Abdominal Pain and Blood in Stool: Key Insights - Gastroenterology and Hepatology

Q: Abdominal Pain and Blood in Stool: Key Insights

Hello Mr. <br>Yang： You inquired about your situation after undergoing a colonoscopy in October of last year. <br>In April of this year, you manually extracted stool from your rectum, which resulted in bleeding the next day, with significant blood on the toilet paper. <br>The ble

Abdominal pain with bowel movement accompanied by blood?

Doctor, I had a colonoscopy in October of last year, and the bowel preparation was good with no issues found, except for internal hemorrhoids.
In April of this year, I manually removed feces from my rectum, and the next day I noticed blood in my stool and on the toilet paper.
The bleeding decreased afterward, but I started to notice some mucus and began experiencing abdominal pain, nausea, and discomfort with bowel movements.
On the third day, I consulted a colorectal surgeon who performed a digital examination and diagnosed me with anal fissures and hemorrhoids.
He prescribed a suppository for hemorrhoids.
After using the suppository, I started to notice a significant amount of blood-tinged, thick, white mucus in my stool, which also became loose and foul-smelling.
I then consulted the colorectal surgeon who performed my initial colonoscopy and showed him photos of my symptoms.
He recommended another colonoscopy to investigate further.
I would like to ask if it is possible for colon cancer to develop in just six months, or if these symptoms could indicate colitis.
The doctor at the nearby clinic believes it is just a case of food poisoning since it has only been six months.
Should I also consider getting an upper endoscopy? Is the white, blood-tinged mucus possibly a result of the suppository? The colorectal surgeon mentioned that this is unlikely.

Xiao Yang, 30~39 year old female. Ask Date: 2021/04/08

Dr. Zhang Kebin reply Gastroenterology and Hepatology

Hello Mr.
Yang: You inquired about your situation after undergoing a colonoscopy in October of last year.
In April of this year, you manually extracted stool from your rectum, which resulted in bleeding the next day, with significant blood on the toilet paper.
The bleeding decreased afterward, but you experienced some mucus and began to have abdominal pain, nausea, and discomfort with bowel movements.
On the third day, you consulted a colorectal surgeon who performed a digital rectal exam and diagnosed you with anal fissures and hemorrhoids.
You were prescribed a topical medication, and after using it, you noticed the presence of blood and a white, viscous discharge during bowel movements, which were also foul-smelling and loose.
If your previous colonoscopy was of good quality and performed by a qualified physician, the likelihood of colorectal cancer is lower.
However, since you mentioned manually extracting stool, it is reasonable to suspect that your rectum may have sustained an injury.
Therefore, undergoing another colonoscopy to closely examine the condition of your colon is warranted.
It is advisable to discuss further treatment options with your attending physician.

Reply Date: 2021/04/08

More Info

Understanding abdominal pain and the presence of blood in stool can be quite complex, especially when previous examinations, such as colonoscopy, have shown no significant issues. Your situation involves a combination of symptoms that warrant careful consideration and further investigation.

Firstly, it is important to recognize that the presence of blood in the stool, especially when accompanied by abdominal pain and changes in bowel habits, should never be taken lightly. While your previous colonoscopy indicated no significant findings other than internal hemorrhoids, the new symptoms you are experiencing could suggest a few different possibilities.

1. Hemorrhoids and Anal Fissures: Given that you have a history of hemorrhoids and the recent diagnosis of anal fissures, it is plausible that these conditions are contributing to your symptoms. Hemorrhoids can bleed, especially after straining during bowel movements, and anal fissures can cause sharp pain and bleeding during and after defecation. The use of topical treatments like suppositories can sometimes lead to irritation or changes in bowel movements, which might explain the presence of mucus or changes in stool consistency.

2. Infectious Colitis: The presence of foul-smelling diarrhea and mucus could indicate an infectious process, such as viral or bacterial gastroenteritis. This could be a result of consuming contaminated food or water, which aligns with the suggestion from your local clinic that you might have "eaten something bad." Infections can lead to inflammation of the intestines, resulting in abdominal pain, diarrhea, and mucus in the stool.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with similar symptoms, including abdominal pain, diarrhea, and blood or mucus in the stool. Although you had a colonoscopy recently, these conditions can sometimes develop or flare up in a short period.
4. Colon Cancer: While the risk of developing colon cancer within six months of a clear colonoscopy is relatively low, it is not impossible, especially if there are risk factors such as family history, age, or other symptoms. The presence of blood and changes in bowel habits can be concerning, and further evaluation is warranted.

5. Other Gastrointestinal Issues: Conditions such as diverticulitis or gastrointestinal infections can also lead to similar symptoms.
Given your symptoms, it is advisable to follow up with your gastroenterologist for a repeat colonoscopy, as they suggested. This will help rule out any new developments in the colon that may not have been present during the last examination. Additionally, if you are experiencing significant abdominal pain, nausea, or changes in your overall health, it may be prudent to seek immediate medical attention.

In terms of next steps, consider the following:
- Keep a Symptom Diary: Document your symptoms, including the frequency and characteristics of your bowel movements, any associated pain, and dietary changes. This information can be invaluable for your healthcare provider.

- Dietary Adjustments: Pay attention to your diet and avoid foods that may exacerbate your symptoms. A bland diet may help alleviate gastrointestinal distress.

- Hydration: Ensure you are well-hydrated, especially if you are experiencing diarrhea.

- Follow-Up Care: Schedule a follow-up appointment with your gastroenterologist to discuss your symptoms and the need for further testing, such as a repeat colonoscopy or possibly an upper endoscopy if warranted.

In conclusion, while your previous colonoscopy was clear, the emergence of new symptoms necessitates further evaluation. It is essential to communicate openly with your healthcare provider about your concerns and symptoms to ensure a thorough investigation and appropriate management of your condition.

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