Rectal Bleeding: Hemorrhoids and Related Concerns

Bleeding during bowel movements and hemorrhoid issues?

Hello, Dr.
Ke.
Earlier this year, after considering relevant opinions, I sought medical attention at the Hsinchu branch of National Taiwan University Hospital.
During the outpatient visit, the doctor performed a digital examination and used a proctoscope to assess the condition of my internal hemorrhoids.
The doctor mentioned that I have internal hemorrhoids, and there are more than one.
To ensure safety, a colonoscopy was scheduled for the end of February this year.
After the examination, the endoscopist indicated that it was a hemorrhoid issue, and upon returning to the outpatient clinic, the doctor confirmed this and prescribed an anal suppository to alleviate the effects of the hemorrhoids.
Recently, I have experienced bleeding after bowel movements, primarily due to hard stools, accompanied by severe pain.
The diameter of the stool is about the size of a circle formed by my thumb and index finger.
This issue has been intermittent for 3-4 weeks.
I have been trying to maintain a normal diet with more vegetables and fruits, drink yogurt, and sleep well, but the stools remain hard, leading to a recurring sensation.
I really want to have bowel movements without pressure, but it feels very difficult.
Do you have any suggestions for softening the stools?
Additionally, I sometimes notice white mucus on the hard part of the stool.
Is this a pathological phenomenon? Three years ago, when I had severe constipation, the white mucus would cover pellet-like stools.
Although I feel it has some lubricating effect, I found online that it could be a precursor to colorectal cancer, which is quite concerning.
I would also like to ask if hemorrhoid bleeding can occur after bowel movements when the anal sphincter relaxes.
Is it possible to have multiple internal hemorrhoids? After experiencing bleeding during bowel movements, could it last for several days? Could this be a sign of rectal cancer near the anal opening? If I have been constipated and sitting on the toilet for a long time, with stool stuck at the anal opening and appearing pellet-like, resulting in a blood volume similar to menstrual blood, and if there are small clots upon wiping, is this also caused by hemorrhoids? Is it possible for multiple internal hemorrhoids to bleed simultaneously? How can this situation be improved?
I apologize for the many questions, and I appreciate your help.
It is not easy to get an appointment at a large hospital, but I am quite worried, so I wanted to inquire first.
Thank you very much.
Best regards, A-Han.

Ahan, 20~29 year old female. Ask Date: 2018/09/17

Dr. Ke Fangxu reply Surgery

At the age of 25, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is very, very low.
Since you have already undergone a colonoscopy, there is no need to worry.
The presence of mucus is mostly related to prolonged bowel movements.
It is advisable to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided.
Increasing your intake of dietary fiber from plant sources can also be beneficial.
If symptoms persist without improvement, you may consult your physician for medication.

Reply Date: 2018/09/17

More Info

Hello 阿涵,
Thank you for your detailed inquiry regarding your rectal bleeding and concerns about hemorrhoids. It’s understandable to feel anxious about these symptoms, especially with the history of constipation and the presence of blood during bowel movements. Let’s break down your concerns and address them one by one.

Understanding Hemorrhoids and Rectal Bleeding
1. Hemorrhoids: Hemorrhoids are swollen veins in the lower rectum and anus, which can cause discomfort, pain, and bleeding during bowel movements. The bleeding you are experiencing, especially after passing hard stools, is a common symptom of hemorrhoids. When hard stools pass through the anal canal, they can irritate and damage the delicate tissue of hemorrhoids, leading to bleeding.

2. Hard Stools: The hardness of your stools can be attributed to several factors, including insufficient fiber intake, dehydration, and lack of physical activity. It’s great that you are trying to incorporate more fruits, vegetables, and yogurt into your diet, as these can help soften stools. However, you may need to increase your fiber intake further. Aim for a daily intake of 25-30 grams of fiber, and consider adding fiber supplements like psyllium husk if necessary.

3. Mucus in Stool: The presence of white mucus in your stool can be normal, as mucus helps lubricate the intestines. However, if you notice an increase in mucus or if it is accompanied by other symptoms like pain, changes in bowel habits, or blood, it’s important to consult a healthcare provider. While mucus alone is not a definitive sign of cancer, any persistent changes in bowel habits should be evaluated.

4. Bleeding After Bowel Movements: It is common for hemorrhoids to bleed after a bowel movement, especially if the stool is hard. The blood is usually bright red and can appear on the toilet paper or in the toilet bowl. If you notice blood that is darker or mixed with stool, or if the bleeding persists, it’s crucial to seek medical attention to rule out other conditions.

5. Multiple Hemorrhoids: It is possible to have multiple hemorrhoids, and they can all contribute to bleeding. The presence of several hemorrhoids can lead to increased discomfort and bleeding, especially if they are aggravated by hard stools.

Recommendations for Improvement
- Dietary Changes: Continue to focus on a high-fiber diet. Foods rich in fiber include whole grains, fruits, vegetables, and legumes. Additionally, drink plenty of water (at least 8-10 glasses a day) to help keep your stools soft.

- Stool Softeners: Over-the-counter stool softeners can be helpful in easing bowel movements. Products like docusate sodium can help soften the stool and make it easier to pass.

- Regular Bowel Habits: Try to establish a regular bowel routine. Don’t ignore the urge to go, and avoid straining during bowel movements. Spending excessive time on the toilet can increase pressure on the hemorrhoids.

- Topical Treatments: Over-the-counter creams or suppositories designed for hemorrhoids can provide relief from pain and itching. These often contain hydrocortisone or witch hazel.

- Warm Baths: Soaking in a warm bath can help relieve discomfort and promote healing. This can be particularly soothing after bowel movements.

When to Seek Further Help
If your symptoms persist despite these measures, or if you experience significant pain, changes in bowel habits, or any new symptoms, it’s important to consult a healthcare professional. While hemorrhoids are a common cause of rectal bleeding, other conditions such as anal fissures, diverticular disease, or even colorectal cancer can also present with similar symptoms.
Given your concerns about the possibility of colorectal cancer, especially with a history of severe constipation and the presence of blood, it may be prudent to seek a second opinion or follow up with a gastroenterologist. They can perform a thorough evaluation and may recommend further diagnostic tests, such as a colonoscopy, to ensure everything is normal.

In summary, while hemorrhoids are likely the cause of your symptoms, it’s essential to monitor your condition closely and maintain open communication with your healthcare provider. Don’t hesitate to seek further evaluation if your symptoms do not improve or if you have any new concerns.

Take care, and I hope you find relief soon!

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