Internal Hemorrhoids: Symptoms, Diagnosis, and Concerns

Internal hemorrhoid bleeding

Since high school, I have experienced blood in my stool but didn't think much of it.
I only saw a doctor last year.
The doctor performed a digital rectal exam and informed me that I have internal hemorrhoids.
At that time, I often had brown mucus in my stool and frequently experienced constipation.
The doctor arranged for a fecal occult blood test, but I mistakenly dug a hole in the stool sample and collected the sample from the middle part of the stool.
I later learned that I was supposed to scrape the surface of the stool.
When the results came back, the doctor told me it was negative and not to worry.
There were many patients that day, over a hundred, and the nurse just told me to wait outside.
I forgot to inform the doctor that I hadn't collected the surface of the stool for testing.
Should I redo the fecal occult blood test, or is the sample I collected from the middle still considered accurate? (Sorry for the lengthy message.) Recently, after six months, I have started to see blood in my stool again, and I am very worried about the possibility of cancer.

Nìmíng, 20~29 year old female. Ask Date: 2018/04/12

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.
Although the probability of developing colorectal cancer at the age of 23 is not zero, it is generally very low.
Since you have observed fresh blood in your stool, the results of a fecal occult blood test are not particularly meaningful.
Performing a superficial scraping or a deeper examination will not significantly impact the situation, and there is no need to repeat the occult blood test.
It is recommended to maintain a light diet and a good lifestyle routine, avoiding spicy, irritating, and greasy foods.
Increasing dietary fiber intake can also be beneficial.
If symptoms persist without improvement, you may consider asking your physician to arrange for a colonoscopy.

Reply Date: 2018/04/12

More Info

Understanding internal hemorrhoids is crucial, especially when experiencing symptoms such as rectal bleeding. Internal hemorrhoids are swollen veins located inside the rectum, and they can cause discomfort, pain, and bleeding, particularly during bowel movements. The bleeding is often bright red and may appear on the toilet paper or in the toilet bowl.
Given your history of rectal bleeding since high school, it is essential to take this symptom seriously. While internal hemorrhoids are a common cause of rectal bleeding, other conditions, including anal fissures, diverticular disease, inflammatory bowel disease (IBD), and colorectal cancer, can also lead to similar symptoms. Therefore, a thorough evaluation is necessary to rule out more serious conditions.

In your case, the initial examination by your doctor, which included a digital rectal exam, indicated the presence of internal hemorrhoids. The fact that you experienced brown mucus and constipation further supports the likelihood of hemorrhoids, as straining during bowel movements can exacerbate this condition. However, the negative result from your fecal occult blood test (FOBT) is reassuring, as it suggests that there is no significant bleeding from the lower gastrointestinal tract at that time.

Regarding your concern about the accuracy of the fecal sample you provided, it is generally recommended to collect samples from different areas of the stool, especially the surface, to increase the likelihood of detecting any hidden blood. If you feel uncertain about the accuracy of your previous test, it would be prudent to repeat the FOBT. This is particularly important given your recent recurrence of rectal bleeding.
It is understandable to feel anxious about the possibility of cancer, especially with a history of rectal bleeding. However, it is essential to remember that the majority of cases of rectal bleeding are due to benign conditions like hemorrhoids or anal fissures. Nevertheless, due to your ongoing symptoms, it would be wise to consult with a gastroenterologist for further evaluation. They may recommend additional diagnostic procedures, such as a colonoscopy, to visualize the entire colon and rectum, allowing for a comprehensive assessment of your gastrointestinal health.

In summary, while internal hemorrhoids are a likely cause of your symptoms, it is crucial to rule out other potential causes of rectal bleeding. Repeating the fecal occult blood test and possibly undergoing a colonoscopy would provide more clarity and peace of mind. Remember, early detection and intervention are key to managing any gastrointestinal issues effectively. Don't hesitate to reach out to your healthcare provider to discuss your concerns and the next steps in your evaluation.

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