Do I Need Another Colonoscopy? Blood in Stool Concerns - Gastroenterology and Hepatology

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Based on your description, it sounds like you are experiencing a concerning symptom: blood in your stool. Given your history of having undergone a colonoscopy in 2017, where no polyps were found but hemorrhoids were noted, it is understandable that you are anxious about the recent increase in blood observed during bowel movements.

Firstly, it's important to recognize that blood in the stool can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, and more serious conditions such as colorectal cancer. The fact that you have seen bright red blood on the toilet paper and in the toilet bowl suggests that the source of the bleeding is likely from the lower gastrointestinal tract, possibly from hemorrhoids or an anal fissure, especially since you have a history of hemorrhoids. However, the increase in blood volume and frequency is concerning and warrants further investigation.

Given your history and the recent changes in your symptoms, it would be prudent to consider undergoing another colonoscopy. While hemorrhoids can cause bleeding, the presence of fresh blood, especially in larger amounts, should not be ignored. A repeat colonoscopy can help rule out any new developments in the colon or rectum that may not have been present during your last examination. It is also worth noting that guidelines generally recommend that individuals at average risk for colorectal cancer begin screening at age 45, and if you have a family history or other risk factors, you may need to be screened more frequently.

In addition to a colonoscopy, you might also want to discuss with your healthcare provider the possibility of other diagnostic tests, such as a fecal occult blood test (FOBT) or a fecal immunochemical test (FIT), which can help detect hidden blood in the stool. These tests can be useful for monitoring and may provide additional information about the source of the bleeding.

Moreover, lifestyle factors should also be considered. If you are experiencing constipation or straining during bowel movements, this can exacerbate hemorrhoids and lead to bleeding. Maintaining a high-fiber diet, staying hydrated, and engaging in regular physical activity can help promote regular bowel movements and reduce the risk of hemorrhoid flare-ups.

In summary, given the increase in blood observed in your stool, it is advisable to consult with your gastroenterologist about scheduling another colonoscopy. This will help ensure that any potential issues can be identified and addressed promptly. Additionally, discussing your overall screening schedule based on your age and risk factors will help you stay proactive about your gastrointestinal health. Remember, it is always better to err on the side of caution when it comes to symptoms like these.