Blood in Stool: Causes, Concerns, and Next Steps

Rectal bleeding

Hello, doctor.
This morning, I noticed mucus with blood in my stool, and I also feel some discomfort around my anus.
I have experienced similar symptoms before.
Over two years ago, I had a colonoscopy, and the doctor diagnosed me with hemorrhoids but did not provide any treatment (although another doctor treated my grandfather).
At that time, when I asked the doctor what to do, he prescribed an ointment for me.
I often experience abdominal rumbling, flatulence, and a sense of urgency to have a bowel movement.
Occasionally, I notice mucus with blood in my stool, and I have also experienced diarrhea with blood (once), which makes me anxious and worried.
I have followed up with a doctor, but they suggested it might be bleeding from hemorrhoids or inflammation of the intestines.
I would like to know if any further tests are necessary (another colonoscopy or other examinations).
My usual bowel habit is once a day (in the morning), and I experience diarrhea approximately once every two weeks.
Additionally, after breakfast and between lunch and dinner, my intestines tend to be active, causing abdominal rumbling and bloating.
Every time I see blood in my stool, I become very concerned.
This has been troubling me for several years, and I hope the doctor can provide some advice.
Thank you.

W, 20~29 year old female. Ask Date: 2018/12/01

Dr. Ke Fangxu reply Surgery

This situation is likely a higher possibility of irritable bowel syndrome combined with hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period, shorten the time spent on the toilet, and increase the intake of dietary fiber, which can be helpful.
Warm sitz baths should assist in alleviating symptoms, and you can also purchase hemorrhoidal suppositories at the pharmacy.
It is best not to take laxatives indiscriminately.
If bleeding persists, it is advisable to consult a physician.
Although the likelihood of developing colorectal cancer at the age of 24 is not zero, it is generally very low.
Based on your description, it seems more like hemorrhoids.
It is recommended to maintain a light diet and a good lifestyle routine, avoiding spicy, irritating, and greasy foods.
If symptoms continue without improvement, you may ask a physician for medication or to undergo a colonoscopy.

Reply Date: 2018/12/01

More Info

Understanding blood in stool can be a concerning issue, and it's important to approach it with a clear understanding of potential causes and necessary next steps. Based on your description, it seems you have experienced intermittent symptoms, including blood in your stool, mucus, and discomfort around the anal area. These symptoms can be distressing, especially when they have persisted over time.

Possible Causes
1. Hemorrhoids: Given your previous diagnosis of hemorrhoids, this is a common cause of blood in the stool. Hemorrhoids can cause bright red blood, especially during bowel movements, and may be accompanied by discomfort or itching.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to bleeding and significant pain during bowel movements.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause inflammation in the intestines, leading to symptoms such as diarrhea, abdominal pain, and blood in the stool.

4. Diverticular Disease: Diverticulosis can lead to diverticulitis, which can cause bleeding and discomfort in the lower abdomen.

5. Polyps or Colorectal Cancer: While less common, polyps can bleed, and in some cases, they can be precursors to colorectal cancer. Given your history of symptoms, this is a consideration that should not be overlooked.

Next Steps
1. Consult a Gastroenterologist: Given the recurrence of your symptoms and the history of blood in your stool, it is advisable to consult a gastroenterologist. They can provide a thorough evaluation and determine if further investigation is necessary.

2. Repeat Colonoscopy: Since you had a colonoscopy two years ago, it may be time for a repeat examination, especially if your symptoms have changed or worsened. A colonoscopy can help visualize the colon and rectum, allowing for the identification of hemorrhoids, fissures, polyps, or signs of IBD.

3. Stool Tests: Your doctor may recommend stool tests to check for infections, blood, or signs of inflammation.

4. Dietary and Lifestyle Modifications: Keeping a food diary may help identify any dietary triggers that could be contributing to your symptoms. Increasing fiber intake, staying hydrated, and avoiding straining during bowel movements can help manage hemorrhoids and prevent constipation.

5. Symptom Management: Over-the-counter treatments such as topical creams for hemorrhoids or fiber supplements may provide relief. However, these should be discussed with your healthcare provider.

When to Seek Immediate Care
If you experience significant changes in your symptoms, such as large amounts of blood, severe abdominal pain, or signs of anemia (like fatigue, weakness, or dizziness), you should seek immediate medical attention.

Conclusion
While hemorrhoids are a common cause of blood in the stool, it is essential to rule out other potential causes, especially given your history of symptoms. A thorough evaluation by a gastroenterologist, including possibly repeating a colonoscopy, will provide clarity and guide appropriate treatment. Remember, it’s always better to address these concerns proactively rather than waiting for symptoms to worsen. Your health and peace of mind are paramount, so don’t hesitate to seek the care you need.

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