Recent Blood and Mucus in Stool: A Gastroenterology Perspective

Recent issues with blood in stool and mucus?

Hello Dr.
Chen, I asked a related question on August 12.
Since I have cerebral palsy and use a wheelchair, I am unable to exercise regularly.
Last time, I mentioned that my bowel habits changed starting at the age of 13, and I often experience blood in my stools along with mucus.
I have also been passing gas more frequently, and sometimes I have diarrhea, while at other times I only pass a small amount.
I always pass gas before having a bowel movement, and I have to exert effort to have a bowel movement.
Usually, I do not experience abdominal pain or discomfort.
I have been diagnosed with internal hemorrhoids since then.
Since college, my fiber intake has been low due to accessibility issues.
My routine is relatively normal, although I sometimes stay up late.
My diet tends to favor meat or fried foods, but I consume them in moderation, and I also do not drink much water.
In July, while living in the dormitory, my diet was less controlled.
On July 11 and July 24, I cooked pork rib brown rice porridge.
Since I couldn't refrigerate food in the dorm, I cooked 600 grams of pork ribs each time.
After eating, I experienced diarrhea.
I checked online and found that brown rice can aid in bowel movements, which might explain the diarrhea.
On July 26, I began experiencing issues with passing gas but being unable to have a bowel movement.
I also researched online and read that one should not exceed 500 grams of red meat per week to avoid increasing the risk of colorectal cancer.
I visited a colorectal specialist clinic and a hospital on July 30 and August 5.
Both doctors performed a digital rectal examination and anoscopy.
They suggested that I might have internal hemorrhoids, mild inflammation, and poor intestinal motility, advising me to increase my water and fiber intake.
They prescribed some medications for constipation and hemorrhoid ointment, assuring me that I should not worry, as it is likely a motility issue and not cancer.
After returning home and taking the medication, I have had more bowel movements and increased my water and fiber intake, which has shown some improvement.
However, I still have issues with passing gas, flat stools, blood, mucus, and a frequent sensation of being stretched in the anus (which is hard to describe).
I have included some images for reference.
Could you please explain my condition and provide some recommendations? Thank you! https://photos.app.goo.gl/sTSQUfeiKx9gGT3FA

Xiao Lin, 20~29 year old female. Ask Date: 2021/08/18

Dr. Chen Shidian reply Gastroenterology and Hepatology

A fecal occult blood test can be performed on normal-looking stools (which rules out bleeding from internal hemorrhoids).
If there are still concerns, please discuss with your outpatient physician whether further examination is necessary.

Reply Date: 2021/08/18

More Info

Understanding the presence of blood and mucus in stool is crucial, especially for individuals with underlying health conditions such as cerebral palsy, which can affect mobility and bowel habits. Based on your description, it seems you have been experiencing a range of gastrointestinal symptoms, including blood in your stool, mucus, flat stools, and the sensation of your anus being stretched. These symptoms can be concerning, and it’s essential to approach them with a comprehensive understanding of potential causes and management strategies.

Possible Causes
1. Internal Hemorrhoids: Given your diagnosis of internal hemorrhoids, it is possible that the blood you are seeing in your stool is related to this condition. Hemorrhoids can cause bleeding, especially during bowel movements, and can also lead to mucus discharge. The sensation of your anus being stretched could be due to the presence of hemorrhoids or anal fissures.

2. Dietary Factors: You mentioned a low intake of fiber and a preference for meat and fried foods. A diet low in fiber can lead to constipation, which may exacerbate hemorrhoids and lead to straining during bowel movements. This straining can cause small tears in the anal lining (fissures), leading to bleeding.

3. Bowel Motility Issues: Your cerebral palsy may contribute to slower bowel motility, which can result in constipation or irregular bowel habits. This can lead to the formation of flat stools and increased gas production, as you have described.

4. Inflammatory Conditions: While less likely given your previous evaluations, conditions such as inflammatory bowel disease (IBD) could also cause similar symptoms. However, your doctors have reassured you that your symptoms are not indicative of cancer, which is a positive sign.

Recommendations
1. Dietary Modifications: Increasing your fiber intake is crucial. Aim for a balanced diet that includes fruits, vegetables, whole grains, and legumes. Fiber helps to bulk up stool and can improve bowel regularity. Consider consulting with a nutritionist who can help you create a meal plan that accommodates your preferences while ensuring adequate fiber intake.

2. Hydration: Drinking plenty of water is essential for maintaining healthy bowel function. Aim for at least 8 cups of water a day, or more if you are consuming high-fiber foods, as fiber absorbs water.

3. Regular Monitoring: Keep track of your bowel habits, including the frequency, consistency, and any associated symptoms like pain or discomfort. This information can be valuable for your healthcare provider in assessing your condition.

4. Medication Compliance: Continue taking any prescribed medications for constipation and hemorrhoids as directed. If you experience side effects or if your symptoms do not improve, consult your doctor for possible adjustments.

5. Follow-Up Care: Regular follow-ups with your gastroenterologist are important, especially if your symptoms persist or worsen. If you notice any new symptoms, such as significant changes in bowel habits, severe pain, or increased bleeding, seek medical attention promptly.

6. Physical Activity: While mobility may be a challenge, engaging in any form of physical activity that you can manage will help stimulate bowel function. Simple movements or stretches can be beneficial.

Conclusion
While the presence of blood and mucus in your stool can be alarming, it is often manageable with appropriate dietary and lifestyle changes. Your previous evaluations have indicated that your symptoms are likely related to hemorrhoids and bowel motility issues rather than a more serious condition. By focusing on a high-fiber diet, staying hydrated, and maintaining regular follow-ups with your healthcare provider, you can improve your gastrointestinal health and overall well-being. If you have any concerns or if your symptoms change, do not hesitate to reach out to your healthcare team for further evaluation and guidance.

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