Rectal Bleeding: Causes and Solutions for Young Adults

Rectal bleeding

Hello, doctor.
Two days ago and today, I experienced rectal bleeding.
The first time I had rectal bleeding was about a few months ago, and I thought it was hemorrhoids.
After visiting a clinic, the doctor said that at my young age, it was unlikely to be hemorrhoids, so he prescribed medication (including a stool softener), and my symptoms improved.
However, two days ago, I experienced rectal bleeding again, coinciding with my menstrual period, just like a few months ago.
I also have hard stools and anal pain during bowel movements.
Both times, the blood was bright red, and I experienced anal pain for a few days afterward, feeling like I had a tear.
After the rectal bleeding two days ago, I did not see a doctor, and because of the anal pain, I was afraid to use the restroom for two days.
Today, I experienced rectal bleeding again; my menstrual period has ended, but the bleeding has not improved.
I have been eating more fruits and vegetables, but my stools are still hard and in pieces, making it difficult to pass a complete stool, and I feel like I am not fully emptying my bowels.
The blood was on top of the stool and not mixed with it, but the amount was somewhat significant.
After using the restroom and wiping a few times, the bleeding stopped.
I would like to ask the doctor if these symptoms indicate hemorrhoids, anal fissures, or menstrual-related bleeding? How can I improve this situation? Thank you.

Niming, 10~19 year old female. Ask Date: 2019/03/06

Dr. Chen Qifeng reply Gastroenterology and Hepatology

The likelihood of hemorrhoids is the highest.
It is recommended to seek medical attention from a colorectal surgeon.

Reply Date: 2019/03/06

More Info

Rectal bleeding in young adults can be concerning and is often a symptom of underlying issues that need to be addressed. Based on your description, it seems you are experiencing rectal bleeding that coincides with your menstrual cycle, along with symptoms of hard stools and anal pain. Let's break down the potential causes and solutions for your situation.

Possible Causes
1. Hemorrhoids (Piles): Although your doctor previously mentioned that hemorrhoids are less common in younger individuals, they can still occur. Hemorrhoids are swollen veins in the rectal area that can bleed, especially during bowel movements. The blood is usually bright red and may appear on the toilet paper or on the stool.

2. Anal Fissures: Given your description of pain during bowel movements and the presence of bright red blood, anal fissures could be a likely cause. These are small tears in the lining of the anus, often caused by passing hard stools. The pain can be sharp and may lead to a fear of bowel movements, creating a cycle of constipation and further injury.

3. Menstrual Cycle Influence: Hormonal changes during your menstrual cycle can affect bowel habits and may lead to increased sensitivity or changes in the rectal area, potentially exacerbating conditions like hemorrhoids or fissures.

4. Dietary Factors: You mentioned that you have been trying to eat more fruits and vegetables, which is excellent. However, if your overall fluid intake is low, it may not be enough to soften your stools. Dehydration can lead to hard, painful stools.

5. Other Conditions: While less common, other gastrointestinal issues such as inflammatory bowel disease (IBD) or infections can also cause rectal bleeding. However, these are usually accompanied by other symptoms such as diarrhea, weight loss, or abdominal pain.

Recommended Solutions
1. Increase Fiber Intake: Continue to consume a diet rich in fiber, including fruits, vegetables, whole grains, and legumes. Aim for at least 25-30 grams of fiber per day. This can help soften stools and promote regular bowel movements.

2. Hydration: Ensure you are drinking plenty of water throughout the day. Adequate hydration is crucial for preventing constipation and maintaining healthy bowel movements.

3. Stool Softeners: If you are still experiencing hard stools, consider using over-the-counter stool softeners or laxatives as recommended by your healthcare provider. These can help ease the passage of stools and reduce the risk of fissures.

4. Warm Sitz Baths: Taking warm baths can help soothe anal pain and promote healing if you have fissures or hemorrhoids. This can also provide relief from discomfort.

5. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to go, don’t delay, as this can lead to harder stools.

6. Consult a Healthcare Provider: Since you have experienced rectal bleeding multiple times, it is essential to consult a healthcare professional for a thorough examination. They may recommend a physical examination or further tests to rule out any serious conditions.

7. Monitor Symptoms: Keep track of your symptoms, including the frequency of bleeding, the consistency of your stools, and any associated pain. This information can be helpful for your healthcare provider.

In conclusion, while hemorrhoids and anal fissures are common causes of rectal bleeding, it is crucial to seek medical advice to ensure proper diagnosis and treatment. By addressing dietary habits, hydration, and seeking professional help, you can manage your symptoms effectively and improve your overall gastrointestinal health.

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