Mixed Blood in Stool: Causes and Concerns

Mixed rectal bleeding

Hello, Doctor.
Recently, I have noticed bright red streaks of blood mixed evenly within my stool after using the restroom.
Additionally, my anus feels slightly swollen and I have a sensation of something being present.
After a digital rectal examination, the doctor mentioned that there is only slight swelling of the anus and suggested that there shouldn't be any issues, possibly indicating a rupture of small blood vessels in the anal area.
However, I thought that anal issues typically present with blood on the surface of the stool.
This has made me quite anxious, and I would like to know what possible conditions could be causing this.
Thank you.

Nìmíng, 20~29 year old female. Ask Date: 2017/06/01

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 over-the-counter hemorrhoid suppositories can be used.
It is best to avoid taking stool softeners indiscriminately.
If bleeding persists, it is advisable to consult a physician.
Although the likelihood of developing colorectal cancer at the age of 24 is not zero, it is generally very low.
It is recommended to maintain a light diet and a good lifestyle.
Spicy, irritating, and greasy foods should be avoided.
If symptoms continue without improvement, a physician may prescribe medication or recommend a colonoscopy.

Reply Date: 2017/06/01

More Info

When it comes to the presence of bright red blood mixed in stool, it can understandably cause concern. The fact that you are experiencing this symptom, along with a feeling of swelling and a sensation of a foreign body in the anal area, warrants a closer examination to rule out any serious underlying conditions.

The bright red blood you are seeing in your stool is often indicative of bleeding that originates from the lower gastrointestinal tract, which includes the rectum and anus. Common causes of this type of bleeding include hemorrhoids, anal fissures, diverticular disease, or even more serious conditions such as colorectal polyps or cancer.
1. Hemorrhoids: These are swollen veins in the lower rectum or anus that can cause bleeding, especially during bowel movements. They can be internal or external. Internal hemorrhoids often present with bright red blood on the stool or toilet paper, while external hemorrhoids can cause pain and swelling.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can result in sharp pain during bowel movements and may also cause bleeding.

3. Diverticular Disease: This condition involves the formation of small pouches (diverticula) in the colon wall. If these pouches become inflamed or infected, they can bleed.

4. Colorectal Polyps or Cancer: While less common, polyps can bleed and may be a precursor to colorectal cancer. If you are experiencing persistent bleeding, it is crucial to investigate this possibility.

Regarding your concern about the blood being mixed within the stool rather than just on the surface, this can indeed happen with conditions like hemorrhoids or diverticular disease, where the bleeding is more significant or occurs higher up in the rectum or colon.
The fact that a digital rectal examination (DRE) indicated only slight swelling in the anal area is a positive sign, but it does not completely rule out other potential causes. It is essential to follow up with further diagnostic tests, such as a colonoscopy, especially if the bleeding persists or if you have other concerning symptoms like significant pain, changes in bowel habits, or weight loss.

In terms of management, if hemorrhoids or anal fissures are diagnosed, treatment may include dietary changes to increase fiber intake, topical treatments, and in some cases, surgical interventions. If diverticular disease or other conditions are suspected, a more comprehensive treatment plan will be necessary based on the specific diagnosis.

Given your symptoms and concerns, it is advisable to consult with a gastroenterologist, who specializes in digestive system disorders. They can provide a thorough evaluation and appropriate diagnostic testing to determine the exact cause of your symptoms.

In summary, while the presence of bright red blood in your stool can be alarming, many causes are treatable. It is crucial to seek further evaluation to ensure proper diagnosis and management. Please do not hesitate to reach out to a healthcare professional for a comprehensive assessment. Your health and peace of mind are paramount.

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