Blood in Diarrhea: When to Seek Medical Attention

Bloody diarrhea

Hello, doctor.
Yesterday afternoon, I noticed mucus mixed with blood in the toilet after experiencing diarrhea.
I thought it might be hemorrhoids (I had a colonoscopy over a year ago, and the doctor said I had hemorrhoids).
However, when I passed gas before going to bed, I noticed a lot of blood mixed with the gas.
I immediately went to the toilet again, and there was blood along with mucus in the stool.
Could this indicate a serious issue, such as colitis? I'm very anxious and plan to visit the hospital next week.
Over a year ago, I had a colonoscopy, and aside from hemorrhoids, there were no abnormalities.
Is it possible that the doctor missed something or there was a blind spot? I have taken photos of the blood in my stool during these episodes; can I show these to the doctor during my appointment? I'm concerned it might make the doctor uncomfortable, so should I see the same doctor who performed my previous colonoscopy or another physician? Would it be necessary to request another colonoscopy? Thank you for your response, doctor.

W, 20~29 year old female. Ask Date: 2018/05/26

Dr. Ke Fangxu reply Surgery

At the age of 23, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is very, very low.
Based on your description, it seems more like irritable bowel syndrome combined with mild hemorrhoidal bleeding.
It is recommended to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber intake can also be beneficial.
If symptoms persist without improvement, you may want to consult a physician for medication or to undergo a colonoscopy.

Reply Date: 2018/05/26

More Info

When it comes to the presence of blood in diarrhea, it is essential to approach the situation with caution and awareness of potential underlying health issues. The symptoms you describe—mucus mixed with blood in the toilet, followed by more significant blood presence after passing gas—can be concerning and warrant immediate medical attention.

Potential Causes of Blood in Diarrhea
1. Hemorrhoids: Given your history of hemorrhoids, it is possible that they could be the source of the bleeding, especially if you have been experiencing straining during bowel movements. Hemorrhoids can cause bright red blood on the stool or toilet paper.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can also lead to bleeding and discomfort.

3. Infectious Colitis: This is inflammation of the colon due to infections, which can cause diarrhea with blood and mucus. Common infectious agents include bacteria (like E. coli or Salmonella), viruses, and parasites.

4. Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease or ulcerative colitis can lead to symptoms of bloody diarrhea, abdominal pain, and urgency.

5. Diverticulitis: This condition occurs when small pouches in the colon become inflamed or infected, potentially leading to bleeding.

6. Colorectal Cancer: Although less common, especially in younger individuals, any new onset of blood in the stool should be evaluated to rule out malignancies.

When to Seek Medical Attention
Given the symptoms you have described, it is advisable to seek medical attention promptly. Here are some guidelines on when to go to the doctor:
- Presence of Blood: If you notice blood in your stool, especially if it is accompanied by other symptoms like abdominal pain, fever, or significant changes in bowel habits.

- Severe Symptoms: If you experience severe abdominal pain, persistent diarrhea, or signs of dehydration (such as dizziness, dry mouth, or decreased urination).

- Worsening Condition: If your symptoms worsen or do not improve over a few days, it is crucial to consult a healthcare provider.

Diagnostic Considerations
Since you have had a colonoscopy in the past year, it is understandable to question whether anything was missed. While colonoscopies are thorough, they are not infallible. If your symptoms persist or worsen, discussing the possibility of a repeat colonoscopy with your doctor may be warranted, especially if there are new symptoms or changes in your health status.

Preparing for Your Appointment
- Documentation: Bring any photos of your stool if you feel comfortable doing so. This can provide valuable information to your healthcare provider.

- History: Be prepared to discuss your medical history, including any previous gastrointestinal issues, medications, and dietary habits.

- Symptoms: Clearly describe your symptoms, including when they started, their frequency, and any associated symptoms like pain or changes in appetite.

Conclusion
In summary, the presence of blood in your stool, particularly when accompanied by mucus and changes in bowel habits, is a sign that you should seek medical evaluation. While hemorrhoids may be a potential cause, other serious conditions must be ruled out. It is always better to err on the side of caution when it comes to gastrointestinal symptoms. Your proactive approach to scheduling an appointment is commendable, and bringing any relevant documentation will aid in your evaluation.

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