Blood After Bowel Movements: Causes and Concerns - Gastroenterology and Hepatology

There is blood when wiping after a bowel movement, but there is no pain?

I am someone who exercises frequently, eats a lot of fruits and vegetables, and has regular bowel movements every day.
Although my job often requires me to sit, I also make it a point to get up and move around.
About two months ago, after a bowel movement, I noticed bright red blood on the toilet paper after wiping.
However, I did not experience any pain or significant itching.
That day, my stool felt only slightly larger than usual, but I did not see any blood in subsequent bowel movements.

Approximately every two weeks, I have experienced a similar situation where, after a slightly larger or harder stool, I notice some blood when wiping, although it is not as significant as the first time.
Again, I do not feel any pain, but occasionally I do experience mild itching (which is really just a slight itch), and the amount of blood is minimal—usually just a drop or two.
When I rinse my anus with a handheld shower or take a sitz bath, I occasionally feel a mild tingling sensation in the anal area (this tingling is quite subtle).
The stool itself does not appear to have blood on it, but I may not be able to distinguish it well.
I visited a clinic for an examination, and after a digital rectal exam, the doctor said he did not find anything abnormal and suspected it was hemorrhoids (I don't quite understand how he could suspect hemorrhoids without finding anything).
In March of this year, I participated in a company health check, and the result for fecal occult blood was normal.

Could this be an anal fissure, a skin tear, or internal hemorrhoids? (Or is a skin tear the same as an anal fissure?) Is there anything specific I should pay attention to, or under what circumstances should I seek medical attention? I apologize for the lengthy message and the many questions, and I appreciate the doctor's patience in reading through it.

Hsuān, 30~39 year old female. Ask Date: 2019/06/04

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Please seek medical attention from a colorectal surgeon.

Reply Date: 2019/06/04

More Info

Experiencing blood after bowel movements can be concerning, and it’s important to understand the potential causes and when to seek medical attention. Based on your description, it seems that you are dealing with a situation that could be related to hemorrhoids, anal fissures, or minor skin irritation around the anal area. Let’s break down these possibilities and provide some guidance.

Possible Causes
1. Hemorrhoids: These are swollen veins in the lower rectum or anus that can cause bleeding, especially during bowel movements. The blood is usually bright red and may be seen on toilet paper or in the toilet bowl. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus). Your doctor’s assessment that it could be hemorrhoids is plausible, especially since you mentioned that there was no significant finding during the examination.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to sharp pain during bowel movements and may also cause bleeding. However, you mentioned that you do not experience significant pain, which makes this less likely, but it is still a possibility if the stool is occasionally hard or large.

3. Skin Irritation or Minor Trauma: Sometimes, the skin around the anus can become irritated due to frequent wiping, especially if you are experiencing diarrhea or softer stools. This irritation can lead to minor bleeding without significant pain.

4. Other Conditions: While less common, other gastrointestinal issues can cause rectal bleeding, including diverticulosis, inflammatory bowel disease (IBD), or colorectal polyps. However, these conditions typically present with additional symptoms.

When to Seek Medical Attention
Given that you have had intermittent bleeding without significant pain, it is advisable to monitor your symptoms closely. Here are some guidelines on when to seek medical attention:
- Persistent Bleeding: If the bleeding continues or worsens, or if you notice a significant change in the amount of blood, it’s important to consult a healthcare provider.

- Pain or Discomfort: If you start experiencing significant pain, discomfort, or changes in bowel habits, seek medical advice.

- Changes in Stool: If you notice changes in your stool consistency, such as persistent diarrhea or constipation, or if you see blood mixed with the stool, it’s essential to get evaluated.

- Other Symptoms: If you experience symptoms like weight loss, fever, or fatigue, these could indicate a more serious condition that requires immediate attention.

Management and Prevention
In the meantime, here are some strategies to help manage and potentially prevent further issues:
- Dietary Adjustments: Continue to eat a high-fiber diet rich in fruits, vegetables, and whole grains to help maintain soft stools and prevent straining during bowel movements.

- Hydration: Drink plenty of water to stay hydrated, which can help soften stools.

- Regular Exercise: Regular physical activity can help promote healthy bowel function.

- Gentle Hygiene: After bowel movements, consider using moist wipes or a bidet instead of dry toilet paper to reduce irritation.

- Avoid Straining: Try to avoid straining during bowel movements, as this can exacerbate hemorrhoids and fissures.

Conclusion
While your symptoms may be indicative of hemorrhoids or minor skin irritation, it’s essential to remain vigilant. If your symptoms change or worsen, don’t hesitate to seek further evaluation from a healthcare professional. Regular check-ups and being proactive about your gastrointestinal health can help ensure that any potential issues are addressed promptly.

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