Rectal Bleeding: Causes and Symptoms in Young Adults

Bowel issues with rectal bleeding?

Hello Doctor: I am 23 years old.
I started experiencing rectal bleeding for the first time on September 27th.
The blood is not bright red but rather dark red and mucous-like.
It has persisted without improvement, and I constantly feel the urge to have a bowel movement.
When I go to the bathroom, I only pass gas and then expel a mucous-like substance, which is also dark red.
Sometimes it appears yellow and resembles pus, or I have bowel movements that are small, hard, and pellet-like, similar to sheep feces.
I experience pain and discomfort around the anal area when riding a bike, and I also feel pain when tapping on the area of my lower back.
I would like to know what this could possibly be.
Additionally, I have been experiencing significant lower back pain since this issue began.
Is this a symptom of the condition, or could it simply be due to the frequent squatting? Thank you, Doctor!

Xiao Qing, 20~29 year old female. Ask Date: 2020/09/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

→ Based on the description, there may be colitis.
Please visit the gastroenterology clinic for a colonoscopy.

Reply Date: 2020/09/30

More Info

Rectal bleeding in young adults can be concerning and may arise from various causes. Given your symptoms, it is crucial to consider several potential underlying conditions that could explain the dark red, mucus-like blood you are experiencing, as well as the associated discomfort.

Possible Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of rectal bleeding, especially in young adults, is hemorrhoids. These are swollen veins in the lower rectum or anus that can cause bleeding, particularly during bowel movements. The blood is often bright red, but if there is significant irritation or thrombosis, it may appear darker.

2. Anal Fissures: Small tears in the lining of the anus can occur due to passing hard stools or straining during bowel movements. This can lead to bleeding and pain, especially when sitting or during bowel movements.

3. Diverticular Disease: Although more common in older adults, diverticulosis can occur in younger individuals. This condition involves the formation of small pouches in the colon wall, which can become inflamed or bleed.

4. Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease or ulcerative colitis can cause rectal bleeding, abdominal pain, and changes in bowel habits. The presence of mucus and dark blood could indicate inflammation in the gastrointestinal tract.

5. Infections: Certain infections, particularly those affecting the gastrointestinal tract, can lead to symptoms such as mucus in the stool, abdominal pain, and rectal bleeding.

6. Polyps or Colorectal Cancer: While less common in young adults, the presence of polyps or colorectal cancer should not be ruled out, especially if there is a family history of these conditions.

Associated Symptoms
The symptoms you describe, such as the feeling of needing to have a bowel movement frequently, the pain near the anus, and the back pain, could be related to several factors:
- Straining: Frequent straining to pass stool can lead to muscle fatigue and discomfort in the lower back and pelvic region.

- Nerve Irritation: Pain in the lower back could also be due to nerve irritation from prolonged sitting or straining during bowel movements.

- Inflammation: If there is an underlying inflammatory condition, it could contribute to both rectal symptoms and generalized discomfort.

Recommendations
Given the persistence and nature of your symptoms, it is essential to seek medical attention. A healthcare provider will likely perform a thorough evaluation, which may include:
- Physical Examination: A digital rectal exam can help assess for hemorrhoids, fissures, or other abnormalities.

- Stool Tests: To check for infections or blood.

- Colonoscopy: Depending on the findings, a colonoscopy may be warranted to visualize the colon and rectum directly.

Conclusion
While some causes of rectal bleeding may be benign, others can indicate more serious conditions. It is crucial to address these symptoms promptly to ensure appropriate diagnosis and treatment. Do not hesitate to reach out to a healthcare professional who can provide personalized care based on your specific situation. Early intervention can lead to better outcomes and peace of mind.

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