Rectal Bleeding: Causes and Concerns for Patients

Blood in the stool has been observed for the past month?

Hello, Dr.
Zhang.
I would like to ask you about my bowel movements.
They have consistently been long and thick, with a yellow-brown color.
The front part is mostly composed of small, granular pieces, while the middle to end section is smooth and of a soft, firm consistency.
I have bowel movements about 3 to 6 times a week.
Over the past month, I have frequently experienced bleeding (I have observed this 8 times).
Initially, there was significant pain at the anus during bowel movements (the pain persisted even after finishing, sometimes lingering until the next day).
However, in the past week, the pain during bowel movements has decreased (possibly because I have been consuming more fiber lately? I eat kiwi every day).
Now, I only feel pain or discomfort at the anus after bowel movements.
The bleeding occurs mostly on the sides after the granular pieces or directly in the gaps between them.
The amount is not significant, but it is clearly visible to the naked eye, and the color is bright red (though the color appears darker in the gaps).
I rarely see blood when wiping, and it is only occasionally that I notice a small amount of blood on the toilet paper.
Could you please help me understand the cause of this bleeding? Thank you.
I have taken photos for reference, but I'm unsure how to upload them.
Thank you.

R, 40~49 year old female. Ask Date: 2021/12/11

Dr. Zhang Shuhao reply Surgery

Minor bleeding accompanied by pain is usually caused by anal fissures.
It is advisable to increase fluid and dietary fiber intake to prevent constipation, and to take warm sitz baths to promote wound healing.
If symptoms persist, medical attention should be sought for further treatment.
Wishing you a speedy recovery.

Reply Date: 2021/12/11

More Info

Rectal bleeding can be a concerning symptom for many patients, and understanding its potential causes is crucial for effective management and treatment. Based on your description, it appears that you are experiencing rectal bleeding associated with bowel movements, which has been accompanied by pain, particularly at the anal region.
The characteristics of your bowel movements, including the presence of hard, pellet-like stools, suggest that you may be experiencing constipation. Constipation can lead to straining during bowel movements, which can cause anal fissures—small tears in the lining of the anus. These fissures can result in sharp pain during and after bowel movements, as well as bright red blood on the stool or toilet paper. The fact that you have noticed blood primarily after the passage of the pellet-like stools supports this possibility.

Another potential cause of rectal bleeding could be hemorrhoids, which are swollen veins in the lower rectum and anus. Hemorrhoids can be internal or external, and they often cause discomfort, itching, and bleeding during bowel movements. The blood from hemorrhoids is typically bright red and can be seen on the stool or toilet paper, similar to what you have described.

Given that you have recently increased your fiber intake by consuming more fruits like kiwis, this may help soften your stools and reduce straining, which could alleviate some of the pain and bleeding. However, if the bleeding persists or worsens, it is essential to seek medical attention.
In addition to fissures and hemorrhoids, other causes of rectal bleeding can include diverticular disease, colorectal polyps, or even more serious conditions such as inflammatory bowel disease (IBD) or colorectal cancer. While these conditions are less common, they should not be overlooked, especially if you have a family history of gastrointestinal issues or if the bleeding continues.

To address your concerns effectively, I recommend the following steps:
1. Consult a Healthcare Provider: It is essential to see a healthcare professional, such as a gastroenterologist, who can perform a thorough evaluation. This may include a physical examination, and possibly a colonoscopy, to visualize the rectum and colon and identify any underlying issues.

2. Maintain a High-Fiber Diet: Continue to increase your fiber intake through fruits, vegetables, whole grains, and legumes. This can help soften your stools and promote regular bowel movements, reducing the risk of straining.

3. Stay Hydrated: Drink plenty of water throughout the day to help prevent constipation.

4. Consider Stool Softeners: Over-the-counter stool softeners or laxatives may be helpful if dietary changes alone do not alleviate your symptoms.

5. Monitor Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, any changes in bowel habits, and the presence of pain. This information will be valuable for your healthcare provider.

6. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to go, do so promptly rather than waiting.

In conclusion, while your symptoms may be indicative of common issues such as anal fissures or hemorrhoids, it is crucial to consult a healthcare professional for a proper diagnosis and treatment plan. Early intervention can help prevent complications and improve your overall gastrointestinal health.

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