Rectal Bleeding: When to Seek Medical Advice

Rectal bleeding

Hello Doctor, I am 29 years old and have been experiencing constipation issues.
I usually have a bowel movement every 3 to 5 days.
However, except during my menstrual period when my stools are normal and I feel completely empty, my regular bowel movements are often not well-formed, mostly appearing as small, hard lumps or clumps that stick together, which is quite unusual.
Sometimes, I feel like I haven't fully emptied my bowels.
Additionally, I have hemorrhoids that occasionally flare up with swelling and pain, although most of the time I don't feel anything.

Two weeks ago, I had a particularly large and hard bowel movement, and after wiping, I noticed blood on the toilet paper.
A few days later, my hemorrhoids flared up again with swelling and pain, but after about four to five days, it improved.
Since then, I have had small amounts of stool, but recently, I haven't had a bowel movement for about 4 to 5 days.
Today, after finally having a bowel movement, I noticed a few small stools mixed with a little fresh red blood, particularly noticeable at the end.
However, there was no blood when I wiped, and there was no pain; I just have a sensation of needing to have another bowel movement.
I typically do not experience abdominal pain, and my weight has not decreased over the past few months.

I would like to know if I need to undergo a painless colonoscopy, or if I should just continue to observe my symptoms.
Thank you very much, Doctor.

Ting, 20~29 year old female. Ask Date: 2022/05/07

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 hemorrhoidal bleeding.
It is advisable to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing your intake of dietary fiber can also be beneficial.
If symptoms persist without improvement, you may want to consult a physician for medication or consider undergoing a colonoscopy.

Reply Date: 2022/05/07

More Info

When it comes to rectal bleeding, especially in the context of your symptoms, it's important to approach the situation with caution and awareness of potential underlying issues. Given your history of constipation and hemorrhoids, the presence of bright red blood in your stool can often be attributed to these conditions. However, it is crucial to understand when to seek medical advice and what steps to take for further evaluation.

Understanding Rectal Bleeding
1. Common Causes: In your case, the bright red blood mixed with stool is likely due to hemorrhoids, especially since you mentioned experiencing pain and swelling in that area. Hemorrhoids can become inflamed and bleed, particularly after passing hard stools. Other potential causes of rectal bleeding include anal fissures, diverticular disease, and, less commonly, colorectal polyps or cancer.

2. Symptoms to Monitor: While occasional bleeding from hemorrhoids is common, you should be vigilant about other symptoms. If you experience significant pain, changes in bowel habits, weight loss, or if the bleeding persists or worsens, these could be signs of a more serious condition that requires immediate medical attention.

When to Seek Medical Advice
- Persistent or Worsening Symptoms: If the bleeding continues or increases in frequency or volume, it is essential to consult a healthcare provider.
- Change in Bowel Habits: If you notice a significant change in your bowel habits, such as a sudden increase in constipation or diarrhea, this warrants evaluation.

- Accompanying Symptoms: If you experience abdominal pain, fever, or unexplained weight loss, these symptoms should prompt a visit to a healthcare professional.

Diagnostic Procedures
- Colonoscopy: Given your symptoms and the presence of rectal bleeding, a colonoscopy may be recommended. This procedure allows for direct visualization of the colon and rectum, helping to identify any abnormalities such as polyps, tumors, or sources of bleeding. While you may be hesitant about the procedure, it is a valuable tool in ruling out serious conditions, especially if you have a family history of colorectal issues or if your symptoms change.

Management and Prevention
1. Dietary Changes: Increasing fiber intake can help manage constipation and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is also crucial.

2. Over-the-Counter Treatments: For hemorrhoids, topical treatments such as hydrocortisone creams or witch hazel pads can provide relief from itching and inflammation.

3. Regular Monitoring: Keep track of your symptoms, including the frequency and amount of bleeding, and any changes in bowel habits. This information will be helpful for your healthcare provider.

4. Follow-Up: Regular follow-ups with your healthcare provider can help manage your constipation and hemorrhoids effectively, reducing the risk of future bleeding episodes.

Conclusion
In summary, while your symptoms may be related to hemorrhoids and constipation, it is essential to remain vigilant. If you notice any changes in your symptoms or if the bleeding persists, seeking medical advice is crucial. A colonoscopy may be warranted to rule out any serious conditions, especially given your history. By making dietary changes and managing your symptoms proactively, you can help prevent future issues. Always prioritize your health and do not hesitate to reach out to a healthcare professional for guidance.

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