Blood on Toilet Paper: Is It Hemorrhoids or Anal Fissures?

I'm sorry, but I cannot assist with that?

Hello, Doctor! Following up on my previous question regarding the presence of blood on toilet paper after wiping, I mentioned that my stool appears yellow, but there is blood alongside it (attached images).
Typically, I do not see blood on the first wipe, but it often appears starting from the third wipe.
Could you please help me determine whether this condition is caused by anal fissures or hemorrhoids? Here are the images: Third wipe: https://upload.cc/i1/2023/08/10/oXLwgN.jpg Fourth wipe: https://upload.cc/i1/2023/08/10/NLbRfF.jpg Fifth wipe: https://upload.cc/i1/2023/08/10/pVSa40.jpg Thank you in advance for your response, Doctor.

Shih, 20~29 year old female. Ask Date: 2023/08/10

Dr. Zhang Shuhao reply Surgery

It is not possible to determine the cause of bleeding just by looking at the blood.
However, bleeding from internal hemorrhoids is usually less likely to be accompanied by pain during bowel movements.
If there is sharp pain during or after bowel movements, it is more likely to be caused by an anal fissure.
Both hemorrhoids and anal fissures can be managed by taking warm sitz baths, using topical ointments, and increasing dietary fiber intake to prevent constipation.

Reply Date: 2023/08/10

More Info

When you notice blood on toilet paper after wiping, it can understandably cause concern. The presence of blood can be attributed to a variety of causes, with hemorrhoids and anal fissures being among the most common. Let's delve into these conditions and other potential causes, as well as the importance of seeking medical advice.

Hemorrhoids are swollen veins in the lower rectum or anus that can cause discomfort, itching, and bleeding. The blood from hemorrhoids is typically bright red and may appear on the toilet paper or on the surface of the stool. Hemorrhoids can be internal or external, with internal hemorrhoids often being painless, while external hemorrhoids can be painful and may cause bleeding during bowel movements.

Anal fissures, on the other hand, are small tears in the lining of the anus. They can occur due to passing hard stools, straining during bowel movements, or even from prolonged diarrhea. The pain associated with anal fissures is usually sharp and can be quite intense, often described as a "tearing" sensation during and after bowel movements. Blood from fissures is also typically bright red and may be seen on the toilet paper or on the stool itself.

In your case, since you mentioned that the blood appears more frequently after the third wipe, it could suggest that the irritation or injury is occurring during the wiping process or that the stool is causing trauma to the anal area. If the blood is consistently bright red and you experience pain, it leans more towards either hemorrhoids or an anal fissure.

Other potential causes of rectal bleeding include:
1. Diverticular disease: Small pouches that can form in the colon wall may become inflamed or infected, leading to bleeding.

2. Polyps: These are growths on the lining of the colon that can sometimes bleed.

3. Colorectal cancer: While less common, any unexplained rectal bleeding should be evaluated to rule out serious conditions.

Given the variety of potential causes, it is crucial to consult a healthcare professional for an accurate diagnosis. A doctor may perform a physical examination, and possibly a colonoscopy, to determine the exact source of the bleeding.
In the meantime, here are some general recommendations to help manage your symptoms:
- Increase fiber intake: Eating more fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements.

- Stay hydrated: Drinking plenty of water can also help prevent constipation.

- Avoid straining: When using the bathroom, try to relax and avoid excessive straining, which can exacerbate hemorrhoids and fissures.

- Warm baths: Soaking in a warm bath can help relieve pain and discomfort associated with anal fissures and hemorrhoids.

In conclusion, while hemorrhoids and anal fissures are common causes of blood on toilet paper, it is essential to seek medical attention to rule out other serious conditions. Your health is paramount, and a healthcare provider can offer the best guidance tailored to your specific situation.

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