Rectal Bleeding: Causes and Next Steps for Treatment

Rectal bleeding

Over two months ago, I underwent an upper gastrointestinal endoscopy and a colonoscopy, which revealed inflammation in the stomach and spotty inflammation in the rectum.
However, there was no occult blood detected in the stool at that time, and the doctor determined that there was no need for anti-inflammatory suppositories.
In the past two months, I have occasionally experienced loud gurgling sounds in my stomach after meals.
Recently, I noticed blood in my stool, with bright red blood at the end of the stool and some blood streaks when wiping, but there is no pain.
I also have a history of hemorrhoids.
I would like to ask the doctor if the blood in my stool is caused by rectal inflammation, and if any further action is needed.

Mr. Feng, 20~29 year old female. Ask Date: 2019/07/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may be related to internal hemorrhoids; you can return to the outpatient clinic of the physician who performed the colonoscopy for follow-up.

Reply Date: 2019/07/02

More Info

Rectal bleeding can be a concerning symptom, and understanding its potential causes and appropriate next steps for treatment is crucial. Based on your description, you have experienced rectal bleeding with fresh red blood on the stool and some blood on the toilet paper after wiping. You also mentioned a history of rectal inflammation and hemorrhoids (thrombosed hemorrhoids).

Possible Causes of Rectal Bleeding
1. Hemorrhoids: Given your history of thrombosed hemorrhoids, this is one of the most common causes of bright red blood in the stool. Hemorrhoids can become inflamed and bleed, especially during bowel movements.

2. Rectal Inflammation: The inflammation noted during your previous colonoscopy could also be a contributing factor. Conditions like proctitis (inflammation of the rectum) can lead to bleeding, especially if the inflammation has worsened.

3. Anal Fissures: Although you mentioned no pain, anal fissures can sometimes bleed without significant discomfort, especially if they are not deep.

4. Polyps or Colorectal Cancer: While less likely given your age and the absence of other symptoms, polyps or malignancies can also cause rectal bleeding. This is particularly a concern if there are changes in bowel habits or if the bleeding persists.

5. Gastrointestinal Conditions: Other gastrointestinal issues, such as diverticulosis or inflammatory bowel disease (IBD), could also lead to rectal bleeding.

Next Steps for Treatment
1. Consult a Healthcare Provider: It is essential to follow up with your healthcare provider, especially since you have a history of gastrointestinal issues. They may recommend further evaluation, such as a repeat colonoscopy or imaging studies, to assess the source of the bleeding.

2. Symptomatic Treatment: If hemorrhoids are the cause, over-the-counter treatments such as topical creams or suppositories may help alleviate symptoms. Increasing fiber intake and hydration can also help soften stools and reduce straining during bowel movements.

3. Monitoring Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, any changes in bowel habits, and any new symptoms like pain or changes in appetite. This information will be valuable for your healthcare provider.

4. Dietary Adjustments: A diet rich in fiber can help prevent constipation and reduce straining, which may alleviate symptoms related to hemorrhoids and rectal inflammation. Foods high in fiber include fruits, vegetables, whole grains, and legumes.

5. Avoiding Irritants: Avoiding irritants such as spicy foods, caffeine, and alcohol may help reduce gastrointestinal discomfort and inflammation.

When to Seek Immediate Care
If you experience significant bleeding (more than a small amount), dizziness, fainting, or severe abdominal pain, seek immediate medical attention. These could be signs of a more serious condition requiring urgent care.

Conclusion
While rectal bleeding can often be attributed to benign causes such as hemorrhoids or rectal inflammation, it is essential to take it seriously, especially given your medical history. Consulting with a healthcare provider for a thorough evaluation and appropriate management is the best course of action. They can provide tailored advice and treatment options based on your specific situation. Remember, early intervention can lead to better outcomes and peace of mind.

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