Severe Rectal Bleeding and Pain: Possible Causes and Treatments

There is a significant amount of bleeding from the anus immediately after straining?

Hello doctor, a few days ago I was under a lot of work stress and didn't have a bowel movement for three days.
As a result, when I finally went, I strained too hard, and now I've been experiencing pain in my buttocks for almost a month.
It hurts to sit and lie down, and every time I exert even a little bit during urination, it causes pain in my buttocks.
Bowel movements are painful and accompanied by bleeding...
I'm almost developing a fear of bowel movements.
Recently, it has gotten worse; whenever I have a bowel movement or exert pressure in the anal area, there is a significant amount of blood.
I can feel warm blood in my buttocks, and when I wipe, I feel pain and notice that my anus seems to protrude.
There is bright red blood on the toilet paper.
Could this be a case of hemorrhoids? Do I need surgery? What department should I visit at the hospital?

Miss, 20~29 year old female. Ask Date: 2021/03/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

It could be an anal fissure; you may visit a gastroenterologist or a family medicine physician to receive topical medication and take a stool softener.

Reply Date: 2021/03/26

More Info

Severe rectal bleeding and pain can be alarming and may indicate several underlying conditions, the most common of which include hemorrhoids, anal fissures, or more serious conditions such as rectal prolapse or colorectal disease. Given your symptoms, it is crucial to seek medical attention promptly.

Possible Causes
1. Hemorrhoids: These are swollen veins in the lower rectum and anus that can cause pain, itching, and bleeding during bowel movements. They can be internal (inside the rectum) or external (under the skin around the anus). Straining during bowel movements, especially after a period of constipation, can exacerbate hemorrhoids and lead to significant bleeding.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can be very painful and may cause bleeding, especially during bowel movements. The pain can be sharp and may persist even after the bowel movement.

3. Rectal Prolapse: This occurs when part of the rectum protrudes through the anus. It can cause discomfort and bleeding and may require surgical intervention.

4. Colorectal Conditions: More serious conditions, such as inflammatory bowel disease (IBD), diverticulosis, or colorectal cancer, can also present with rectal bleeding and pain. These conditions are less common but should be ruled out, especially if you have other concerning symptoms.

Recommended Actions
1. Seek Medical Attention: Given the severity of your symptoms, including significant bleeding and pain, it is essential to see a healthcare provider as soon as possible. You should visit a gastroenterologist or a colorectal surgeon, as they specialize in conditions affecting the lower gastrointestinal tract.

2. Diagnostic Tests: Your doctor may recommend several tests to determine the cause of your symptoms. These may include:
- Physical Examination: A thorough examination of the anal area to check for hemorrhoids or fissures.

- Anoscopy or Sigmoidoscopy: These procedures allow the doctor to visualize the rectum and lower colon to identify any abnormalities.

- Colonoscopy: If necessary, a colonoscopy may be performed to examine the entire colon and rule out more serious conditions.

3. Treatment Options: Treatment will depend on the underlying cause of your symptoms:
- For Hemorrhoids: Over-the-counter treatments, such as topical creams or suppositories, can help relieve symptoms. In more severe cases, procedures such as rubber band ligation or surgical removal may be necessary.

- For Anal Fissures: Increasing fiber intake, staying hydrated, and using stool softeners can help reduce straining. Topical anesthetics or nitroglycerin ointments may also be prescribed to relieve pain and promote healing. In chronic cases, surgical intervention may be required.

- For Rectal Prolapse: Surgical options are often necessary to correct the prolapse.

- For Colorectal Conditions: Treatment will vary based on the specific diagnosis and may include medications, dietary changes, or surgery.

Prevention and Management
To prevent further issues, consider the following:
- Dietary Changes: Increase fiber intake through fruits, vegetables, and whole grains to promote regular bowel movements and prevent constipation.

- Hydration: Drink plenty of fluids to help soften stools.

- Avoid Straining: When using the bathroom, try to relax and avoid straining, as this can worsen hemorrhoids and fissures.

- Regular Exercise: Physical activity can help maintain regular bowel function.

Conclusion
Your symptoms of rectal bleeding and pain are concerning and warrant immediate medical evaluation. Do not delay seeking help, as early diagnosis and treatment can prevent complications and improve your quality of life. Please take care of yourself and prioritize your health by consulting a healthcare professional.

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