Rectal Concerns: Symptoms, Risks, and Screening Guidelines

Rectal issues

Hello Doctor, three years ago I had a colonoscopy, which only showed irritable bowel syndrome and hemorrhoids, with no other issues.
For the past six months, while showering, I have been using body wash as a lubricant to insert my finger into my rectum to check for any unusual findings.
Recently, I noticed that when I reach deep inside, there is a hard surface, and I can feel slight extensions on both sides, resembling grooves.
I would like to ask if this is normal and why this might be happening.
Additionally, I have noticed that below that hard surface (after passing through the upper part of the bowel), the lower bowel seems to feel softer, and I’m unsure if this is just my perception.
Could this be a rectal polyp, or is it normal for the gastrointestinal tract to feel soft? Lastly, I would like to inquire about the frequency of colonoscopies.
Since I had one three years ago and I am part of the obese population, how long should I wait before having another colonoscopy? Is the risk of developing colorectal cancer high between these two examinations? I read online that if the previous exam was normal, it can be extended to over five years, but for high-risk groups like those who are obese, it is recommended every 2-3 years.
I seem to fit both criteria, and I am currently 21 years old.
Thank you, Doctor.

Nìmíng, 20~29 year old female. Ask Date: 2021/08/14

Dr. Hong Yuanbin reply Internal Medicine

Hello, what you are feeling are the folds and mucosa of the rectum, which is a normal finding.
As for polyps, they are usually small and cannot be definitively diagnosed by palpation; a colonoscopy is necessary for diagnosis.
Given your age, unless there is a family history of colorectal cancer, it is recommended to have a colonoscopy every 5 to 7 years.
If you are very concerned in the meantime, a fecal occult blood test can be used as an alternative.
Thank you for your question.

Reply Date: 2021/08/14

More Info

Hello! Thank you for your detailed inquiry regarding your rectal concerns. It's great that you are proactive about your health, especially considering your previous history of irritable bowel syndrome (IBS) and hemorrhoids. Let's address your questions step by step.

Understanding Your Symptoms
1. Hard Surface and Grooves: The sensation you describe when you insert your finger into your rectum and feel a hard surface with grooves could be related to several factors. The rectum and surrounding areas can have natural anatomical variations, including folds and ridges. However, if you feel something that seems unusual or different from what you have felt before, it is essential to consult a healthcare professional for a thorough examination.
2. Soft Area Below the Hard Surface: The softer area you mention could be normal tissue or possibly an indication of a polyp or other growth. The rectum and colon can have varying textures, and the presence of soft tissue does not automatically indicate a problem. However, any new or concerning changes should be evaluated by a doctor.

Potential Concerns
- Rectal Polyps: Rectal polyps are growths on the lining of the rectum, and while many are benign, some can develop into colorectal cancer over time. If you have concerns about polyps, it is advisable to have them evaluated through a colonoscopy.

- Cancer Risk: Given your age (21 years) and your previous colonoscopy results, the risk of developing colorectal cancer is generally low. However, being overweight can increase your risk factors. The general recommendation for screening in average-risk individuals is every 10 years, but for those with risk factors (like obesity), it may be prudent to have screenings more frequently.

Screening Guidelines
- Frequency of Colonoscopy: Since you had a colonoscopy three years ago with no significant findings, the typical recommendation for someone of your age and health status would be to wait at least five years for the next screening. However, because you mentioned being in a higher-risk category due to obesity, it may be wise to consider a follow-up colonoscopy in 2-3 years.
- Consultation with a Healthcare Provider: It is crucial to discuss your specific situation with a gastroenterologist. They can provide personalized recommendations based on your medical history, current symptoms, and risk factors.

Conclusion
In summary, while some of the sensations you are experiencing may be normal anatomical variations, any new or concerning changes should be evaluated by a healthcare professional. Given your history and current symptoms, it would be prudent to schedule a follow-up appointment with a gastroenterologist for a thorough evaluation and to discuss the appropriate timing for your next colonoscopy.
Remember, early detection is key in managing any potential issues, and being proactive about your health is always a positive step. If you have any further questions or concerns, please don't hesitate to reach out to a healthcare provider. Thank you for taking the time to address your health concerns!

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