Bleeding from Internal and External Hemorrhoids: Key Insights

Bleeding from internal and external hemorrhoids?

Hello, doctor.
I would like to ask you a few questions.
I have both internal and external hemorrhoids.
Previously, when I had frequent bowel movements or constipation, my external hemorrhoids would protrude, and there would be blood when I wiped, but my stool was normal yellow.
However, this time is different; I had soft stools (in several batches), and when I wiped afterward, I noticed only a little blood on the toilet paper, but there were several spots of blood in the soft stool.
I was worried and went to a clinic for an examination.
The doctor said I had a tear in my internal hemorrhoid, which caused the bleeding, and prescribed me an ointment.
Unsatisfied, I went to a larger hospital for a colonoscopy and gastroscopy.
The results showed that a small polyp was removed from my rectum, which the doctor said was benign, and advised me to follow up in 2-3 years.
There were no issues with my stomach.

1.
My question is, if my stomach examination showed no problems, why did the doctor prescribe medication for gastroesophageal reflux, a stool softener, and medication for Helicobacter pylori?
2.
I sometimes experience cramping pain in the lower left side of my abdomen.
Is this related to the small polyp that was removed?
3.
Since the colonoscopy, I have had soft stools for three consecutive days, and there has been blood at the end of my stool (the blood is not dripping outside).
When I wiped, there was a little blood for the first time, but the following two or three times there was no blood.
This is different from my external hemorrhoids, which have also protruded again.
Is the blood in my stool related to the polyp that was removed?
4.
My external hemorrhoids have reduced swelling with warm water, but the ointment for my internal hemorrhoids hasn’t helped (the blood is still mixed in the stool).
Should I take medication or buy a specific ointment to stop the internal hemorrhoids from bleeding? I apologize for the lengthy questions.
Thank you, doctor.

Dou Xiao Xiong, 40~49 year old female. Ask Date: 2022/07/24

Dr. Zhang Shuhao reply Surgery

1.
If the gastroscopy shows no issues, medication may not be necessary.
Doctors may prescribe medication based on gastrointestinal symptoms, but usually, treatment for Helicobacter pylori is not required.
2.
It is generally unrelated to rectal polyps.
3.
It is not necessarily related to polyps; however, taking laxatives before the examination can make hemorrhoids more likely to flare up.
If the stool color is normal, it is more indicative of hemorrhoidal bleeding.
4.
Internal hemorrhoidal bleeding can be managed with ligation, but if symptoms are severe and recurrent, surgical removal is still recommended.

Reply Date: 2022/07/24

More Info

Understanding bleeding from internal and external hemorrhoids can be a complex issue, especially when there are additional factors such as polyps or other gastrointestinal conditions involved. Let's break down your concerns and provide some insights based on your situation.

1. Gastroesophageal Reflux Disease (GERD) and Treatment: You mentioned that your doctor prescribed medication for GERD, along with a stool softener and treatment for H. pylori. The reason for this could be that even if your stomach examination showed no issues, GERD can still be present without visible damage during an endoscopy. Symptoms like heartburn, regurgitation, or discomfort can lead a physician to treat for GERD as a precautionary measure. The stool softener is often recommended to prevent straining during bowel movements, which can exacerbate hemorrhoid symptoms. H. pylori treatment is standard if there are indications of infection, as it can contribute to gastric issues.

2. Left Lower Abdominal Pain: The pain you are experiencing in the left lower abdomen could be related to several factors. After the removal of a polyp, it is not uncommon to experience some discomfort as your body heals. However, if the pain persists or worsens, it is essential to follow up with your healthcare provider to rule out any complications or other underlying issues.

3. Blood in Stool: The presence of blood in your stool, especially if it has been consistent over three days, warrants attention. While it could be related to your hemorrhoids, particularly if they are inflamed or irritated, it is crucial to ensure that it is not indicative of a more serious condition. Since you had a polyp removed, it is essential to monitor this symptom closely. If the bleeding continues or increases, you should return to your doctor for further evaluation.

4. Management of Hemorrhoids: For your internal hemorrhoids, if topical treatments have not been effective, you might consider discussing other options with your doctor. These can include dietary changes to increase fiber intake, oral medications, or even procedures like rubber band ligation or sclerotherapy if the hemorrhoids are persistent and causing significant discomfort. Warm sitz baths can help alleviate swelling and pain associated with external hemorrhoids, and maintaining good hydration and a high-fiber diet can prevent constipation, which is a common trigger for hemorrhoid flare-ups.

In summary, while your symptoms may be related to your existing hemorrhoids, the presence of blood in your stool, especially after a polyp removal, should be taken seriously. It is advisable to maintain open communication with your healthcare provider, follow their recommendations, and seek further evaluation if your symptoms persist or worsen. Regular follow-ups are essential, especially after any gastrointestinal procedures, to ensure that any potential issues are addressed promptly.

Similar Q&A

Understanding Hemorrhoids and Anal Fissures: Surgical Options and Relief

Hello, doctor. Over five months ago, I experienced constipation and hard stools for two consecutive weeks. After wiping, I noticed excessive bleeding and itching, which led me to seek medical attention. I was informed for the first time that I had both internal and external hemor...

Dr. Ke Fangxu reply Surgery
1. Both external hemorrhoids and anal fissures can cause itching, but pain is mostly caused by anal fissures. 2. The amount of bleeding from an anal fissure is generally minimal; if there is significant bleeding, the likelihood of hemorrhoidal bleeding is greater. If only exter...

Understanding Hemorrhoids and Rectal Cancer Concerns: What You Need to Know

Hello, doctor: About 20 days ago, I experienced bleeding from internal hemorrhoids (a small amount of blood dripping or bleeding when wiping). I bought hemorrhoid relief pills and ointment, which helped stop the bleeding. However, after each bowel movement, the internal hemorrhoi...

Dr. Ke Fangxu reply Surgery
1. Continuing the medication should help improve the condition of hemorrhoidal prolapse; however, achieving complete resolution of the hemorrhoids may be difficult. It is recommended to shorten the duration of bowel movements to avoid exacerbating the prolapse. 2. Internal hemorr...

Understanding Rectal Bleeding After Painkillers: Hemorrhoids or More?

Hello, I used to experience rectal bleeding after taking painkillers. Later, I consulted a proctologist who diagnosed me with internal hemorrhoids and prescribed topical medication for me. After some time, I didn't have any bleeding. Recently, after having a tooth extraction...

Dr. Cai Yaozhou reply Gastroenterology and Hepatology
Rectal bleeding can be caused by excessive straining during bowel movements or relaxation of the vascular tissue in the anal area, leading to anal fissures or hemorrhoids. It may also indicate colorectal cancer or the presence of polyps. Patients often experience significant pain...

Understanding Rectal Bleeding: Causes, Symptoms, and Treatment Options

Hello Dr. Ke, I experienced anal pain during bowel movements the day before yesterday and yesterday, and I noticed fresh blood in the toilet. There was also blood on the toilet paper when I wiped. Additionally, I found a large and a small lump at the anal opening. Could this be e...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems you may have a combination of internal and external hemorrhoids along with an anal fissure. If the bleeding is not severe, using a topical hemorrhoid cream is acceptable. Of course, constipation can exacerbate the symptoms of hemorrhoids and an...