Blood After Bowel Movements: Hemorrhoids or Something More?

Bleeding after bowel movements?

On June 23, after having a bowel movement, I noticed blood on the toilet paper while wiping, approximately the size of a five-dollar coin, but there was no pain.
Prior to this date, I had also seen one or two spots of blood on the toilet paper after bowel movements, initially thinking it was just a skin tear.
On June 23, I immediately consulted a primary care physician, who diagnosed me with hemorrhoids and prescribed an anal suppository to be used for eight consecutive days.
During this time, I had my menstrual period, so I couldn't confirm if there was any improvement after using the medication.
In the first few days of my period, I felt the urge to have a bowel movement first thing in the morning, but the stools were somewhat loose and unformed; they later returned to a banana shape.
After my period ended, I had a bowel movement (that day, the stool felt bulkier and required some effort to pass), and I noticed blood on the toilet paper again, but less than on June 23.
There was no blood in the stool (although one day I did see blood at the end of the stool).
Now, after every bowel movement, I still notice a small amount of blood on the toilet paper, but the amount is very minimal.
The stool is normal in color and banana-shaped, with no blood on it.
I feel a sensation of stretching on the left side of the anus, which is not painful.
After a bowel movement, there is slight discomfort in the anal area, and I usually need to exert a little effort to pass stool.
Currently, I have a bowel movement once a day (with a larger volume and bulkier stool), whereas previously, I would go 2-3 times a day (with smaller volumes and less formed stools).
Today, during a bowel movement, I again felt a stretching sensation on the left side of the anus, which was not painful, but there was blood on the toilet paper (about one or two drops).
Upon wiping a second time, there were only one or two small spots.
Afterward, the anal area felt a bit warm and uncomfortable (I haven't eaten spicy food in the last two months).
My weight and appetite have not changed, and I have not experienced any abdominal pain, but I have been passing gas more frequently at night.
Could this be rectal cancer or anal cancer, or is it more likely to be internal hemorrhoids or an anal fissure?

Niming, 20~29 year old female. Ask Date: 2021/07/19

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 28-year-old female is experiencing blood after bowel movements, with blood on toilet paper, and has loose stools.
There is no pain in the anus, and her weight has not changed after bowel movements.
Common causes of post-defecation bleeding include hemorrhoids, anal fissures, proctitis, polyps, and cancer.
It is recommended to follow up with a colorectal or gastroenterology clinic for further examination.
Wishing you safety and health! Sincerely, Dr.
Lin Ming-Hui, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/19

More Info

Based on the symptoms you've described, it seems likely that you are dealing with hemorrhoids or possibly an anal fissure rather than something as serious as rectal or anal cancer. However, it's essential to approach this situation with caution and ensure that you receive appropriate medical evaluation and treatment.

Understanding Your Symptoms
1. Blood After Bowel Movements: The presence of blood on toilet paper after a bowel movement is a common symptom associated with hemorrhoids or anal fissures. Hemorrhoids are swollen veins in the lower rectum or anus that can cause bleeding, especially during bowel movements. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools.

2. Pain and Discomfort: You mentioned that there is no pain associated with the bleeding, which is more characteristic of hemorrhoids. Anal fissures typically cause sharp pain during and after bowel movements. The feeling of pressure or discomfort in the anal area can also be associated with hemorrhoids.

3. Bowel Movement Characteristics: The changes in your bowel movements, from less formed to more formed stools, could indicate dietary changes or hydration levels. It's important to maintain a diet rich in fiber and stay hydrated to prevent straining during bowel movements, which can exacerbate hemorrhoids or fissures.

4. Other Symptoms: The sensation of heat or discomfort in the anal area, along with increased flatulence, could be related to dietary factors or irritation from wiping. If you have not changed your diet significantly, consider whether any foods might be causing irritation.

When to Seek Further Evaluation
While your symptoms suggest hemorrhoids or an anal fissure, it is crucial to rule out more serious conditions, including colorectal cancer, especially if you have any of the following:
- A significant change in bowel habits (e.g., diarrhea or constipation lasting more than a few weeks).

- Blood in your stool (not just on toilet paper).

- Unexplained weight loss.

- A family history of colorectal cancer or other gastrointestinal diseases.

Given your concerns about rectal or anal cancer, it would be prudent to follow up with a gastroenterologist or a colorectal surgeon. They may recommend a digital rectal exam or a colonoscopy to visualize the rectum and colon and rule out any serious conditions.

Treatment and Management
1. Conservative Measures: If hemorrhoids or an anal fissure are confirmed, treatment often begins with conservative measures:
- Dietary Changes: Increase fiber intake through fruits, vegetables, and whole grains to soften stools and reduce straining.

- Hydration: Drink plenty of water to help prevent constipation.

- Topical Treatments: Over-the-counter creams or suppositories can help relieve symptoms.

- Warm Baths: Soaking in warm water can provide relief from discomfort.

2. Medical Treatment: If conservative measures do not alleviate your symptoms, your doctor may recommend other treatments, such as:
- Rubber Band Ligation: A procedure to treat hemorrhoids by cutting off their blood supply.

- Surgery: In severe cases, surgical intervention may be necessary.

3. Follow-Up: Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as necessary.

Conclusion
While your symptoms are concerning, they are more indicative of hemorrhoids or an anal fissure rather than rectal or anal cancer. However, it is essential to consult with a healthcare professional for a thorough evaluation and appropriate management. Early detection and treatment can prevent complications and improve your quality of life.

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