Bleeding After Wiping: Insights on Hemorrhoids and Care

Blood on toilet paper after wiping?

Hello Doctor, after having a bowel movement today, I wiped with toilet paper and there was no blood, and the stool was normal.
However, I have a slight flare-up of hemorrhoids, which are mildly swollen and painful.
I kept worrying that I might have some unnoticed bleeding, so I kept pressing and wiping with toilet paper.
After several times, I actually noticed a small amount of blood on the toilet paper, which looked like it might be from a small abrasion.
Could this situation be due to me irritating the skin? Additionally, if I am very concerned about unnoticed bleeding, what should I do? Is it true that if there is blood during a bowel movement, it is usually easy to notice, so I don't need to keep wiping to check? Normally, after using the toilet, I wash my bottom with a bidet and let it air dry, without using toilet paper.
Would this be better for my hemorrhoids? I had a colonoscopy a year ago, which showed no polyps and was normal.
I have both internal and external hemorrhoids, but they don't flare up often.
If they do swell, they usually resolve on their own in about one to two weeks.
I don't recall seeing blood in my stool; I only notice a small amount of bright red blood after wiping (maybe once a year I irritate myself).
Thank you, Doctor.

Youyou, 30~39 year old female. Ask Date: 2022/02/25

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Spicy and irritating foods should be temporarily avoided, and increasing dietary fiber intake can be helpful.
Warm sitz baths may assist in alleviating symptoms.
Using a bidet is acceptable, but it is advisable to avoid sitting on it for too long.
You can also purchase hemorrhoidal suppositories at the pharmacy.
It is best not to use laxatives indiscriminately.
If bleeding persists, it is advisable to consult a physician for evaluation.
If a colonoscopy was performed a year ago, there should be no need for another one in such a short time frame.

Reply Date: 2022/02/25

More Info

When it comes to the issue of bleeding after wiping, particularly in the context of hemorrhoids, it is essential to understand the underlying causes and appropriate care strategies. Based on your description, it seems that the bleeding you observed could indeed be a result of irritation or minor abrasion caused by excessive wiping, especially if you have hemorrhoids that are currently inflamed or swollen.

Hemorrhoids, which are swollen veins in the lower rectum and anus, can cause discomfort, pain, and bleeding. The bleeding you noticed on the tissue could be due to the delicate skin around the hemorrhoids being irritated or even slightly torn from the friction of wiping. This is not uncommon, especially if the hemorrhoids are active or inflamed. It is important to note that while minor bleeding from hemorrhoids is usually not a cause for alarm, persistent or significant bleeding should always be evaluated by a healthcare professional.

To address your concerns about whether you might be missing any bleeding, it is generally true that if there is significant bleeding from the rectum, it is usually noticeable. However, if you are experiencing minor bleeding that is only visible upon wiping, it may be more challenging to detect without careful observation. If you are worried about missing any bleeding, consider the following steps:
1. Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and amount of bleeding, pain, or discomfort. This information can be helpful for your healthcare provider.

2. Gentle Wiping: Instead of excessive wiping, consider using moist wipes or a bidet, as you mentioned using a washlet. This can help reduce irritation and is generally more comfortable for individuals with hemorrhoids.

3. Avoid Straining: Ensure that you are not straining during bowel movements, as this can exacerbate hemorrhoids. A diet high in fiber, along with adequate hydration, can help maintain softer stools and reduce the need for straining.

4. Consult a Healthcare Provider: If you notice any significant changes in your symptoms, such as increased bleeding, pain, or changes in bowel habits, it is advisable to consult a healthcare provider. They may recommend further evaluation or treatment options.

5. Regular Check-ups: Since you had a colonoscopy a year ago with normal results, it is good practice to continue regular check-ups, especially if you have a history of hemorrhoids. This can help ensure that any potential issues are caught early.

In terms of your hygiene practices, using a bidet or a washlet can be beneficial for individuals with hemorrhoids, as it minimizes friction and irritation compared to wiping with toilet paper. After using a bidet, gently pat the area dry with a soft towel or toilet paper to avoid any additional irritation.

In summary, while the bleeding you experienced may be a minor issue related to your hemorrhoids, it is essential to monitor your symptoms and practice gentle hygiene. If you have ongoing concerns or if the bleeding persists, do not hesitate to reach out to a healthcare professional for further evaluation and guidance.

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