Blood in Stool: Causes and When to Seek Help - Gastroenterology and Hepatology

Q: Blood in Stool: Causes and When to Seek Help

Hello： 1. <br>Melanocytic nevi can cause discoloration of the stool, which is often distributed on the surface and can occur in the anterior, middle, or posterior segments. <br>2. <br>X-rays are primarily used to check for fecal impaction or gas. <br>If there is a possibility of

Blood in the stool for two consecutive days?

Hello Doctor, I would like to ask for your advice: Yesterday, my bowel movement was clay-colored, soft, and in small quantities, with one piece having a large area of light purple blood on its surface.
Initially, there was no blood on the toilet paper when I wiped, but later there was a significant amount of bright red blood.
I went to see a doctor in the afternoon, who performed a digital rectal examination and suggested that it might be caused by internal hemorrhoids (I have a history of both internal and external hemorrhoids).
However, I have been experiencing occasional pain in the same spot in my left lower abdomen for several years.
Previous doctors indicated that it was due to a muscle strain (I only feel pain when I take a deep breath while lying flat, causing my abdomen to contract, but it doesn't happen every time).
The doctor suggested scheduling a colon X-ray, but since I am currently trying to conceive (and taking ovulation medication), the doctor advised against it and suggested that I observe my symptoms further.
Today, my bowel movement was again clay-colored (the previous days were darker, coffee-colored, but for the last two days, it has been clay-colored).
Today, one of the pieces of stool had light purple blood in the middle, and I did not experience abdominal pain; I only felt the urge to go to the bathroom.
I usually have a bowel movement almost every day, with occasional constipation leading to harder stools (but I often have anal fissures).
I would like to ask the doctor: 1.
If it is internal hemorrhoids, can blood appear in the middle of the stool? 2.
Do I need to have an X-ray, or are there other tests that would be more suitable for me? 3.
If I do go for the X-ray, how long after the procedure should I wait before trying to conceive? Thank you, Doctor, for your assistance!

Shuhui, 20~29 year old female. Ask Date: 2017/10/26

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
Melanocytic nevi can cause discoloration of the stool, which is often distributed on the surface and can occur in the anterior, middle, or posterior segments.
2.
X-rays are primarily used to check for fecal impaction or gas.
If there is a possibility of pregnancy, it is still recommended to avoid the procedure.
Additionally, fecal impaction can cause left lower abdominal pain, and if the left ovary is stimulated by ovulation medication, it can also lead to discomfort during ovulation.
3.
Generally, if there is no pregnancy and no concerns about visualizing the fetus, the X-ray can be performed.
X-rays involve a single exposure to radiation, which does not remain in the body, and the basic dosage is low, posing minimal risk to unfertilized eggs.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/10/26

More Info

Understanding blood in stool can be concerning, and it’s important to approach this issue with a clear understanding of potential causes and when to seek medical help. Based on your description, it seems you have experienced rectal bleeding, which can arise from various conditions, some benign and others more serious.

1. Causes of Blood in Stool: The presence of blood in your stool can be attributed to several factors. In your case, the doctor suggested that it might be due to internal hemorrhoids (or internal piles), which is a common cause of rectal bleeding. Hemorrhoids can cause bright red blood on the surface of the stool or on toilet paper after wiping. Other potential causes of blood in the stool include anal fissures, diverticular disease, colorectal polyps, or even more serious conditions like colorectal cancer. The fact that you have a history of hemorrhoids supports this diagnosis, but it’s essential to rule out other causes, especially given your ongoing abdominal pain.

2. Blood Appearance: Regarding your question about whether blood can appear in the middle of the stool if it is due to hemorrhoids, the answer is yes. Hemorrhoids can cause blood to coat the stool or appear on its surface, but it typically does not mix with the stool itself. If the blood is bright red, it usually indicates that the source of bleeding is from the lower gastrointestinal tract, such as the rectum or anus.

3. Need for Imaging: As for the necessity of an X-ray or other imaging studies, it’s understandable that your doctor is cautious, especially since you are preparing for pregnancy. While an X-ray can provide some information, it may not be the most effective method for evaluating gastrointestinal bleeding. A colonoscopy is often the preferred method for visualizing the colon and identifying any abnormalities. However, this procedure may also be deferred if you are actively trying to conceive. It’s crucial to have a thorough discussion with your healthcare provider about the risks and benefits of any imaging studies, considering your current health status and future plans.

4. Timing for Pregnancy: If you do undergo an X-ray, the timing for resuming attempts to conceive will depend on the type of imaging and any potential exposure to radiation. Generally, if a standard X-ray is performed, the radiation exposure is minimal, and you may not need to wait long before trying to conceive again. However, if you have any concerns about radiation exposure, it’s best to consult with your doctor for personalized advice.

5. Monitoring Symptoms: Given your history of abdominal pain and the recent changes in your bowel habits, it’s essential to monitor your symptoms closely. If you experience any worsening of your abdominal pain, changes in bowel habits, or if the bleeding persists or increases, you should seek medical attention promptly.
In conclusion, while internal hemorrhoids could be the cause of your symptoms, it’s vital to remain vigilant and communicate openly with your healthcare provider. They can help you navigate the best course of action, including whether further testing is necessary and how to manage your symptoms while considering your plans for pregnancy. Always prioritize your health and well-being, and don’t hesitate to seek a second opinion if you feel uncertain about your diagnosis or treatment plan.

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