Dizziness and Bright Red Blood in Stool: When to Seek Further Evaluation

Dizziness, hematochezia?

Hello, Dr.
Chang.
I usually have a daily bowel movement.
One night, I suddenly experienced mild dizziness without abdominal pain or other symptoms.
The next morning, I had a bowel movement (soft stool) that was accompanied by bright red blood, which was enough to turn the toilet water red, and there was a significant amount of fresh blood on the toilet paper after wiping.
At that moment, I felt no pain, itching, or foreign body sensation.
After visiting the doctor that day, the physician performed a digital rectal examination and a sigmoidoscopy, stating that "no obvious abnormalities were found, the color of the retained stool was normal, and it was determined to be internal hemorrhoids." They prescribed an anal suppository.
I would like to ask if the source of the bright red blood could be located beyond the reach of the digital examination and sigmoidoscopy? If there are no further episodes of bloody stools, is it still necessary to return for a follow-up or to schedule a colonoscopy?

Shore, 30~39 year old female. Ask Date: 2023/03/21

Dr. Zhang Shuhao reply Surgery

The bleeding point of bright red blood in the stool may exceed the detection range of a digital rectal exam and colonoscopy.
However, given your age, the likelihood of colorectal lesions is lower.
If you have internal hemorrhoids, the treatment for that condition should be prioritized.
If there are no other abdominal discomfort or abnormal bowel symptoms, a colonoscopy may not be necessary.

Reply Date: 2023/03/21

More Info

Dizziness and the presence of bright red blood in the stool can be concerning symptoms that warrant careful evaluation. Based on your description, it seems that you experienced a sudden episode of mild dizziness followed by a significant amount of bright red blood during bowel movements. The fact that your stool was soft and that you had no accompanying abdominal pain or other symptoms is noteworthy.
Bright red blood in the stool typically indicates that the source of the bleeding is from the lower gastrointestinal tract, such as the rectum or anus. Common causes of such bleeding include hemorrhoids (internal or external), anal fissures, diverticular disease, or even more serious conditions like colorectal polyps or cancers. Given that your physician performed a digital rectal exam and a flexible sigmoidoscopy (or anoscopy) and found no significant abnormalities, the most likely diagnosis in your case is indeed internal hemorrhoids, especially since you mentioned that the bleeding was bright red and there was no pain associated with it.

Regarding your question about whether the bleeding point could be beyond the reach of the digital examination and the scope used, it is theoretically possible. While a digital rectal exam and a flexible sigmoidoscopy can identify many conditions in the lower rectum and sigmoid colon, they may not visualize the entire colon. If there are lesions or sources of bleeding located further up in the colon, such as polyps or tumors, they may not be detected by these methods.
However, if you have not experienced any further episodes of bright red blood in your stool since the initial incident, and if your symptoms remain stable, it may not be immediately necessary to schedule a follow-up appointment or a colonoscopy. That said, it is essential to monitor your symptoms closely. If you experience any recurrence of bleeding, changes in bowel habits, abdominal pain, or any other concerning symptoms, you should seek medical attention promptly.

In general, for individuals over the age of 50 or those with risk factors for colorectal cancer (such as a family history of the disease, personal history of polyps, or inflammatory bowel disease), it is recommended to undergo regular screening colonoscopies. If you fall into this category, discussing the need for a colonoscopy with your healthcare provider may be prudent, even if you are currently asymptomatic.

In summary, while your current symptoms and the findings from your examination suggest that hemorrhoids are the likely cause of your bleeding, it is essential to remain vigilant. If you notice any changes or if the bleeding recurs, do not hesitate to seek further evaluation. Regular screenings and open communication with your healthcare provider are key components of maintaining gastrointestinal health.

Similar Q&A

Orange Stool and Fainting: When to Seek Medical Attention?

Hello doctor, I left home today without having breakfast and ended up fainting twice along the way, experiencing tinnitus, blurred vision, and nearly losing consciousness. After eating, I did not experience any more fainting episodes. However, when I returned home in the evening ...

Dr. Ke Fangxu reply Surgery
Fainting is a more significant issue, and abnormal stool color should be tested to determine if there is bleeding. I recommend that you consult a physician for diagnosis, as I am more concerned about potential central nervous system problems.

Understanding Dizziness and Bowel Issues: Possible Links to Gastrointestinal Health

Hello, doctor. I started feeling dizzy on the morning of September 13. I went to a clinic for an injection and medication, but it didn't help. Recently, my bowel movements have either been yellow and sticky or I have difficulty passing stool. When I do go, it's usually ...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: Your symptoms appear to be acute. If the emergency blood test does not indicate anemia, then the dizziness is not caused by hemorrhagic anemia. It is recommended that you consult a neurologist or an otolaryngologist to determine the cause of the dizziness. As for the sympt...

Understanding Your Symptoms: When to Seek Medical Help for Discomfort

Hello Doctor: In recent months, I have been experiencing various pains, and I'm unsure if they are due to stress or if there are actual health issues. For the past few weeks, I have been feeling very dizzy, accompanied by a constant desire to sleep. Often, I feel the urge to...

Dr. Xu Peiqi reply Family Medicine
Hello Mr. Hsueh, thank you for your inquiry, and I appreciate your efforts regarding your health condition. To summarize your concerns, you are experiencing dizziness and fatigue, nausea, poor appetite, acid reflux, irregular bowel movements with blood, and occasional chest tight...

Persistent Blood in Stool: When to Consider Small Bowel Endoscopy?

Symptoms: First episode of bloody stool from January 9 to January 11. Patient: 68-year-old female with a history of mild gastric ulcer and elevated cholesterol. Treatment: On January 9, in the afternoon, the patient had bloody stools three times and experienced dizziness. An ambu...

Dr. Chen Shidian reply Gastroenterology and Hepatology
It should not be related to the liver. It is necessary to work with a gastroenterologist and take some time for a thorough examination. Small bowel endoscopy and angiography are both considerations.