Anal Itching and Blood After Walking: Should You Get a Colonoscopy?

After walking, there is anal itching, and wiping the anus reveals yellowish fecal mucus with a small amount of light red blood streaks?

Hello Doctor, I usually have normal bowel movements in terms of frequency and shape, and I have not noticed any visible blood in my stool or toilet.
However, for the past three months, I have experienced anal itching during my walk to work after having a bowel movement in the morning and wiping clean.
When I return to the office and wipe, I sometimes see a small amount of light red blood on the toilet paper, along with a small amount of fecal mucus, and I also feel a slight burning sensation in the anal area.
(In the past, I have experienced anal itching after walking, but I did not notice any blood on the toilet paper.) My last colonoscopy was four years ago, during which the doctor found a very small polyp that was removed, and I was also diagnosed with mild internal hemorrhoids.
Doctor, do you think these symptoms require me to undergo another colonoscopy for further examination?

David, 30~39 year old female. Ask Date: 2022/03/25

Dr. Zhang Shuhao reply Surgery

There are many causes of anal itching, including the prolapse of internal hemorrhoids, which can lead to a sensation of mucus due to the eversion of the mucosa, minor anal fissures, allergies, and even less common causes such as parasites.
If there are no accompanying abdominal or bowel symptoms, it is rarely related to tumors.
If you are concerned, it is advisable to first visit a colorectal clinic for an examination.
An anoscopy or sigmoidoscopy can be performed in the clinic, and if the cause is still not identified, a colonoscopy can be done.

Reply Date: 2022/03/25

More Info

Based on your symptoms of anal itching, the presence of a small amount of blood on toilet paper, and a history of a small polyp and mild internal hemorrhoids, it is advisable to consider a follow-up colonoscopy. While your symptoms may be attributed to benign conditions such as hemorrhoids or anal fissures, the presence of blood, even in small amounts, warrants further investigation to rule out any serious underlying issues.

Anal itching can be caused by various factors, including irritation from moisture, hygiene products, or dietary choices. However, when accompanied by blood, it raises the concern for potential complications. The blood you are observing could be due to irritation or trauma to the anal area, possibly from the hemorrhoids or even a fissure. Hemorrhoids can cause bright red blood on the toilet paper or in the stool, especially if they are inflamed or thrombosed.
Given that you had a colonoscopy four years ago, it is important to note that the risk of developing new polyps or other abnormalities increases with age and over time, particularly if there is a family history of colorectal cancer. Since your last examination, there may have been changes in your gastrointestinal health that need to be assessed.
The American College of Gastroenterology recommends that individuals with a history of polyps or colorectal issues undergo regular screenings. If you have had a polyp previously, especially if it was adenomatous (which can be precursors to cancer), the guidelines suggest more frequent surveillance.
In your case, the combination of anal itching, the presence of blood, and your previous medical history suggests that a colonoscopy could be beneficial. It would allow for a thorough examination of the colon and rectum, ensuring that any potential issues are identified and addressed early.
Additionally, if you experience any worsening symptoms, such as increased bleeding, severe pain, or changes in bowel habits, you should seek medical attention promptly. It is also important to maintain a healthy diet rich in fiber, stay hydrated, and practice good anal hygiene to help alleviate some of the discomfort you are experiencing.

In conclusion, while your symptoms may not immediately indicate a serious condition, the presence of blood and your medical history suggest that a follow-up colonoscopy is a prudent step to ensure your gastrointestinal health. It is always better to err on the side of caution when it comes to potential signs of gastrointestinal issues. Please consult with your healthcare provider to discuss your symptoms and the need for further evaluation.

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