Post-Surgery Bleeding During Bowel Movements: Is It Normal?

Bleeding during bowel movements?

Hello, I had surgery for hemorrhoids and anal fistula at the end of June, and then in September, I underwent a procedure for internal hemorrhoids.
However, I have noticed that whenever I exert a little pressure during bowel movements, the likelihood of seeing blood on the toilet paper increases.
One particularly alarming instance occurred when I lightly touched the anal area, and the toilet paper was completely stained with blood, although it was not a significant amount or dripping into the toilet.
I have been observing this for several months, and it seems to happen a few times intermittently.
I returned to see the doctor, who mentioned that it is common for people to experience bleeding when straining during bowel movements and advised me not to worry.
He also stated that he did not see any wounds during the examination.

I would like to ask if it is normal to experience bleeding when straining during bowel movements.
I remember that before the surgery, even when I strained, there would only be a small amount of blood on the toilet paper because I had noticeable external hemorrhoids at that time.
However, after the surgery, the likelihood of bleeding has significantly increased with even slight exertion.
Why is this the case? Is it really normal for healthy individuals to experience bleeding during bowel movements? If so, wouldn't that mean many people would frequently test positive for occult blood in their stool? This would render colorectal cancer screening quite meaningless.
Should I seek another physician for further evaluation or arrange for additional tests? Thank you.

aa, 30~39 year old female. Ask Date: 2018/12/15

Dr. Ke Fangxu reply Surgery

In healthy individuals, blood in the stool is certainly not normal.
This situation is more likely to be caused by hemorrhoidal bleeding.
As long as there is no continued heavy bleeding, it should not be a major concern.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
Increasing dietary fiber intake can also be beneficial.
Warm sitz baths may help alleviate symptoms, and over-the-counter hemorrhoid suppositories can be used.
It is best to avoid taking stool softeners indiscriminately.
If bleeding persists, it is advisable to consult a physician.
If necessary, a colonoscopy can be arranged.

Reply Date: 2018/12/15

More Info

Post-surgery bleeding during bowel movements can be concerning, especially after undergoing procedures like hemorrhoidectomy or fistula surgery. It’s understandable to feel anxious about the presence of blood on toilet paper after a bowel movement, particularly when you’ve had surgeries that involve the anal region.
Firstly, it is important to note that minor bleeding after such surgeries can be relatively common. The surgical sites may still be healing, and any strain during bowel movements can lead to irritation or trauma to the delicate tissues in the area. This can result in bleeding, especially if there are still residual effects from the surgery, such as inflammation or sensitivity.
The fact that you are experiencing bleeding only when you exert some effort during bowel movements suggests that the bleeding may not be from a significant source. However, it is crucial to differentiate between minor bleeding and more serious conditions. If the blood is bright red and only appears on the toilet paper or stool, it is often indicative of a superficial source, such as hemorrhoids or minor fissures, rather than a more serious issue.
Your doctor’s reassurance that it is not uncommon for individuals to experience some bleeding when straining during bowel movements is consistent with medical understanding. However, it is essential to monitor the situation closely. If the bleeding becomes more frequent, increases in volume, or is accompanied by other symptoms such as severe pain, changes in bowel habits, or signs of infection (like fever or increased swelling), you should seek medical attention promptly.

Regarding your concerns about the implications of blood in the stool for colorectal cancer screening, it is important to understand that while minor bleeding can be common, it should not be dismissed. Routine screening for colorectal cancer, such as fecal occult blood tests, is designed to detect hidden blood in the stool that may not be visible. If you are experiencing visible blood, it is advisable to discuss this with your healthcare provider, as they may recommend further evaluation, such as a colonoscopy, to rule out any underlying conditions.

In terms of managing your symptoms, ensuring that your bowel movements are soft and regular can help minimize straining. This can be achieved through dietary adjustments, such as increasing fiber intake, staying well-hydrated, and possibly using stool softeners if recommended by your doctor.
If you continue to experience bleeding, or if you feel that your symptoms are not improving, it may be worthwhile to seek a second opinion or further evaluation from a specialist, such as a gastroenterologist or a colorectal surgeon. They can provide a more thorough examination and determine if any additional interventions are necessary.

In summary, while some bleeding after bowel movements can be normal following anal surgeries, it is essential to monitor the situation closely and maintain open communication with your healthcare provider. If you have any doubts or if your symptoms change, do not hesitate to seek further medical advice. Your health and peace of mind are paramount, and it is always better to err on the side of caution when it comes to potential complications following surgery.

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