Blood in Stool: Causes, Concerns, and When to Seek Help

Blood in the stool?

Hello Doctor, I have been experiencing constipation for a long time, and it has worsened since I started losing weight this past year.
I usually drink at least 2000 cc of water but still only have a bowel movement about once every five days.
For the past two weeks, I've been drinking okra green tea, which has slightly improved my situation to having a bowel movement every three to four days.
Additionally, I have hemorrhoids that occasionally flare up with swelling and pain, although most of the time I don't feel anything.
Since I started losing weight, the shape and timing of my stools have become irregular; sometimes they are pellet-like, and other times they are elongated.
This week, I had two days where my stools were about 2 to 3 centimeters in diameter, and I had to go at least twice before it stopped.
I experienced a bit of diarrhea at the end, not watery but the stools were not formed together.
After a bowel movement today, I noticed a lot of blood above the toilet bowl when I passed gas.
It didn't hurt much at the time, but there was some pain when wiping.
The blood was bright red, similar to menstrual bleeding.
I'm not sure if there was blood in the stool, but it stopped afterward.
However, I still have a sensation of needing to have a bowel movement, but I can't seem to pass anything when I sit on the toilet.
I'm only 28 years old, and I'm very worried.
😭 Last year on May 26, I had a tumor marker test (CEA) that was 0.66.
I would like to know if there is a possibility of colon cancer and if I need to undergo a colonoscopy.

SS, 20~29 year old female. Ask Date: 2021/06/23

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is likely mild bleeding from internal hemorrhoids.
Initially, medication to improve bowel movements should be administered.
If symptoms persist or there are concerns, a fecal occult blood test or colonoscopy should be considered.

Reply Date: 2021/06/23

More Info

Understanding blood in stool can be a concerning issue, especially when accompanied by symptoms such as constipation, hemorrhoids, and changes in bowel habits. Based on your description, it appears that you are experiencing a combination of gastrointestinal symptoms that warrant further investigation.

Firstly, the presence of bright red blood in your stool or on the toilet paper after wiping is often indicative of bleeding from the lower gastrointestinal tract, particularly the rectum or anus. This can be caused by several factors, including hemorrhoids, anal fissures, or more serious conditions such as diverticulosis or colorectal cancer. Given your history of hemorrhoids, it is quite possible that the bleeding is related to this condition, especially if you have experienced pain during bowel movements.

Your constipation and irregular bowel habits are also significant. Chronic constipation can lead to straining during bowel movements, which can exacerbate hemorrhoids and lead to anal fissures, both of which can cause bleeding. The fact that you have been experiencing changes in the shape and consistency of your stool, along with episodes of diarrhea, suggests that your bowel function is not normal. The presence of hard, pellet-like stools followed by softer stools can indicate a fluctuation between constipation and diarrhea, which may be related to dietary changes or stress.

Regarding your concern about colorectal cancer, while your CEA (Carcinoembryonic Antigen) level of 0.66 is within the normal range, it is important to note that this test is not definitive for cancer diagnosis. Colorectal cancer can occur in younger individuals, especially if there is a family history of the disease or other risk factors. Given your age of 28 and the symptoms you are experiencing, it is advisable to consult with a gastroenterologist for a thorough evaluation. A colonoscopy may be recommended to rule out any serious conditions, including polyps or cancer, especially since you have noted blood in your stool.

In addition to a colonoscopy, your doctor may suggest other diagnostic tests, such as blood tests to check for anemia, stool tests to look for hidden blood, and imaging studies if necessary. It is also essential to address your constipation and hemorrhoid issues. Increasing your fiber intake, staying well-hydrated, and possibly using stool softeners or laxatives under medical supervision can help improve your bowel regularity.
In summary, while your symptoms may be related to hemorrhoids and constipation, the presence of blood in your stool should not be ignored. It is crucial to seek medical attention to determine the underlying cause and receive appropriate treatment. Early intervention can lead to better outcomes and peace of mind. Please do not hesitate to reach out to a healthcare professional for further evaluation and management of your symptoms.

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