Blood on Stool: When to Seek Medical Attention

Blood on the surface of the stool?

Hello doctor, I first noticed blood streaks on the surface of my stool last September.
Over the next few days and occasionally for one to two months, I continued to see this.
After consulting a doctor, I was told it was a mild case of internal hemorrhoids.
I asked the doctor if I needed a colonoscopy, but he believed it was unnecessary since the frequency of bleeding was not very high.
Since then, I have developed a habit of monitoring my stool, which mostly appears normal, but I also experience abdominal pain and loose stools.
Sometimes, I feel like I have finished but still have the urge to push, and afterward, I notice light red blood on the toilet paper, or sometimes blood mixed with mucus.
My bowel habits are usually daily or every other day.
Since discovering the blood in my stool, I have also frequently experienced bowel sounds and a sensation of gas moving through my intestines, along with occasional abdominal pain and frequent flatulence.
A few days ago, after taking cold medicine containing antibiotics for three days, I had diarrhea for two days, followed by a day without a bowel movement.
This morning, when I had a bowel movement, I suddenly noticed blood streaks embedded in the stool, resembling two or three twig-like shapes, and there was also some blood mixed with mucus on the toilet paper.
Could you please tell me what this situation might be? Do I need to undergo a colonoscopy? I tend to be a very anxious person and have been worried about the possibility of cancer.

Niming, 20~29 year old female. Ask Date: 2019/02/20

Dr. Ke Fangxu reply Surgery

At the age of 27, 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.
Increasing dietary fiber intake can also be beneficial.
If symptoms persist without improvement, you may consult a physician for medication or consider undergoing a colonoscopy.

Reply Date: 2019/02/20

More Info

When it comes to the presence of blood in stool, it is essential to approach the situation with caution and awareness. Blood in the stool can be alarming and may indicate various underlying conditions, ranging from benign to serious. In your case, you have experienced intermittent blood on the surface of your stool, which your doctor attributed to mild internal hemorrhoids. However, the persistence of symptoms, including abdominal pain, changes in bowel habits, and the appearance of mucus with blood, warrants further investigation.

Understanding Blood in Stool
Blood in the stool can manifest in different forms, such as bright red blood, which often indicates bleeding from the lower gastrointestinal tract (like hemorrhoids or anal fissures), or darker blood, which may suggest bleeding from higher up in the digestive system (like ulcers or tumors). The fact that you have observed bright red blood and mucus suggests that the bleeding may be localized to the rectum or anus.

When to Seek Medical Attention
While your doctor initially deemed a colonoscopy unnecessary due to the infrequent nature of the bleeding, it is crucial to consider several factors that may necessitate further evaluation:
1. Frequency and Quantity of Blood: If the blood becomes more frequent or the quantity increases, it is advisable to seek medical attention. The appearance of multiple streaks of blood, as you described, should not be ignored.

2. Accompanying Symptoms: The presence of abdominal pain, changes in bowel habits (such as diarrhea followed by constipation), and the sensation of incomplete evacuation are significant symptoms that warrant further investigation. These could indicate underlying conditions such as inflammatory bowel disease (IBD), infections, or even polyps.

3. Duration of Symptoms: Since you have been observing these symptoms for an extended period, it is prudent to consult with a gastroenterologist. They can provide a thorough evaluation and determine whether a colonoscopy or other diagnostic tests are necessary.

4. Family History and Risk Factors: If there is a family history of colorectal cancer or other gastrointestinal diseases, this increases the importance of timely evaluation.

The Importance of Colonoscopy
A colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify sources of bleeding, such as hemorrhoids, polyps, diverticulosis, or more serious conditions like colorectal cancer. Given your ongoing symptoms and concerns, a colonoscopy could provide peace of mind and ensure that any potential issues are addressed early.

Managing Anxiety
It is understandable to feel anxious about the possibility of serious conditions like cancer, especially when experiencing concerning symptoms. However, it is important to remember that many causes of blood in the stool are benign. Engaging in open discussions with your healthcare provider about your fears and symptoms can help alleviate anxiety and guide you toward appropriate care.

Conclusion
In summary, while your initial assessment indicated mild internal hemorrhoids, the persistence and nature of your symptoms suggest that further evaluation is warranted. A colonoscopy can provide clarity and help rule out any serious conditions. It is essential to prioritize your health and seek medical attention when symptoms change or worsen. Remember, early detection and intervention are key to managing any potential health issues effectively.

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