Rectal Bleeding: Causes and Concerns in Gastrointestinal Health

Sudden rectal bleeding?

Hello Doctor, I have been experiencing ongoing gastrointestinal discomfort for the past three months, so I scheduled a painless colonoscopy.
After the examination, the doctor said everything was fine, but I still experience bloating almost daily and have constipation (I have bowel movements every day, but they are in small, hard pieces).
Occasionally, I notice small streaks of blood (0.1-0.3 mm) when wiping.
Until today, February 13th, during my bowel movement, I first passed a hard stool, followed by a softer stool that was reddish-brown in color, and when I wiped, there was some red and yellow substance.
Is this normal? If it is blood, it seems like the stool and blood are not very separate.
Thank you, Doctor.

Yang, 10~19 year old female. Ask Date: 2020/02/13

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, I often experience abdominal bloating, abdominal pain, and constipation.
My stools are pellet-like and there is blood in my stool.
A painless colonoscopy showed no issues.
Common causes of blood in the stool include hemorrhoids, anal fissures, colitis, and proctitis.
I recommend drinking plenty of water, increasing your intake of fruits and vegetables for fiber, engaging in moderate exercise, and maintaining regular bowel movements.
If there is no improvement, I suggest seeking a medical evaluation for an anal and rectal examination.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/02/13

More Info

Understanding rectal bleeding can be a complex issue, especially when it involves gastrointestinal health. Based on your description, it seems that you have been experiencing ongoing gastrointestinal discomfort, including symptoms of bloating, constipation, and occasional rectal bleeding. While your recent colonoscopy showed no significant abnormalities, the presence of blood in your stool and the changes in your bowel habits warrant further discussion.

Firstly, it’s important to understand that rectal bleeding can arise from various causes, ranging from benign to more serious conditions. Common causes include hemorrhoids, anal fissures, diverticular disease, and inflammatory bowel diseases (IBD) such as Crohn's disease or ulcerative colitis. Given that you have experienced hard stools and occasional blood, it is possible that you may have developed anal fissures or hemorrhoids due to straining during bowel movements. These conditions can cause pain and bleeding, particularly when passing hard stools.

The fact that you mentioned seeing blood that appears mixed with your stool rather than separate could indicate that the bleeding is originating from the lower gastrointestinal tract, possibly from the rectum or anus. This is often seen in cases of hemorrhoids or fissures, where the blood may appear bright red due to its proximity to the exit point. In contrast, blood that is darker or tarry (melena) typically indicates bleeding from higher up in the gastrointestinal tract, such as the stomach or small intestine.

Your symptoms of persistent bloating and constipation are also noteworthy. Chronic constipation can lead to the formation of hard stools, which can exacerbate the risk of developing fissures or hemorrhoids. It is essential to address these underlying issues to prevent further complications. Dietary modifications, such as increasing fiber intake, staying hydrated, and regular physical activity, can help improve bowel regularity and consistency. Over-the-counter stool softeners or laxatives may also be beneficial, but it is advisable to consult with your healthcare provider before starting any new medication.

Given your history of gastrointestinal discomfort and the recent changes in your bowel habits, it is crucial to monitor your symptoms closely. If the bleeding persists, increases in volume, or is accompanied by other concerning symptoms such as severe abdominal pain, weight loss, or changes in appetite, you should seek immediate medical attention. Further evaluation may be necessary, which could include additional imaging studies or even repeat endoscopy, depending on your physician's assessment.

In summary, while occasional rectal bleeding can be benign, especially if associated with hard stools, it is essential to remain vigilant. Maintaining a healthy diet, managing constipation, and monitoring your symptoms will be key in managing your gastrointestinal health. If you have any concerns or if your symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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