Blood in Stool: When to Consider a Colonoscopy

Blood in the stool?

Hello Doctor, I have been experiencing constipation issues, having bowel movements every 3 to 5 days.
During college, I had some bleeding during bowel movements and consulted a doctor who diagnosed me with anal fissures.
I also had a history of internal hemorrhoids.
Recently, I visited a traditional Chinese medicine practitioner, and my constipation improved to having bowel movements every 1 to 2 days.
However, lately, I often feel that my stools are somewhat hard and difficult to pass, and I experience a slight tearing pain in the anal area.
After bowel movements, I notice bright red blood on the toilet paper, and there is also a small amount of bright red blood at the end of the stool.
The color of my stool is brown, and its shape is mostly normal but occasionally lumpy.
Aside from this, I do not have any other symptoms like abdominal pain.
Almost two years ago, I underwent cancer marker screening, and my CEA level was 0.66.
I would like to know if I need to undergo a colonoscopy.
I am very concerned about the possibility of colon cancer.
Thank you for your help.

S, 20~29 year old female. Ask Date: 2022/02/14

Dr. Ke Fangxu reply Surgery

The likelihood of developing colorectal cancer at the age of 29 is not zero, but generally speaking, it is very, very low.
Based on your description, it seems more like bleeding from an anal fissure.
I recommend starting with a light diet and maintaining a good lifestyle.
You should avoid spicy, irritating, and greasy foods, and increasing your intake of dietary fiber can also be helpful.
If symptoms persist without improvement, you can consult a physician for medication.
If you wish to have a colonoscopy, you can ask your doctor to arrange it.

Reply Date: 2022/02/14

More Info

When it comes to understanding blood in the stool and determining whether a colonoscopy is necessary, several factors must be considered. Blood in the stool can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease (IBD), and colorectal cancer. Given your history of constipation, anal fissures, and hemorrhoids, it's essential to evaluate the current symptoms in context.

From your description, it appears that you have experienced a change in bowel habits, with a history of constipation and recent episodes of bright red blood on the toilet paper and at the end of your stool. The presence of bright red blood typically indicates that the bleeding is occurring in the lower gastrointestinal tract, which could be due to hemorrhoids or anal fissures, especially considering your previous diagnoses. However, it is crucial to rule out other potential causes of rectal bleeding.

The fact that you have had a colon cancer screening (CEA level of 0.66) is reassuring, as this level is within the normal range. However, CEA is not a definitive test for colorectal cancer, and its levels can be influenced by various factors, including smoking, liver disease, and other cancers. Therefore, while your CEA level is normal, it does not entirely eliminate the need for further investigation if symptoms persist.

Given your symptoms of bright red blood, especially after straining during bowel movements, it is advisable to consider a colonoscopy. This procedure allows for a direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as polyps, fissures, or signs of inflammatory bowel disease. Additionally, if any lesions are found, they can often be biopsied or treated during the same procedure.

You mentioned that your bowel movements have improved with traditional Chinese medicine, but the presence of blood is concerning. Even if the blood is likely due to hemorrhoids or fissures, it is essential to ensure that there are no other underlying issues, particularly given your anxiety about colorectal cancer. A colonoscopy is a safe and effective way to address these concerns.

In summary, while your symptoms may be attributed to hemorrhoids or anal fissures, the presence of blood in the stool warrants further investigation through a colonoscopy. This procedure will provide clarity and peace of mind, allowing for appropriate management of any identified issues. It is always better to err on the side of caution when it comes to gastrointestinal symptoms, especially with a history of constipation and rectal bleeding. Please consult with your healthcare provider to discuss your symptoms and the potential need for a colonoscopy.

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