Severe Rectal Bleeding and Pain: When to Seek Medical Help

There is a significant amount of bleeding from the anus when 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 much, and now I've been experiencing pain in my buttocks for almost a month.
It hurts when I sit or lie down, and every time I exert even a little during urination, it causes pain in my buttocks.
Having a bowel movement is painful and causes 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, it feels like my anus is protruding and is very painful.
There is bright red blood on the toilet paper.
Could this be a case of prolapsed hemorrhoids? Do I need surgery? Which department should I visit at the hospital?

Miss, 20~29 year old female. Ask Date: 2021/03/27

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may be an anal fissure; you can visit a gastroenterologist or a family medicine physician to use topical medications and take stool softeners.

Reply Date: 2021/03/27

More Info

Severe rectal bleeding and pain can be alarming and may indicate a serious underlying condition. Based on your description, it sounds like you are experiencing significant discomfort and bleeding, particularly after bowel movements. This could be due to several potential causes, including hemorrhoids, anal fissures, or other gastrointestinal issues.
Given that you have been experiencing these symptoms for almost a month, it is crucial to seek medical attention promptly. Here are some key points to consider regarding your situation:
1. Symptoms and Their Implications: The fact that you are experiencing pain, bleeding, and a sensation of something protruding from the anus suggests that you may have developed hemorrhoids or an anal fissure. Hemorrhoids are swollen veins in the lower rectum or anus that can cause pain, itching, and bleeding, especially during bowel movements. An anal fissure is a small tear in the lining of the anus, which can also lead to significant pain and bleeding.

2. When to Seek Medical Help: You should seek medical help immediately if:
- You experience heavy bleeding (more than a small amount of blood on toilet paper).

- You feel faint, dizzy, or lightheaded, which could indicate significant blood loss.

- The pain is severe and not relieved by over-the-counter pain medications.

- You notice any changes in your bowel habits, such as diarrhea or constipation, that persist.

- You have any other concerning symptoms, such as fever or abdominal pain.

3. Medical Evaluation: When you visit a healthcare provider, it is advisable to see a gastroenterologist or a colorectal surgeon. They specialize in conditions affecting the gastrointestinal tract and can provide a thorough evaluation. The doctor will likely perform a physical examination, which may include a digital rectal exam, and possibly recommend further tests such as a colonoscopy to assess the condition of your rectum and colon.

4. Treatment Options: Treatment will depend on the underlying cause of your symptoms. If hemorrhoids are diagnosed, treatment options may include:
- Lifestyle changes, such as increasing fiber intake and hydration to soften stools and reduce straining during bowel movements.

- Over-the-counter topical treatments to relieve pain and inflammation.

- In some cases, minimally invasive procedures may be necessary to remove or reduce the hemorrhoids.

If an anal fissure is identified, treatment may involve:
- Topical medications to promote healing and relieve pain.

- Sitz baths to soothe the area.

- In chronic cases, surgical intervention may be required to alleviate the fissure.

5. Preventive Measures: To prevent future episodes, consider adopting a high-fiber diet, staying hydrated, and establishing a regular bowel routine. Avoid straining during bowel movements, and if you feel the urge to go, try not to delay it.

In summary, your symptoms warrant a medical evaluation as soon as possible. Do not hesitate to seek help, as timely intervention can prevent complications and improve your quality of life. Remember, it is always better to err on the side of caution when it comes to health concerns, especially those involving bleeding.

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