Bleeding from the Anus Without Bowel Movement: What to Do?

Bleeding from the anus without having a bowel movement?

Hello Doctor: I have a chronic anal fissure issue.
This morning, I had a hard bowel movement, and my anus was a bit painful, but there was no bleeding.
I thought I would apply some hemorrhoid cream in the evening.
However, when I used a cotton swab to apply the medication tonight, I suddenly experienced a lot of bleeding.
I'm not sure if I accidentally aggravated the fissure or if it was the hemorrhoids that caused the bleeding.
I quickly inserted a hemorrhoid suppository.
I've never had this situation before, and it makes me a bit scared.
I'm concerned about the possibility of colorectal cancer.
Should I see a doctor again or get a colonoscopy?

Liu Xiaojie, 20~29 year old female. Ask Date: 2020/09/25

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
You can also purchase hemorrhoid suppositories over the counter.
Although the likelihood of developing colorectal cancer at the age of 21 is not zero, it is generally very low.
It is advisable to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber can also be beneficial.
If symptoms persist without improvement, you may consult a physician for medication or consider undergoing a colonoscopy.

Reply Date: 2020/09/25

More Info

Bleeding from the anus can be a concerning symptom, especially for individuals with a history of chronic anal fissures or hemorrhoids. Given your description, it seems that the bleeding may have been triggered by the use of a cotton swab to apply medication, which could have aggravated an existing fissure or hemorrhoid.
First, it’s important to understand that rectal bleeding can stem from various causes, including hemorrhoids, anal fissures, diverticular disease, or more serious conditions like colorectal cancer. In your case, since you have a known history of chronic anal fissures, it is plausible that the bleeding is related to this condition. Anal fissures can cause sharp pain during bowel movements and may bleed, especially if the stool is hard or if there is trauma to the area.

Here are some steps you can take to manage the situation:
1. Avoid Further Trauma: It’s crucial to avoid any further irritation to the area. This means being gentle when cleaning and applying medications. Avoid using cotton swabs or any other objects that could cause additional trauma.

2. Soothing Treatments: You may continue to use over-the-counter hemorrhoid creams or ointments, as they can help soothe the area and reduce inflammation. Warm sitz baths can also provide relief and promote healing.

3. Dietary Adjustments: To prevent hard stools, which can exacerbate fissures, ensure you are consuming a high-fiber diet. Foods rich in fiber, such as fruits, vegetables, and whole grains, can help soften stools. Staying well-hydrated is also essential.

4. Monitor Symptoms: Keep an eye on your symptoms. If the bleeding continues, increases in volume, or is accompanied by severe pain, changes in bowel habits, or any other concerning symptoms, it is essential to seek medical attention.

5. Consult a Healthcare Professional: Given your concerns about potential serious conditions like colorectal cancer, it would be prudent to consult with a healthcare provider. They may recommend a physical examination and possibly a colonoscopy, especially if you have risk factors or if the bleeding persists. A colonoscopy can help rule out any serious conditions and provide peace of mind.

6. Follow-Up Care: If you have been diagnosed with chronic anal fissures or hemorrhoids, regular follow-up with your healthcare provider is important to manage the condition effectively and prevent complications.

In summary, while the bleeding you experienced may be related to your existing anal fissures or hemorrhoids, it is essential to monitor your symptoms closely and consult with a healthcare professional for a thorough evaluation. Early intervention can help prevent complications and ensure appropriate treatment. Remember, it’s always better to err on the side of caution when it comes to health concerns.

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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 fibe...

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