Blood in Stool: Hemorrhoids vs. Polyps

Blood in the stool?

Hello, doctor.
Around May, I noticed blood on the toilet paper after having a bowel movement, about the size of a five-dollar coin.
Since then, there has been a consistent presence of blood in my stools, with noticeable streaks of blood on the surface, although the shape of the stool remains normal.
I consulted a doctor, who diagnosed it as internal hemorrhoids.
After using a topical ointment, the bleeding stopped.
However, recently, the bleeding has resumed, with the blood still being bright red and adhering to the surface of the stool.
It takes about three pieces of toilet paper to wipe until there are no traces of blood.
Now, I'm uncertain whether I should undergo a colonoscopy, as I've read many articles but still cannot clearly determine whether it is internal hemorrhoids or possibly colorectal polyps.

aa, 20~29 year old female. Ask Date: 2017/06/03

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 bowel movements.
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 risk of developing colorectal cancer at the age of 20 is not zero, it is generally very low.
It is recommended to maintain a light diet and a good lifestyle, avoiding spicy, irritating, and greasy foods.
If symptoms continue without improvement, a physician can prescribe medication or perform a colonoscopy to check for colorectal polyps, as only a colonoscopy can provide a definitive diagnosis.

Reply Date: 2017/06/03

More Info

When it comes to understanding blood in stool, distinguishing between hemorrhoids and polyps is crucial for proper diagnosis and treatment. Hemorrhoids are swollen veins in the lower rectum or anus, often resulting in bright red blood on the toilet paper or in the stool. They can be caused by straining during bowel movements, prolonged sitting, or increased pressure during pregnancy. On the other hand, polyps are growths on the lining of the colon or rectum, which can vary in size and may be benign or precancerous.
In your case, the presence of bright red blood on the toilet paper and the surface of the stool, along with the normal shape of the stool, initially suggested hemorrhoids, especially since you experienced relief with topical treatments. However, the recurrence of bleeding raises valid concerns about the underlying cause. While hemorrhoids can cause intermittent bleeding, persistent or recurrent blood in the stool warrants further investigation to rule out other conditions, including polyps or even colorectal cancer.

The fact that you have experienced blood in your stool multiple times, even after treatment, indicates that a more thorough evaluation is necessary. A colonoscopy is a recommended procedure for anyone with rectal bleeding, especially if the bleeding persists or if there are changes in bowel habits. This procedure allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities, including hemorrhoids, polyps, or other potential issues.

It is also important to consider your age, family history, and any additional symptoms you may have, such as changes in weight, appetite, or bowel habits. These factors can influence the urgency and type of diagnostic tests that may be necessary.
In summary, while hemorrhoids are a common cause of bright red blood in the stool, the recurrence of your symptoms suggests that further evaluation is warranted. A colonoscopy will provide clarity and help rule out more serious conditions. It is essential to communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you through the necessary steps for diagnosis and treatment. Remember, early detection and intervention are key in managing any potential gastrointestinal issues effectively.

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