Bleeding During Bowel Movements: Is It Just Hemorrhoids or Something More?

Blood dripping while having a bowel movement?

Hello doctor, I am a mother who has given birth naturally to two children.
Last year, after delivering my second child, I experienced rectal prolapse.
At that time, I couldn't push it back in, but it gradually improved, and I have been living with it without much issue.
However, in the past few days, I've noticed that my bowel movements are accompanied by dripping blood; the blood comes out before the stool.
Additionally, my internal hemorrhoids protrude in a circular shape, resembling a cluster of grapes.
There is no pain, but I do suffer from constipation, so the front part of my stool is hard and gradually becomes softer towards the end.
The stool color is dark brown, and I usually don't drink much water.

I would like to know if this is simply hemorrhoids or if there is a risk of colon cancer.
I have seen two doctors, and neither recommended a colonoscopy, but I am still experiencing the bleeding symptoms.
What should I do?

Er Bao Ma, 30~39 year old female. Ask Date: 2018/11/15

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more likely that the prolapsed hemorrhoids are caused by constipation and should not be related to colorectal cancer.
I recommend that you first address the constipation issue and try to shorten the time spent on the toilet.
Increasing your intake of dietary fiber and fluids can also be beneficial.
If the symptoms persist without improvement, you should consult a physician for evaluation and possible medication.
If necessary, a colonoscopy can also be arranged.

Reply Date: 2018/11/15

More Info

Bleeding during bowel movements can be concerning, especially for someone with a history of hemorrhoids and rectal prolapse. Based on your description, it seems that you are experiencing rectal bleeding that occurs before and during bowel movements, along with the presence of internal hemorrhoids that protrude. While hemorrhoids are a common cause of rectal bleeding, it is essential to consider other potential causes, including more serious conditions such as colorectal cancer.

Hemorrhoids, both internal and external, can cause bright red blood to appear on the toilet paper or in the toilet bowl. Internal hemorrhoids can sometimes protrude from the anal canal, especially during bowel movements, and may appear as swollen, grape-like clusters. The fact that you are experiencing bleeding before the stool passes and that your stools are hard due to constipation suggests that straining during bowel movements could be exacerbating your hemorrhoid symptoms.

However, the presence of blood in your stool, even if it is bright red, should not be overlooked. While hemorrhoids are a common and often benign cause of rectal bleeding, other conditions such as anal fissures, diverticular disease, or even colorectal cancer can also present with similar symptoms. Given your history of rectal prolapse and the current symptoms, it is crucial to rule out any serious underlying conditions.

You mentioned that you have consulted with two doctors who did not recommend a colonoscopy. While it is possible that they assessed your symptoms and determined that hemorrhoids are the likely cause, it is essential to advocate for your health. If you continue to experience bleeding, especially if it is persistent or worsening, it would be prudent to seek a second opinion or request a referral to a gastroenterologist for further evaluation. A colonoscopy is a valuable diagnostic tool that can help visualize the colon and rectum, allowing for the identification of any abnormalities, including polyps or tumors.

In the meantime, managing your constipation is crucial. Increasing your fluid intake, consuming a high-fiber diet, and possibly using stool softeners can help prevent straining during bowel movements, which may alleviate some of the pressure on your hemorrhoids. Additionally, over-the-counter treatments such as topical creams or suppositories for hemorrhoids may provide symptomatic relief.

In summary, while your symptoms may be consistent with hemorrhoids, it is essential to remain vigilant and ensure that no serious conditions are overlooked. If bleeding persists or worsens, do not hesitate to seek further medical evaluation. Your health and peace of mind are paramount, and addressing these symptoms proactively is the best approach.

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