Bowel Issues: When to Worry About Rectal Pain and Bleeding

Bowel issues

Hello Doctor, I recently experienced rectal bleeding during bowel movements, and after a digital rectal examination at a large hospital, I was diagnosed with an anal fissure.
No further tests were conducted.
However, the bleeding has recurred, and I am experiencing pain in the anal area during bowel movements.
I wonder if this could be related to my decreased water intake.
Additionally, due to my menstrual period, I suddenly ate significantly more than usual yesterday, and since then, I have been experiencing bowel sounds and diarrhea.
Is this normal? If I am concerned and wish to undergo a colonoscopy, is it appropriate for my age? I am worried it might be cancer.
Thank you for your response.
🙏

Yang Cheng, 10~19 year old female. Ask Date: 2022/02/28

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 17-year-old female is experiencing bowel issues—severe anal fissures causing bleeding and pain.
Diarrhea or difficulty in bowel movements can exacerbate the fissure problem.
It is important to drink plenty of water, increase fiber intake, engage in moderate exercise, and develop good bowel habits.
There are symptoms of abdominal rumbling and diarrhea; however, the presence of blood in the stool is abnormal.
Is the bleeding from the anal fissure or due to colitis? A colonoscopy is an invasive procedure, and it is primarily arranged to check for ulcers, inflammation, polyps, or tumors.
Before undergoing a colonoscopy, a low-residue diet should be followed for three days, and a bowel prep should be taken to cleanse the intestines prior to the examination.
The age of 17 is not a concern; the focus should be on whether there are indications for a colonoscopy and the patient's ability to cooperate.
If symptoms persist, follow-up outpatient examinations are necessary.
Wishing you safety and health.
Sincerely, Dr.
Ming-Hui Lin, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/28

More Info

When it comes to bowel issues, particularly rectal pain and bleeding, it's essential to understand the potential causes and when to seek further medical evaluation. Based on your description, it seems you have experienced rectal bleeding and pain associated with bowel movements, which can be concerning. However, there are several common reasons for these symptoms that may not necessarily indicate a severe underlying condition.

Firstly, you mentioned that you were diagnosed with an anal fissure previously. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. They can lead to significant pain and bleeding, especially during and after bowel movements. If your symptoms have recurred, it is possible that the fissure has reopened, particularly if you have been experiencing constipation or if your hydration levels have been low, leading to harder stools.

You also noted experiencing diarrhea and increased bowel sounds after eating more than usual, especially during your menstrual period. This could be related to dietary changes or stress associated with your menstrual cycle, which can affect gastrointestinal motility. The gastrointestinal tract is sensitive to hormonal changes, and many individuals experience changes in bowel habits during menstruation. Increased intake of food, particularly if it is rich in fiber or fat, can also lead to temporary diarrhea, especially if your body is not accustomed to it.

Regarding your concern about colorectal cancer, it is understandable to feel anxious, especially with symptoms like rectal bleeding. However, at your age, the likelihood of developing colorectal cancer is quite low. Most cases of rectal bleeding in younger individuals are due to benign conditions such as hemorrhoids, anal fissures, or inflammatory bowel disease. Nevertheless, if you have persistent symptoms, it is always prudent to discuss your concerns with your healthcare provider.

If you are considering a colonoscopy, it is generally safe for individuals of your age, especially if you have concerning symptoms or a family history of colorectal cancer. A colonoscopy can help rule out any serious conditions and provide peace of mind. Your doctor can guide you on whether this procedure is appropriate based on your symptoms and medical history.

In summary, while your symptoms may be alarming, they are often associated with benign conditions. It is crucial to maintain adequate hydration, consume a balanced diet rich in fiber, and manage stress levels, especially during your menstrual cycle. If your symptoms persist or worsen, or if you experience additional symptoms such as significant weight loss, changes in appetite, or persistent abdominal pain, it is essential to seek medical attention promptly. Regular follow-ups with your healthcare provider can help monitor your condition and address any concerns you may have.

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