Blood in Stool During Menstruation: When to Seek Help

Menstrual blood in stool?

Previously, my menstrual cycle was irregular, and after consulting a gynecologist, I was told that I had a cyst and should just monitor it.
However, in the past month or two, I have noticed a small amount of bright red blood on my stool during my menstrual period (without experiencing constipation, but I do have mild diarrhea).
I also experience slight pain and itching around the anus, and when I wipe with toilet paper, there is a significant amount of bright red blood.
This situation resolves after my period ends.
Two months ago, I had gastrointestinal discomfort and consulted a gastroenterologist, who performed a stool occult blood test, which came back normal.
I would like to know if I should see a gynecologist or a gastroenterologist regarding the presence of blood in my stool during my menstrual period.
Could this be related to the cyst that was previously found?

Bo Bo, 20~29 year old female. Ask Date: 2021/01/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, blood in the stool is likely not related to obstetrics and gynecology.
It is recommended to consult a colorectal surgeon.
Wishing you good health.

Reply Date: 2021/01/10

More Info

When it comes to the presence of blood in stool during menstruation, it is essential to approach the situation with caution and a clear understanding of the potential underlying causes. Given your history of irregular menstrual cycles and the presence of an ovarian cyst, it is understandable to be concerned about the implications of these symptoms.

Firstly, the occurrence of blood in the stool, especially if it coincides with your menstrual period, can be attributed to several factors. One possibility is that the blood is not originating from the gastrointestinal tract but rather from the reproductive system. This can happen in cases of endometriosis, where endometrial tissue grows outside the uterus, potentially affecting the intestines and leading to bleeding during menstruation. Another possibility is that the blood could be related to hemorrhoids or anal fissures, which can cause bleeding during bowel movements, especially if there is any straining or irritation.

Your symptoms of mild diarrhea, anal pain, and itching, along with the fresh blood observed on toilet paper, suggest that there may be an issue in the anal or rectal area, such as hemorrhoids or fissures. These conditions can be exacerbated during menstruation due to hormonal changes that affect blood flow and tissue sensitivity. However, the fact that the bleeding resolves after your menstrual period is noteworthy and may indicate a cyclical pattern related to your menstrual cycle.

Given that you have already undergone a stool occult blood test that returned normal results, this is reassuring, but it does not entirely rule out the possibility of other gastrointestinal issues. It is also important to consider that the ovarian cyst may not be directly related to your gastrointestinal symptoms, but it is wise to keep your healthcare provider informed about all your symptoms.

In terms of seeking medical help, it would be prudent to consult both a gynecologist and a gastroenterologist. A gynecologist can evaluate the ovarian cyst and assess whether it could be contributing to your symptoms, particularly if there are any signs of endometriosis or other gynecological issues. On the other hand, a gastroenterologist can further investigate the gastrointestinal symptoms, including the blood in the stool, to rule out any underlying conditions such as inflammatory bowel disease (IBD) or other gastrointestinal disorders.

In summary, while the presence of blood in the stool during menstruation can be concerning, it is essential to consider the broader context of your symptoms. Consulting both a gynecologist and a gastroenterologist will provide a comprehensive evaluation and help determine the appropriate course of action. It is crucial to address these symptoms promptly, especially if they persist or worsen, as early intervention can lead to better outcomes and peace of mind.

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