Blood in Stool: When to Seek Further Medical Evaluation

There are small pinpoint red blood spots in the stool?

Hello, around early October, I noticed small pinpoint spots of fresh blood when wiping after using the restroom, but it wasn't very noticeable.
I visited a small clinic, and the doctor believed that due to my young age and long hours of sitting at work, it might be hemorrhoids.
However, after taking medication, I still intermittently noticed blood, and I often experienced unexplained pain and discomfort between my lower left abdomen and left leg.
Therefore, I decided to persist and underwent a colonoscopy at that clinic in mid-October.
After the procedure, the doctor informed me that there was non-specific mild inflammatory bleeding in the colon and that nothing concerning was found, advising me not to worry.
However, as of mid-November, I am still experiencing bleeding.
During a follow-up visit in early November, the doctor suggested that it might be due to low immunity and slow healing of the intestinal mucosa.
Indeed, I have not exercised for a long time and have a sedentary job.
I would like to know if I should go to a larger hospital for further examination, or is it possible that the recovery is just slow?

Niming, 20~29 year old female. Ask Date: 2017/11/12

Dr. Ke Fangxu reply Surgery

If the colonoscopy was performed in October, there should be no need to repeat it in a short period of time.
Mild bleeding should not be a cause for excessive concern.
Besides hemorrhoids, irritable bowel syndrome can also present with mucosal bleeding.
As long as there are no malignant tumors or ulcerative colitis, there is no need to worry.

Reply Date: 2017/11/12

More Info

When it comes to the presence of blood in the stool, it is essential to take this symptom seriously, even if the initial evaluation suggests a benign cause such as hemorrhoids or non-specific colitis. Given your history of seeing blood and experiencing discomfort in your left lower abdomen and leg, it is prudent to consider further medical evaluation, especially since the bleeding has persisted despite treatment.

Understanding Blood in Stool
Blood in the stool can arise from various sources, including the upper gastrointestinal tract (like the stomach or duodenum) or the lower gastrointestinal tract (like the colon or rectum). The appearance of blood can vary; it may be bright red, indicating fresh blood from the lower GI tract, or darker, suggesting older blood from higher up in the digestive system. In your case, the small pinpoint spots of bright red blood could indicate a localized issue, such as hemorrhoids or anal fissures, but persistent bleeding warrants further investigation.

Initial Evaluation and Findings
You mentioned that a colonoscopy was performed, which is a critical diagnostic tool for evaluating the colon. The finding of non-specific inflammation is somewhat reassuring, as it suggests that there is no immediate malignancy or severe pathology. However, the persistence of symptoms, including the blood and abdominal discomfort, raises questions about the underlying cause. Factors such as immune function, diet, and lifestyle can significantly impact gastrointestinal health and healing.

When to Seek Further Evaluation
1. Persistent Symptoms: Given that you continue to see blood and experience discomfort, it is advisable to seek further evaluation. While the initial findings were non-concerning, ongoing symptoms could indicate that the inflammation has not resolved or that there is another underlying issue.

2. Change in Symptoms: If you notice any changes in the nature of the blood (e.g., becoming more frequent, changing color, or accompanied by other symptoms like weight loss, changes in bowel habits, or severe pain), you should seek immediate medical attention.

3. Consulting a Specialist: If your primary care physician or the initial gastroenterologist is not providing satisfactory answers or if you feel your concerns are not being adequately addressed, consider seeking a second opinion from a gastroenterologist. They may recommend additional tests, such as imaging studies (like a CT scan) or repeat colonoscopy, to rule out other conditions.

4. Lifestyle Factors: You mentioned a sedentary lifestyle and lack of exercise, which can contribute to gastrointestinal issues. Incorporating regular physical activity, a high-fiber diet, and adequate hydration can help improve bowel health and potentially aid in recovery.

Conclusion
In summary, while your initial evaluation did not reveal any alarming findings, the persistence of blood in your stool and associated discomfort necessitates further investigation. It is essential to advocate for your health and ensure that your concerns are addressed. Seeking a second opinion or further testing may provide clarity and peace of mind. Remember, gastrointestinal symptoms can often be multifactorial, and a comprehensive approach that includes lifestyle modifications alongside medical evaluation is crucial for optimal health.

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