Rectal Bleeding: When to Seek Medical Attention

Rectal bleeding

Hello, doctor.
For the past few years, I have been experiencing blood at the front end of my stool, with the blood mixed in (sometimes present, sometimes absent), and my abdomen often feels like it is moving quickly with gurgling sounds, causing discomfort.
I have also had diarrhea with blood streaks.
Three years ago, I underwent a colonoscopy, and the doctor mentioned hemorrhoids and diverticula (I was given ointment for the hemorrhoids, but there were no instructions on how to manage the diverticula).
I would like to ask the doctor:
1.
Isn't the bleeding from hemorrhoids usually at the end of the stool? Additionally, I have been gradually losing weight.
Is it possible that small polyps could have been missed? Should I undergo another colonoscopy to ensure everything is okay, and how often should I have one?
2.
Also, due to the COVID-19 pandemic, there has been a strong recommendation to avoid going to hospitals.
Do you suggest that I seek immediate medical attention, or should I wait until the situation improves to get checked? I appreciate your advice.
Thank you.

W, 20~29 year old female. Ask Date: 2020/03/09

Dr. Ke Fangxu reply Surgery

1.
Although the probability of developing colorectal cancer at the age of 1.25 years is not zero, it is generally very low.
Based on your description, it seems more like hemorrhoidal bleeding.
I recommend starting with a light diet and maintaining a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber intake can also be helpful.
If symptoms persist without improvement, you may consult a physician for medication or consider undergoing a colonoscopy.

2.
Your situation does not seem urgent.
You can first focus on improving your bowel habits and dietary practices, and then observe for a while to see how it progresses.

Reply Date: 2020/03/09

More Info

Rectal bleeding can be a concerning symptom, and it is essential to understand when to seek medical attention. Based on your description, you have experienced intermittent rectal bleeding mixed with stool, along with abdominal discomfort and changes in bowel habits. You also mentioned a history of hemorrhoids and diverticulosis diagnosed during a colonoscopy three years ago.
Firstly, it is important to clarify that rectal bleeding can arise from various causes, including hemorrhoids, diverticular disease, polyps, or even more serious conditions such as colorectal cancer. Hemorrhoids typically cause bright red blood on the surface of the stool or on toilet paper, while bleeding associated with diverticulosis may be more variable. The presence of blood mixed with stool, especially if it is dark or tarry, can indicate a more significant issue that requires further evaluation.

1. Frequency of Colonoscopies: Given your history of diverticulosis and the presence of rectal bleeding, it is advisable to have a follow-up colonoscopy. The general recommendation is to undergo a colonoscopy every 10 years starting at age 45 for average-risk individuals. However, if you have risk factors such as a history of polyps, diverticulosis, or rectal bleeding, your healthcare provider may recommend more frequent screenings. It is crucial to discuss your symptoms and history with your physician to determine the appropriate timing for your next colonoscopy.

2. Symptoms to Watch For: You should seek immediate medical attention if you experience any of the following:
- Significant or persistent rectal bleeding (more than a few drops).

- Blood in your stool that is dark or tarry.

- Severe abdominal pain or cramping.

- Changes in bowel habits, such as diarrhea or constipation lasting more than a few days.

- Unexplained weight loss or fatigue.

3. COVID-19 Considerations: The ongoing pandemic has made many hesitant to seek medical care. However, it is essential to prioritize your health. If your symptoms are concerning or worsening, it is better to seek medical attention sooner rather than later. Many healthcare facilities have implemented safety measures to minimize the risk of COVID-19 transmission, such as telehealth consultations and enhanced sanitation protocols. If you feel uncomfortable visiting a hospital or clinic in person, consider discussing your symptoms with your healthcare provider via telemedicine.

In conclusion, while hemorrhoids and diverticulosis can explain some of your symptoms, the presence of blood mixed with stool and other gastrointestinal discomfort warrants further evaluation. It is crucial to have an open dialogue with your healthcare provider about your symptoms, the need for follow-up colonoscopy, and the best course of action considering the current pandemic. Your health is paramount, and timely medical intervention can help address any underlying issues effectively.

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