Blood in Stool: Causes and Concerns in Gastroenterology

Blood in the stool?

In the past three months, I have had five bowel movements with a drop of blood at the end.
When wiping after a bowel movement, there is fresh red blood about the size of a ten-dollar coin mixed with the stool.
I have been experiencing diarrhea continuously for over three months.
I underwent a colonoscopy (on August 1), an upper endoscopy (on August 1), an ultrasound (on August 29), a CT scan (on September 20), fecal occult blood tests (on July 29 and October 14), blood tests (on July 25, August 29, and October 14), and a urinalysis (on July 29).
The results showed hepatitis B, with the ultrasound revealing a 2 cm hypoechoic lesion and the CT scan showing a 0.3 cm liver cyst; however, the 2 cm lesion was not present on the CT scan (aside from hepatitis B, liver function tests and other blood markers were normal).
Three polyps measuring approximately 0.3 to 0.5 cm were removed from the stomach, and one 0.5 cm polyp was removed from the ascending colon, all of which were benign.
Additionally, I have internal and external hemorrhoids.
The fecal occult blood test results were normal, and cancer markers (CEA, AFP, CA19-9) were also normal.
I have discussed the presence of blood in my stool and diarrhea with my doctor, which led to the colonoscopy and other examinations.
Is the blood at the end of my stool and the blood when wiping caused by the internal hemorrhoids? Or could there have been something missed in the previous examinations? I need to take one loperamide (Imodium) daily to control the diarrhea.
Thank you for your response, doctor.

Liu Xiansheng, 40~49 year old female. Ask Date: 2022/11/15

Dr. Chen Shidian reply Gastroenterology and Hepatology

All examinations should be complete; continuous monitoring and medication management are sufficient.

Reply Date: 2022/11/15

More Info

Understanding blood in stool can be a concerning issue, especially when it is accompanied by other gastrointestinal symptoms such as diarrhea. In your case, the presence of bright red blood at the end of your stool and on toilet paper, along with a history of diarrhea over the past three months, warrants a thorough evaluation.
From the information provided, it appears that you have undergone a comprehensive series of diagnostic tests, including colonoscopy, gastroscopy, ultrasound, CT scans, and various blood tests. The findings indicate that you have hepatitis B, benign polyps in the stomach and ascending colon, and internal and external hemorrhoids. The fact that your cancer markers (CEA, AFP, CA19-9) are normal is reassuring, as it suggests that there is no evidence of malignancy at this time.

The blood in your stool is likely related to the internal hemorrhoids, which can cause bright red blood to appear when straining during bowel movements. Hemorrhoids are swollen blood vessels in the rectal area that can bleed, especially if there is associated straining or constipation. Given that you have been experiencing diarrhea, the irritation from frequent bowel movements could exacerbate the hemorrhoids, leading to bleeding.

However, it is also essential to consider other potential causes of gastrointestinal bleeding. While your colonoscopy and gastroscopy have ruled out significant lesions or malignancies, there are still conditions that may not have been fully evaluated. For instance, inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, can cause both diarrhea and rectal bleeding. These conditions may require specific tests, such as stool studies for pathogens or inflammatory markers, to rule them out.

Additionally, the fact that you require a daily anti-diarrheal medication (loperamide) to manage your symptoms suggests that there may be an underlying issue with your gastrointestinal motility or absorption. Chronic diarrhea can lead to dehydration and electrolyte imbalances, which can further complicate your condition. It is crucial to address the underlying cause of your diarrhea, as it may contribute to the irritation of your hemorrhoids and the resultant bleeding.

In summary, while the blood in your stool is likely due to your internal hemorrhoids, it is essential to continue monitoring your symptoms and maintain open communication with your healthcare provider. If the bleeding persists or worsens, or if you develop new symptoms such as abdominal pain, weight loss, or changes in bowel habits, further evaluation may be necessary. It may also be beneficial to consult a gastroenterologist specializing in inflammatory bowel diseases to explore any potential underlying conditions that may not have been fully addressed in your previous evaluations.

In the meantime, managing your hemorrhoids through dietary changes (increasing fiber intake), hydration, and possibly topical treatments may help alleviate some of the bleeding. Regular follow-ups with your healthcare provider will ensure that any changes in your condition are promptly addressed.

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