Blood in Stool: When to Seek Medical Attention

Blood in the stool?

Hello Doctor: Six years ago (around the age of 20), I experienced rectal bleeding, which led to a colonoscopy.
The results showed no major issues, possibly just mild hemorrhoids.
However, in the past two months, I have had rectal bleeding two to three times, with bright red blood on toilet paper, and sometimes the blood drips into the toilet, but there is almost no blood on the stool itself.
When I notice the blood, I sometimes feel that the stool is harder, and there is mild discomfort (sometimes there is no pain).
Due to the increased frequency of rectal bleeding recently, I would like to know if this is a normal occurrence for hemorrhoidal bleeding.
Should I go to the hospital for further colonoscopy? Additionally, in the past six months, I have been exercising actively (about four to five times a week), and I have lost weight (from 154 lbs to around 143 lbs), but I cannot determine if this is due to a gastrointestinal issue or the effects of exercise.
I would appreciate your assessment.
Thank you very much, Doctor.

Niming, 20~29 year old female. Ask Date: 2020/09/11

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Increasing dietary fiber intake can also be beneficial.
Warm sitz baths may help alleviate symptoms, and over-the-counter hemorrhoid suppositories can be used.
It is best not to take stool softeners indiscriminately.
If bleeding persists, it is advisable to consult a physician, especially since it has been over five years since the last examination.
Therefore, scheduling a colonoscopy again could be appropriate.

Reply Date: 2020/09/11

More Info

When it comes to blood in the stool, it is essential to approach the situation with caution and awareness of potential underlying issues. Given your history of rectal bleeding six years ago, which was attributed to mild hemorrhoids, and the recent recurrence of blood in your stool, it is prudent to consider a few key points.

Firstly, the presence of bright red blood on toilet paper or in the toilet bowl typically indicates that the bleeding is coming from the lower gastrointestinal tract, such as the rectum or anus. This is often associated with conditions like hemorrhoids, anal fissures, or other benign issues. However, the fact that you have experienced this symptom multiple times over the past two months warrants further investigation.

The characteristics of your symptoms—such as the hardness of your stool and the mild pain you sometimes experience—suggest that constipation may be a contributing factor. Hard stools can lead to straining during bowel movements, which can exacerbate hemorrhoids or cause anal fissures, both of which can result in bleeding. While these conditions are generally not serious, they can cause discomfort and require management.

However, it is crucial to recognize that while hemorrhoids are a common cause of rectal bleeding, other more serious conditions can also present with similar symptoms. These include diverticular disease, colorectal polyps, and even colorectal cancer, especially if there is a change in bowel habits, unexplained weight loss, or if you are over the age of 50. Given that you have experienced a significant weight loss (from 70 kg to 65 kg) and an increase in the frequency of blood in your stool, it is advisable to seek medical attention.

In your case, a follow-up with a healthcare provider is recommended. They may suggest a repeat colonoscopy to rule out any significant pathology, especially since your previous examination was six years ago. The guidelines for screening and surveillance for colorectal cancer recommend that individuals at average risk begin screening at age 45, and those with a history of gastrointestinal issues may need to be screened more frequently.

Additionally, your recent increase in physical activity and weight loss could be beneficial for your overall health, but it is essential to ensure that these changes are not masking an underlying gastrointestinal issue. Maintaining a balanced diet rich in fiber can help alleviate constipation and reduce the strain during bowel movements, potentially minimizing the risk of hemorrhoids and fissures.

In summary, while your symptoms may be consistent with hemorrhoidal bleeding, the recurrence and associated factors such as weight loss and changes in bowel habits necessitate further evaluation. It is advisable to consult with a healthcare professional who can perform a thorough assessment and determine the need for further diagnostic procedures, such as a colonoscopy. Early detection and intervention are key to managing any potential gastrointestinal issues effectively.

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