Rectal Bleeding: Causes and Solutions for Painful Bowel Movements

Issues related to rectal bleeding?

I am experiencing sharp pain and friction in the anal area during bowel movements, with a few drops of blood in the toilet.
There are several pieces of stool that appear to have fresh blood, and wiping the anal area results in a small amount of fresh blood.
After using the restroom, wiping the anal area often reveals more blood on the toilet paper.
I previously took traditional Chinese herbal supplements, and I am unsure if they caused excessive heat in my body, as I experienced a significant amount of fresh blood in the toilet during bowel movements for the next two days, along with pain.
Currently, I have gastroesophageal reflux disease (GERD) and pharyngitis, for which I am taking medication, leading to frequent constipation.
What could be the issue, and how can I improve this situation? Thank you for your response!

Lin Ting-Tzu, 20~29 year old female. Ask Date: 2021/01/20

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.
If necessary, a colonoscopy can also be arranged.

Reply Date: 2021/01/20

More Info

Rectal bleeding during bowel movements can be alarming and is often associated with various underlying conditions. Based on your description, it seems that you are experiencing a combination of rectal pain, fresh blood on toilet paper, and possibly some bleeding into the toilet bowl. These symptoms can be indicative of several issues, primarily related to the anal region, such as anal fissures, hemorrhoids, or other gastrointestinal conditions.

Possible Causes
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. The pain associated with fissures can be sharp and may lead to bleeding, especially when wiping after a bowel movement. Given your history of constipation, this could be a likely cause.

2. Hemorrhoids: These are swollen veins in the rectal area that can become inflamed and bleed. Internal hemorrhoids may not be visible but can cause bright red blood on the toilet paper or in the bowl. External hemorrhoids can cause pain and discomfort, especially during bowel movements.

3. Constipation: Chronic constipation can lead to straining, which increases the risk of both fissures and hemorrhoids. It can also lead to the development of hard stools that can cause pain during passage.

4. Gastrointestinal Issues: Conditions such as diverticulitis or inflammatory bowel disease (IBD) can also cause rectal bleeding, though these are less common in young individuals without other symptoms.

Recommendations for Management
1. Dietary Changes: Increase your intake of dietary fiber to help soften stools and promote regular bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Consider fiber supplements if necessary.

2. Hydration: Drink plenty of water throughout the day. Staying hydrated can help prevent constipation and make bowel movements easier.

3. Regular Bowel Habits: Try to establish a regular schedule for bowel movements. Don’t ignore the urge to go, as this can lead to harder stools and increased straining.

4. Warm Sitz Baths: Taking warm baths can help soothe the anal area and reduce pain associated with fissures or hemorrhoids. This can also promote healing.

5. Over-the-Counter Treatments: Consider using topical treatments such as hydrocortisone cream or witch hazel pads to reduce inflammation and discomfort associated with hemorrhoids. Stool softeners may also be beneficial to ease the passage of stools.

6. Avoid Straining: When using the bathroom, avoid straining or sitting for prolonged periods. This can exacerbate existing issues.

7. Medication Review: Since you mentioned taking medication for esophageal reflux and throat inflammation, it’s essential to discuss with your healthcare provider whether these medications could be contributing to your constipation.

When to Seek Medical Attention
If your symptoms persist despite these measures, or if you experience significant pain, large amounts of bleeding, or any other concerning symptoms (such as weight loss, changes in bowel habits, or abdominal pain), it is crucial to seek medical attention. A healthcare provider may recommend a physical examination and possibly further investigations, such as a colonoscopy, to rule out more serious conditions.

In summary, while your symptoms may be indicative of common issues like anal fissures or hemorrhoids, it is essential to address the underlying causes, particularly your constipation. Implementing dietary changes, maintaining hydration, and practicing good bowel habits can significantly improve your condition. However, do not hesitate to consult a healthcare professional for personalized advice and treatment options.

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