Blood in Stool: Causes and When to Seek Help

Rectal bleeding

Hello doctor, I sometimes experience constipation, and it has been more severe lately, with bowel movements occurring every 2 to 3 days.
The stools are somewhat hard and vary in size, with some being larger and some smaller.
During these recent bowel movements, I have noticed blood in my stool, and I also feel a sensation of blockage in my anus whenever I am constipated.
The hard stools can sometimes be difficult to pass.
The blood in the stool appears bright red and is attached to the feces, while the color of the stool is usually normal, either coffee-colored or golden.
However, there are times when I notice white mucus mixed in.
Could this be due to hard stools causing anal fissures and bleeding? Or could it be hemorrhoids or a precursor to colorectal cancer? However, when I notice blood, I don't see any on the toilet paper after wiping.
I have a habit of eating fruit regularly, at least every two days, and there is no family history of cancer.
I am unsure if it is necessary to undergo a colonoscopy or similar examination.

Xiao Yi, 20~29 year old female. Ask Date: 2017/08/22

Dr. Ke Fangxu reply Surgery

At the age of 22, the likelihood of developing colorectal cancer is not zero, but generally, it is very low.
In this case, the possibility of hemorrhoidal bleeding is higher.
As long as there is no further bleeding, there is no need for 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 laxatives indiscriminately.
If bleeding persists, it is advisable to consult a physician.
If there are still concerns, a colonoscopy can be arranged.

Reply Date: 2017/08/22

More Info

When it comes to blood in the stool, it is essential to understand the potential causes and when to seek medical help. Based on your description, it seems you are experiencing constipation, which can lead to hard stools that may cause discomfort during bowel movements. The presence of bright red blood on the stool or on the toilet paper can indeed be alarming, and it is crucial to consider several factors.

1. Causes of Blood in Stool: The bright red blood you are observing is often associated with bleeding from the lower gastrointestinal tract, which includes the rectum and anus. Common causes of such bleeding include:
- Hemorrhoids: Swollen blood vessels in the rectal area that can bleed during bowel movements, especially if the stool is hard and requires straining.

- Anal Fissures: Small tears in the lining of the anus that can occur due to passing hard stools. These can cause sharp pain and bleeding during and after bowel movements.

- Diverticular Disease: Small pouches that can form in the colon wall and may bleed.

- Colorectal Polyps or Cancer: While less common, these can also cause bleeding. However, given your age and lack of family history of cancer, this is less likely.

2. Symptoms and Signs: The fact that you are experiencing constipation and hard stools suggests that the blood may be due to hemorrhoids or anal fissures. The bright red color of the blood typically indicates that the source of bleeding is near the end of the gastrointestinal tract. If the blood were darker, it could indicate a source higher up in the digestive tract.

3. When to Seek Help: It is advisable to seek medical attention if:
- The bleeding persists or worsens.

- You experience significant pain or discomfort.

- You notice other symptoms such as weight loss, changes in bowel habits, or abdominal pain.

- You have a family history of colorectal cancer or other gastrointestinal diseases.

4. Diagnostic Procedures: A colonoscopy may be recommended if there are concerning symptoms or if the bleeding does not resolve. This procedure allows the doctor to visualize the colon and rectum and can help identify the source of bleeding. However, if your symptoms are primarily related to constipation and you are otherwise healthy, your doctor may first recommend dietary changes, increased hydration, and possibly stool softeners or laxatives.

5. Management and Prevention: To manage your current symptoms and prevent future occurrences:
- Increase your fiber intake through fruits, vegetables, and whole grains to help soften stools.

- Stay hydrated by drinking plenty of water.

- Consider regular physical activity to promote bowel regularity.

- Avoid straining during bowel movements, as this can exacerbate hemorrhoids and fissures.

In conclusion, while the presence of blood in your stool can be concerning, it is often related to benign conditions such as hemorrhoids or anal fissures, especially in the context of constipation. However, it is essential to monitor your symptoms and consult a healthcare professional for a thorough evaluation and appropriate management. If you have any doubts or if your symptoms persist, do not hesitate to seek medical advice.

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