Rectal Bleeding: Causes and When to See a Doctor

Rectal bleeding

Hello doctor, I have been experiencing difficulty with bowel movements recently.
After eating hot pot (which was spicy) yesterday, I felt pain in my anus this morning during a bowel movement, but there was no bleeding.
About ten minutes later, I still felt the urge to go.
Later in the afternoon, after having lunch, I felt the urge again, but after using the toilet, I noticed there was only blood in the toilet and no stool.
When I wiped with toilet paper, I also found a blood clot.
Previously, after having a bowel movement, I often noticed a piece of tissue protruding from my anus, which I would push back in with my fingers.
I also have a small piece of tissue near my anus regularly.
Could you please advise me on what this might be? Should I see a doctor, or would increasing my intake of vegetables and fruits be sufficient?

Lin, 20~29 year old female. Ask Date: 2018/01/07

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.
Increasing dietary fiber intake can also be beneficial.
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.
If necessary, a colonoscopy can be arranged.

Reply Date: 2018/01/07

More Info

Rectal bleeding can be a concerning symptom, and it's important to understand its potential causes and when to seek medical attention. Based on your description, it sounds like you may be experiencing a combination of symptoms that could be related to hemorrhoids or anal fissures, but there are other possibilities as well.

Possible Causes of Rectal Bleeding
1. Hemorrhoids: These are swollen blood vessels in the rectal area that can cause pain, itching, and bleeding during bowel movements. The presence of a "meat-like" protrusion that you mentioned could be indicative of external hemorrhoids. They can bleed, especially if they are irritated or thrombosed.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain during and after bowel movements, and sometimes bleeding can occur.

3. Diverticular Disease: This condition involves small pouches that can form in the colon wall, which may become inflamed or infected, leading to bleeding.

4. Colorectal Polyps or Cancer: While less common, bleeding can also be a sign of polyps or colorectal cancer, especially if there are changes in bowel habits or if the bleeding is persistent.

5. Infections or Inflammatory Conditions: Conditions such as inflammatory bowel disease (IBD) or infections can also cause rectal bleeding.

When to See a Doctor
Given your symptoms, especially the presence of blood in the toilet and the blood clots, it is advisable to consult a healthcare professional. Here are some specific indicators that warrant a visit to the doctor:
- Persistent Bleeding: If you notice blood in your stool consistently over several days.

- Severe Pain: If the pain during bowel movements becomes severe or unbearable.

- Changes in Bowel Habits: If you experience significant changes in your bowel habits, such as diarrhea or constipation that lasts for more than a few days.

- Associated Symptoms: If you experience other symptoms such as weight loss, fever, or fatigue.

- Prolapse: If the "meat" you mentioned is a prolapsed hemorrhoid that cannot be pushed back in or is painful.

Dietary Considerations
While increasing your intake of fruits, vegetables, and fiber can help improve bowel regularity and may alleviate some symptoms, it is not a substitute for medical evaluation, especially given the presence of blood. A high-fiber diet can help prevent constipation and reduce straining during bowel movements, which is beneficial for both hemorrhoids and fissures.

Conclusion
In summary, while your symptoms may be related to common conditions like hemorrhoids or anal fissures, the presence of blood and clots is a sign that you should seek medical attention. A healthcare provider can perform a thorough examination, possibly including a digital rectal exam or colonoscopy, to determine the exact cause of your symptoms and recommend appropriate treatment. Early intervention can help prevent complications and ensure better outcomes.

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