Blood on Toilet Paper: Gastrointestinal Health Concerns

There is blood on the toilet paper?

Hello Doctor: I am 25 years old and my bowel habits are about 2 to 3 times a week (the shape varies, and sometimes I experience abdominal pain and diarrhea).
A few months ago, I was hospitalized due to a fever, and for a period of time, I had daily bowel movements (about a week, with stools being long and solid).
After that, I experienced abdominal pain and had infrequent or small bowel movements, but eventually returned to my usual habits.
During this time, I noticed some red on the toilet paper after a bowel movement, and once, there was a little red in the water when using a squat toilet.
Recently, although my bowel movement frequency has returned, my stools are often small and pellet-like, and I feel abdominal pain more frequently than before (usually I feel the pain and immediately need to go to the bathroom).
Sometimes, I notice a brownish, mucous-like substance on the toilet paper after wiping (the stool color is somewhat dark, not light brown).
Occasionally, even when the color appears normal, I can't tell if it's psychological or real, but I always feel like there is a slight red or orange tint on the toilet paper.
A few days ago, after using the bathroom, I noticed some red again after wiping, possibly due to straining, and I feel quite anxious about it.
Do you think I need to get a colonoscopy or is there anything I should pay attention to? Additionally, a few years ago, due to chronic constipation (I don't drink enough water), my family was concerned and I underwent a colonoscopy, which indicated some internal hemorrhoids and a small polyp, but there were no significant issues, so I haven't had any further examinations.
Since then, possibly due to issues with my immune system and medication, my bowel habits have changed to about 2 to 3 times a week.
I apologize for the lengthy message, and thank you for your help.

Niming, 20~29 year old female. Ask Date: 2019/10/30

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 25-year-old female is concerned about noticing red streaks on toilet paper after bowel movements, which may indicate bleeding.
She has a history of colonoscopy showing internal hemorrhoids and polyps.
The polyps require follow-up colonoscopy.
Hard stools can cause hemorrhoids to bleed occasionally.
Medications may affect bowel habits.
Inflammatory bowel diseases, such as ulcerative colitis, can sometimes cause diarrhea with mucus and blood.
It is recommended to follow up with outpatient examinations.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2019/10/30

More Info

When you notice blood on toilet paper after a bowel movement, it can understandably cause concern. Blood in the stool or on toilet paper can stem from various gastrointestinal issues, ranging from benign conditions to more serious health concerns. Based on your description, several potential causes could be contributing to your symptoms.

1. Hemorrhoids: One of the most common causes of blood on toilet paper is hemorrhoids, particularly internal hemorrhoids. These are swollen veins in the rectal area that can bleed during bowel movements, especially if you are straining or experiencing constipation. Given your history of constipation and the fact that you have previously been diagnosed with internal hemorrhoids, this could be a likely cause of your current symptoms.

2. Anal Fissures: Another possibility is an anal fissure, which is a small tear in the lining of the anus. This can occur due to passing hard stools or straining during bowel movements. Fissures can cause sharp pain and bleeding, often resulting in blood on toilet paper.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can also lead to bleeding. While this condition is more common in older adults, it can occur in younger individuals, especially if there is a history of constipation.

4. Gastrointestinal Infections or Inflammatory Conditions: Conditions such as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, can cause symptoms like abdominal pain, diarrhea, and blood in the stool. These conditions often require more extensive evaluation and management.

5. Polyps or Colorectal Cancer: Although less common in younger individuals, polyps can develop in the colon and may bleed. A family history of colorectal cancer or personal history of polyps increases the importance of monitoring your gastrointestinal health.

Given your symptoms, including changes in bowel habits, abdominal pain, and the presence of blood, it would be prudent to consult a healthcare professional. A gastroenterologist can perform a thorough evaluation, which may include a physical examination, stool tests, and possibly a colonoscopy to visualize the colon and rectum directly. This is particularly important considering your previous history of hemorrhoids and polyps.

In the meantime, here are some general recommendations to help manage your symptoms:
- Increase Fiber Intake: Consuming a diet rich in fruits, vegetables, and whole grains can help soften stools and promote regular bowel movements, reducing the risk of straining.

- Stay Hydrated: Drinking plenty of water can help prevent constipation and promote overall digestive health.

- Avoid Straining: When using the restroom, try to relax and avoid straining, which can exacerbate hemorrhoids and cause fissures.

- Warm Sitz Baths: If you are experiencing discomfort, warm sitz baths can help soothe the anal area and promote healing.

- Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and appearance of blood, as well as any new symptoms that may arise.

In conclusion, while blood on toilet paper can often be attributed to benign conditions like hemorrhoids or fissures, it is essential to seek medical advice to rule out more serious conditions, especially given your history and current symptoms. Early diagnosis and management can significantly improve your gastrointestinal health and overall well-being.

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