Rectal Bleeding: Insights for Patients with Cerebral Palsy

Regarding rectal bleeding?

Due to my cerebral palsy and being wheelchair-bound, I am unable to exercise regularly.
I mentioned previously that my bowel habits began to change when I was 13 years old, and I often experience blood in my stool along with mucus.
I also find myself 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 strain to get it out.
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 difficulties in obtaining it.
My routine is relatively normal, although I sometimes stay up late.
I tend to prefer meat or fried foods, but I consume them in moderation, and I 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 would cook 600 grams of pork ribs at once.
After eating, I experienced diarrhea.
I checked online and found that brown rice can help with bowel movements, which might explain the diarrhea.
On July 26, I began to experience 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 reduce the risk of colorectal cancer.
On July 30 and August 5, I visited a gastroenterology clinic and a hospital.
Both doctors performed a digital rectal exam and anoscopy.
They suggested that I might have internal hemorrhoids, mild inflammation, and poor bowel motility.
They advised me to increase my water and fiber intake and prescribed some medications for constipation and hemorrhoids.
Both doctors reassured me that I should not worry, as it is likely a motility issue and not cancer.
After starting the medication, I have been having larger bowel movements and have 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 at the anus (which is hard to describe).
I have included some images for reference.
Could you please help me explain my condition and provide some recommendations? Thank you!

Xiao Lin, 20~29 year old female. Ask Date: 2021/08/21

Dr. Ke Fangxu reply Surgery

Although the probability of developing colorectal cancer at the age of 24 is not zero, it is generally very low.
Abnormal stool color is often caused by food residues, with common culprits including carrots, dragon fruit, tomatoes, and pumpkin.
Fruit seeds may also be a potential cause.
It is advisable to temporarily avoid dark-colored foods and to follow a light diet while maintaining a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber intake can be beneficial.
If the issue persists, it is recommended to consult a physician for a colonoscopy.

Reply Date: 2021/08/21

More Info

Rectal bleeding can be a concerning symptom, especially for individuals with cerebral palsy who may have unique challenges related to mobility and bowel function. Based on your description, it seems that you have been experiencing rectal bleeding, mucus in your stool, and changes in your bowel habits, which have been attributed to internal hemorrhoids and possibly other gastrointestinal issues.

Understanding Your Symptoms
1. Internal Hemorrhoids: These are swollen veins in the rectum that can cause bleeding, especially during bowel movements. They are often associated with straining, which can occur if you have difficulty passing stool. Given your history of constipation and the need to exert effort to have a bowel movement, this could be a significant factor contributing to your symptoms.

2. Bowel Habits: The changes in your bowel habits, including alternating between diarrhea and constipation, could indicate a condition known as irritable bowel syndrome (IBS) or could be related to your diet and hydration levels. A diet low in fiber and inadequate fluid intake can lead to hard stools, which can exacerbate hemorrhoids and cause bleeding.

3. Mucus in Stool: The presence of mucus can be a normal finding, but excessive mucus can indicate inflammation in the intestines. This could be due to various factors, including dietary choices or underlying gastrointestinal conditions.

Recommendations for Management
1. Dietary Changes: Increasing your fiber intake is crucial. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. These foods can help soften your stool and promote regular bowel movements. Since you mentioned a preference for meat and fried foods, consider gradually incorporating more fiber-rich foods into your meals.

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 active or in a hot environment. Proper hydration helps prevent constipation and can ease the passage of stool.

3. Regular Bowel Routine: Establishing a regular time for bowel movements can help train your body. Try to sit on the toilet at the same time each day, even if you don’t feel the urge to go. This can help regulate your bowel habits.

4. Physical Activity: While you may have mobility challenges, engaging in any form of physical activity that you can manage is beneficial. Even light stretching or movements can promote bowel motility.

5. Medication: Continue to follow your doctor's recommendations regarding medications for constipation and hemorrhoids. Over-the-counter stool softeners or fiber supplements can be helpful, but consult your healthcare provider before starting any new medication.

6. Follow-Up Care: Since you have already seen specialists, it’s important to maintain regular follow-ups to monitor your condition. If your symptoms persist or worsen, further evaluation may be necessary to rule out other gastrointestinal issues.

When to Seek Immediate Care
If you experience significant changes in your symptoms, such as increased bleeding, severe pain, or any signs of infection (fever, chills), seek medical attention promptly. While your doctors have reassured you that your symptoms are likely not indicative of cancer, it’s essential to remain vigilant and communicate any new or worsening symptoms to your healthcare team.

Conclusion
Managing rectal bleeding and associated symptoms requires a multifaceted approach, focusing on diet, hydration, and regular medical follow-up. Given your cerebral palsy and the challenges it presents, working closely with your healthcare providers to tailor a management plan that suits your needs is crucial. Remember, you are not alone in this, and there are resources and support available to help you navigate these health concerns.

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