiber intake through dietary changes (such as vegetables, fruits, and special beverages), enhancing satiety, and reducing calorie absorption can lead to a significant increase in stool volume (indigestible residues).
This can alter bowel habits.
While drinking plenty of water can help some individuals, many still experience difficulties, especially those who previously had irregular bowel movements.

If weight loss is combined with exercise, the increased metabolic rate and elevated body temperature and sweating can raise overall water needs, which may also enhance the intestines' water absorption.
Although increasing water intake is beneficial, bowel habits may still change.
These changes are not necessarily negative but are often a matter of habit and adaptation.
If clinical discomfort arises, it is advisable to pause the weight loss plan.
1.
If bowel movements increase, please be gentle when wiping afterward.
Consider using moist wipes or a bidet to clean, which can reduce friction around the anal area and minimize the risk of bleeding.

2.
If symptoms of anemia appear, seek medical attention promptly for evaluation.
Blood donors typically give 250-500 mL per donation, and the body requires iron to produce new red blood cells afterward.
If your weight loss plan lacks sufficient iron (as plant-based iron sources are not as rich as those from meat or eggs), you may develop iron-deficiency anemia, accompanied by various discomforting symptoms.
Pausing the weight loss plan and gradually returning to a normal diet may help, and medical supplementation of iron can expedite recovery (though iron supplements can also lead to constipation).
Weight loss and blood donation are generally not compatible.
3.
Regarding concerns about gastrointestinal issues, bleeding, weight loss, abdominal pain, or other serious conditions such as cancer, the likelihood is low given your recent dietary changes, but it cannot be entirely ruled out.
If discomfort persists after pausing weight loss or if you are very concerned about these issues, it is recommended to consult a gastroenterologist or a colorectal surgeon for further evaluation, including a colonoscopy.
I hope this information is helpful to you!

Reply Date: 2017/05/27

More Info

Prolonged rectal bleeding in young adults can be concerning and may indicate underlying health issues that require medical evaluation. In your case, the symptoms you describe, including weight loss, changes in bowel habits, and the presence of blood during wiping, warrant a thorough investigation.

Firstly, the significant weight loss of 10 kilograms over 2-3 months, especially when combined with dietary changes, could be a sign of an underlying condition. While healthy eating and increased water intake are beneficial, unintentional weight loss can sometimes indicate gastrointestinal issues, metabolic disorders, or even malignancies. It is essential to consider the context of this weight loss; if it was intentional and part of a weight management plan, it may not be as concerning. However, if it was unintentional, it is crucial to seek medical advice.

Your bowel habits have also changed, with constipation being a primary issue. The fact that you are experiencing infrequent bowel movements (every 2-3 days) and that you feel the need to strain during defecation can lead to rectal bleeding, especially if there is any tearing of the anal tissue or hemorrhoids. The presence of blood on toilet paper, while concerning, is not uncommon in cases of constipation and anal fissures. However, it is essential to rule out more serious conditions such as inflammatory bowel disease (IBD), colorectal polyps, or even colorectal cancer, especially given your age and the other symptoms you are experiencing.

The description of your stools as large and hard, along with the occasional presence of mucus, could indicate a blockage or irritation in the intestines. The deep brown or black stools may suggest the presence of digested blood, which can be a sign of bleeding higher up in the gastrointestinal tract. This is particularly concerning and should be evaluated by a healthcare professional.

Additionally, the symptoms of anemia, such as dizziness, nausea, and cold extremities, are significant. Anemia can result from chronic blood loss, which may be related to your gastrointestinal symptoms. The drop in your iron levels from 13 to 11 is also concerning and could indicate that your body is not absorbing iron properly or that you are losing blood at a rate that your body cannot compensate for.

The lower abdominal discomfort and occasional severe abdominal pain further complicate your situation. These symptoms could be related to gastrointestinal issues, such as IBD, diverticulitis, or even gynecological conditions, given your age and gender.
In light of these symptoms, it is crucial to seek medical attention promptly. A healthcare provider may recommend a series of tests, including blood tests to check for anemia, stool tests to check for blood, and possibly imaging studies or a colonoscopy to visualize the intestines and identify any abnormalities.
In summary, your symptoms of prolonged rectal bleeding, weight loss, changes in bowel habits, and signs of anemia are concerning and should not be ignored. It is essential to consult with a healthcare professional who can provide a comprehensive evaluation and appropriate management. Early diagnosis and treatment are key to addressing any potential underlying conditions effectively.

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