Rectal Bleeding: Causes, Concerns, and When to Seek Help

Bowel issues, rectal bleeding?

Hello Doctor, I am 20 years old and a few months ago, I started noticing blood on the toilet paper after having a bowel movement.
This situation occurs about 1 to 2 times a month (though I can't remember exactly if it's every month), lasting for 1 to 3 days each time.
Whenever there is bleeding, I experience pain during bowel movements (the stool feels quite hard), and sometimes it hurts when I wipe with wet wipes after finishing.
The blood is bright red, sometimes faintly red, or it starts bright red on the first day and then gradually decreases or fades.
The blood is only on the toilet paper, or occasionally there are a few drops, but there is no blood mixed with the stool itself, and I don't recall seeing any blood streaks if there is mucus.
I usually have a bowel movement every morning, about once or twice a day, and I don't feel that my stool has become unusually thin; it seems to be normal.
I tend to be very anxious by nature, and every time I see blood, I fear that I might have cancer, which makes me quite anxious.
I wonder if this is just simple hemorrhoids or anal fissures? Should I get a fecal occult blood test or a colonoscopy? Recently, my gastrointestinal tract has been a bit uncomfortable; I still have normal bowel movements every morning (the stool hasn't become thin), but sometimes after a while, I feel the urge to go again, although I can't seem to pass anything (this urge isn't very urgent, just a vague feeling).
However, the next morning, I will have a normal bowel movement again.
My stomach also feels uncomfortable; I feel a bit nauseous but haven't vomited (I often experience bloating), and my stomach makes gurgling sounds but I'm not hungry.
However, I haven't had any bleeding in the past few days.
These discomforts have only started recently.
Now I'm worried that it could be colon cancer, or could it be something else, like simple gastrointestinal inflammation or irritable bowel syndrome?

Kandi, 20~29 year old female. Ask Date: 2020/12/15

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, shorten the time spent on bowel movements, and increase the intake of dietary fiber, which can be helpful.
Warm sitz baths should aid in alleviating symptoms, and you can also purchase over-the-counter hemorrhoid suppositories.
It is best not to use stool softeners indiscriminately.
Although the risk of developing colorectal cancer at the age of 20 is not zero, it is generally very low.
The likelihood of irritable bowel syndrome or gastroenteritis is higher.
It is advisable to maintain a light diet and good lifestyle habits, avoiding spicy, irritating, and greasy foods.
If symptoms persist without improvement, you may consult a physician for medication or to undergo a colonoscopy.

Reply Date: 2020/12/15

More Info

Rectal bleeding can be a concerning symptom, especially for someone as young as 20 years old. It's understandable that you are feeling anxious about the possibility of serious conditions like cancer. However, it's important to approach this situation with a clear understanding of potential causes and when to seek medical help.

Based on your description, the blood you see on the toilet paper after wiping, along with the pain during bowel movements, suggests that you may be experiencing either hemorrhoids (commonly known as piles) or an anal fissure. Both conditions are relatively common and can cause bright red blood on the surface of the stool or on toilet paper. Hemorrhoids are swollen veins in the lower rectum or anus, while anal fissures are small tears in the lining of the anus, often caused by passing hard stools.

The fact that you mentioned the blood is bright red and appears only on the toilet paper, rather than mixed in with the stool, further supports the likelihood of these conditions. Additionally, the pain you experience during bowel movements, especially if your stools are hard, is a common symptom associated with both hemorrhoids and fissures.
It's also worth noting that your bowel habits seem relatively normal, with regular daily bowel movements and no significant changes in stool consistency. This is a positive sign, as significant changes in bowel habits or the appearance of your stool can indicate more serious issues.

Regarding your concerns about cancer, while rectal bleeding can be a symptom of colorectal cancer, it is less common in younger individuals, especially if there are no other alarming symptoms such as significant weight loss, changes in bowel habits, or a family history of colorectal cancer. However, your anxiety is valid, and it’s always better to err on the side of caution.

Given your recent gastrointestinal discomfort, including feelings of nausea and bloating, it might be beneficial to consider other gastrointestinal issues such as gastritis, irritable bowel syndrome (IBS), or even food intolerances. Stress and anxiety can also exacerbate gastrointestinal symptoms, leading to discomfort and changes in bowel habits.

Here are some recommendations on what to do next:
1. Consult a Healthcare Provider: It’s important to see a doctor, preferably a gastroenterologist, who can evaluate your symptoms in detail. They may recommend tests such as a stool test for occult blood or a colonoscopy, especially if your symptoms persist or worsen.

2. Dietary Adjustments: Ensure you are consuming a high-fiber diet to help soften your stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

3. Over-the-Counter Treatments: If hemorrhoids or fissures are suspected, over-the-counter treatments such as topical creams or ointments can provide relief. Warm sitz baths can also help soothe the area.

4. Monitor Symptoms: Keep track of your symptoms, including any changes in bowel habits, the frequency of bleeding, and any new symptoms that arise. This information will be valuable for your healthcare provider.

5. Manage Anxiety: Since anxiety can exacerbate gastrointestinal symptoms, consider techniques such as mindfulness, relaxation exercises, or speaking with a mental health professional if your anxiety about your health becomes overwhelming.

In summary, while your symptoms may be indicative of common conditions like hemorrhoids or anal fissures, it is essential to consult with a healthcare provider for an accurate diagnosis and appropriate treatment. Early intervention can help alleviate your symptoms and address any underlying issues.

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