Fecal Occult Blood: When to Seek Further Evaluation

Fecal occult blood

Hello Doctor: I have a history of constipation and mixed hemorrhoids.
In June 2018, I underwent a colonoscopy at Boai Hospital, and the results were normal with no polyps.
After giving birth to two children, my hemorrhoid issues have worsened.
Following an evaluation by a colorectal specialist at the Maternal Hospital in September of this year, I underwent hemorrhoid surgery.
It has been a month and a half since the surgery (today is November 8), but I have recently noticed occult blood in my stool (bright red).
During my follow-up appointment, the doctor mentioned that there is a tear at the anal opening, possibly due to excessive straining during bowel movements.
However, I have observed occult blood in my stool every time I use the restroom over the past few days (I am not straining excessively, as I am taking stool softeners, so my stool is not hard).
This has made me anxious.
Doctor, should I schedule another colonoscopy? I am afraid to have a bowel movement.

Miss Pan, 20~29 year old female. Ask Date: 2019/11/08

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Ms.
Pan, your condition still needs to be addressed.
If the moles are internal or external, they can be treated through medical or surgical intervention.
Therefore, it is important for you to seek a physician's evaluation before proceeding with further treatment.
Thank you for your inquiry.

Reply Date: 2019/11/08

More Info

When it comes to interpreting fecal occult blood (FOB) test results, especially in the context of your recent medical history, it is essential to approach the situation with caution and a clear understanding of the potential implications. Given your background of constipation and mixed hemorrhoids, along with a recent hemorrhoid surgery, the presence of fresh red blood in your stool can understandably cause concern.

Firstly, it is important to recognize that the presence of blood in the stool can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, or more serious conditions such as colorectal cancer. Since you have recently undergone surgery for hemorrhoids, it is plausible that the blood you are observing could be related to the surgical site, particularly if there is any irritation or healing issues. The doctor’s assessment that the blood may be due to a tear or irritation at the anal opening is a reasonable explanation, especially if you are experiencing discomfort during bowel movements.

However, the persistence of blood in your stool, even after a period of time following surgery, warrants further evaluation. While it is possible that the bleeding is benign and related to your hemorrhoids or anal fissures, it is crucial to rule out any other potential causes. The fact that you are experiencing fresh red blood, rather than the darker blood that typically indicates a higher source of bleeding in the gastrointestinal tract, is somewhat reassuring, but it does not eliminate the need for further investigation.

In your case, scheduling another colonoscopy may be advisable. A colonoscopy can provide a direct view of the colon and rectum, allowing for the identification of any abnormalities, such as residual hemorrhoids, fissures, or other lesions that may be contributing to the bleeding. Additionally, if there are any concerns about the healing process post-surgery, a colonoscopy can help assess the surgical site and ensure that there are no complications.

It is also worth considering other diagnostic tests that may be beneficial. For instance, stool tests can help identify any signs of infection or inflammation, and imaging studies may be useful in evaluating the surrounding structures. If you have not already done so, discussing your symptoms with your healthcare provider and expressing your concerns about the ongoing bleeding is crucial. They can help determine the most appropriate next steps based on your specific situation.

In summary, while the presence of blood in your stool following hemorrhoid surgery may be related to the surgical site, it is essential to take this symptom seriously. Given your history and the persistence of the bleeding, arranging for a follow-up colonoscopy would be a prudent course of action. This will not only provide peace of mind but also ensure that any potential issues are addressed promptly. Remember, it is always better to err on the side of caution when it comes to your health, especially concerning gastrointestinal symptoms.

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