Rectal Bleeding: Is It Hemorrhoids or Something More? - Gastroenterology and Hepatology

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Rectal bleeding


A few months ago, I experienced tearing pain and a sensation of foreign body in the anus during bowel movements, with blood at the end of my stool.
After researching, I concluded it was hemorrhoids and self-treated with ointments from the pharmacy and warm baths, which improved my condition.
However, recently I have started to notice bright red blood during bowel movements (the stool comes out first, followed by the blood), with the blood separating from the stool.
I do not have any abdominal pain or bloating, and I do not experience the same anal pain or sensation of a foreign body as before.
After cleaning myself, there is no further bleeding.
I have also checked internally with my finger (about one to two finger-breadths deep) and found it to be clean.
Therefore, I am uncertain if this is still hemorrhoids or if it could be indicative of other gastrointestinal issues.

Zhenzhen, 20~29 year old female. Ask Date: 2019/10/25

Dr. Lin Minghui reply Gastroenterology and Hepatology


Hello, there is rectal bleeding with blood separate from the stool.
A 27-year-old female is experiencing rectal bleeding, where the blood is separate from the stool.
Common causes of rectal bleeding include hemorrhoids, anal fissures, polyps, inflammation, and tumors.
If this occurs frequently, while hemorrhoids are still a possibility, it is important to be concerned about other gastrointestinal issues.
It is recommended to follow up with a colorectal or gastroenterology specialist for examination.
Wishing you safety and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2019/10/25

More Info


When it comes to rectal bleeding, it is essential to understand that while hemorrhoids are a common cause, there are several other potential issues that could lead to similar symptoms. Given your description, it seems that you have experienced rectal bleeding associated with bowel movements, which can be alarming. However, the fact that you have previously dealt with hemorrhoids and have seen some improvement with over-the-counter treatments suggests that this could be a recurring issue related to that condition.

Hemorrhoids, which are swollen veins in the lower rectum and anus, can cause bleeding, especially during bowel movements. The blood is typically bright red and may appear on the toilet paper or in the toilet bowl. The absence of pain during bowel movements and the lack of ongoing bleeding after wiping are positive signs that may indicate that the bleeding is indeed related to hemorrhoids rather than a more serious condition.

However, it is crucial to consider other potential causes of rectal bleeding, especially since you have experienced a recurrence of symptoms. Conditions such as anal fissures, diverticular disease, colorectal polyps, or even colorectal cancer can also lead to similar symptoms. Anal fissures, for example, can cause sharp pain during bowel movements and may also result in bleeding. Diverticulosis, which involves the formation of small pouches in the colon, can lead to diverticulitis and subsequent bleeding. Polyps are growths on the lining of the colon that can sometimes bleed, and while most are benign, some can be precursors to cancer.

Given your situation, it is advisable to take the following steps:
1. Consult a Healthcare Provider: It is essential to see a healthcare professional for a thorough evaluation. They may recommend a physical examination, and possibly a colonoscopy, to visualize the colon and rectum directly. This is particularly important if you are experiencing recurrent bleeding or if the bleeding persists.

2. Monitor Symptoms: Keep track of any additional symptoms that may arise, such as changes in bowel habits, abdominal pain, weight loss, or changes in appetite. These could provide important clues to your healthcare provider.

3. Dietary Adjustments: Ensure that you are consuming a high-fiber diet, which can help prevent constipation and reduce straining during bowel movements. Staying well-hydrated is also crucial.

4. Avoid Straining: If you are experiencing constipation, consider using stool softeners or mild laxatives as recommended by your healthcare provider to ease bowel movements.

5. Follow-Up: If the bleeding continues or worsens, or if you develop new symptoms, follow up with your healthcare provider promptly.

In summary, while your symptoms may suggest hemorrhoids, it is essential to rule out other potential causes of rectal bleeding. A healthcare professional can provide a definitive diagnosis and appropriate treatment options. Early intervention is key to addressing any underlying issues effectively.

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