Abdominal Pain and Hemorrhoids: When to Seek Help - Gastroenterology and Hepatology

Abdominal pain and hemorrhoid issues?

Hello, I have recently experienced some abdominal pain, particularly on the left side.
One time, after having dinner, I felt a sharp pain in my abdomen, which seemed to be related to my stomach, but there was also some discomfort in the middle.
After I paused my meal and rested for a bit, the pain gradually subsided.
Regarding my bowel movements, they are mostly formed and the color is generally normal, although occasionally I notice darker stools.
The frequency is about once every one to two days, but sometimes I have days where I go twice with thinner stools, though not every time is it thinner.
Additionally, I currently have an external hemorrhoid, which feels about 0.5 to 1 cm in size.
It usually doesn’t hurt, but if my eating habits or daily routine are irregular, it can become hard and swollen, causing pain or leading to diarrhea, which results in blood on the toilet paper.
About four to five years ago, I underwent a colonoscopy due to hemorrhoids, and although there was a positive fecal occult blood test, the actual examination was relatively normal.
I would like to ask: 1.
Given my symptoms, do I need to undergo an upper endoscopy or colonoscopy? 2.
Is it true that if I have hemorrhoids, the fecal occult blood test will always be positive? If so, does that mean I won’t need to do the test in the future? 3.
Since I am unsure if I have internal hemorrhoids and only know about the external ones, which have been present for about ten years, is there a need for surgery? 4.
If I neglect the hemorrhoid issue, will it worsen or become difficult to treat as I age? Thank you.

p, 30~39 year old female. Ask Date: 2018/02/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
Please visit the gastroenterology outpatient clinic for a gastroscopy and a stool occult blood test.
Additionally, internal hemorrhoids are a common issue, and surgical treatment is only considered if there is frequent bleeding.
Internal hemorrhoids are vascular tissues in the anal area and do not evolve into colorectal cancer.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/02/19

More Info

When it comes to abdominal pain and hemorrhoids, understanding the symptoms and knowing when to seek medical help is crucial, especially for individuals with a history of gastrointestinal issues. Based on your description, it seems you are experiencing a combination of abdominal discomfort, changes in bowel habits, and issues related to hemorrhoids. Let's break down your concerns and address them systematically.

1. Symptoms and Diagnostic Procedures
Given that you have experienced left-sided abdominal pain, particularly after meals, and occasional changes in your bowel movements (including black stools and thinner stools), it is essential to consider a few factors. The black stools could indicate the presence of blood in the gastrointestinal tract, which may require further investigation. While hemorrhoids can cause rectal bleeding, the presence of black stools (melena) often suggests bleeding from higher up in the digestive tract, such as the stomach or small intestine.

Considering your symptoms, it would be prudent to consult with a gastroenterologist. They may recommend both an upper endoscopy (esophagogastroduodenoscopy or EGD) and a colonoscopy to thoroughly evaluate your gastrointestinal tract. These procedures can help identify any potential sources of bleeding, inflammation, or other abnormalities.

2. Hemorrhoids and Blood in Stool
Regarding your question about the relationship between hemorrhoids and positive stool blood tests, it is important to note that while hemorrhoids can cause blood in the stool, not all instances of rectal bleeding are due to hemorrhoids. Therefore, if you have a history of positive fecal occult blood tests (FOBT) due to hemorrhoids, it does not mean that future tests will always be positive. However, any instance of rectal bleeding should be evaluated to rule out more serious conditions, including colorectal cancer.

3. Management of Hemorrhoids
You mentioned having an external hemorrhoid that has been present for about ten years. While many individuals live with hemorrhoids without requiring surgery, the decision to undergo surgical intervention often depends on the severity of symptoms and the impact on quality of life. If your hemorrhoids are causing significant pain, bleeding, or discomfort, it may be worth discussing surgical options with a colorectal surgeon. They can provide insight into whether a procedure like hemorrhoidectomy or other minimally invasive treatments would be beneficial for you.

4. Long-term Management and Prognosis
If hemorrhoids are left untreated, they can potentially worsen over time, especially if lifestyle factors such as diet, hydration, and bowel habits are not addressed. Chronic straining during bowel movements can exacerbate hemorrhoids and lead to complications such as thrombosis or prolapse. Therefore, it is advisable to adopt a high-fiber diet, stay well-hydrated, and avoid prolonged sitting or straining during bowel movements. Regular follow-ups with your healthcare provider can help monitor your condition and prevent complications.

Conclusion
In summary, given your symptoms of abdominal pain, changes in bowel habits, and the presence of hemorrhoids, it is essential to seek a thorough evaluation from a gastroenterologist. Diagnostic procedures such as an upper endoscopy and colonoscopy may be warranted to rule out any serious underlying conditions. Additionally, discussing your hemorrhoid symptoms with a colorectal specialist can help determine the best course of action for management. Remember, timely intervention can significantly improve your quality of life and prevent potential complications.

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