Rectal Bleeding: Fissures vs. Hemorrhoids

There is blood on the toilet paper?

Last week, I experienced a tearing sensation in my anus while using the restroom in the morning.
Later that afternoon, I noticed a small amount of red mucus when I went to the bathroom.
I'm unsure if this is an anal fissure or hemorrhoids.
Since then, I've noticed some redness on the toilet paper after bowel movements, and sometimes there is even a small amount of red mucus, but it's not much.
I bought hemorrhoid cream to apply to the anus and have been trying to eat more vegetables, but the results have not been significant.
Although the bleeding has decreased when I apply the cream, if I don't use it and the tearing occurs again, I will bleed.
I would like to know how I can improve this situation.
Should I see a doctor?

Niming, 20~29 year old female. Ask Date: 2023/12/02

Dr. Zhang Shuhao reply Surgery

If there is a sharp pain and slight bleeding during bowel movements, it is most likely caused by an anal fissure.
In addition to using topical ointments, it is advisable to take warm sitz baths, increase fluid intake, and consume dietary fiber to soften stools, as well as to minimize the time spent on the toilet.
If symptoms persist, a consultation with a colorectal specialist may be necessary to examine the wound, assess for excessive sphincter tone, and prescribe oral medications if needed.

Reply Date: 2023/12/02

More Info

Understanding rectal bleeding can be quite concerning, especially when it involves discomfort and visible blood. Based on your description, it sounds like you might be experiencing either anal fissures or hemorrhoids, both of which are common causes of rectal bleeding. Let's break down the differences and discuss potential treatments and when to seek medical attention.

Anal Fissures vs. Hemorrhoids
Anal Fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, and you may notice bright red blood on the toilet paper or in the stool. The pain can be quite severe, leading to a fear of bowel movements, which can create a cycle of constipation and worsening fissures.

Hemorrhoids, on the other hand, are swollen veins in the rectal area that can be internal or external. Symptoms may include itching, discomfort, and bleeding during bowel movements. The blood is usually bright red and may be seen on the toilet paper or in the toilet bowl. Hemorrhoids can also cause a feeling of fullness or pressure in the rectal area.

Your Symptoms
Given that you are experiencing a tearing sensation and seeing blood on the toilet paper, it is possible that you have an anal fissure, especially if the pain is sharp. The presence of red mucus could suggest irritation in the anal area, which can occur with both conditions. The fact that you have tried over-the-counter hemorrhoid creams and increased your fiber intake is a good start, but it seems that the bleeding persists when you are not using the medication.

Recommendations for Improvement
1. Dietary Changes: Continue to increase your fiber intake through fruits, vegetables, and whole grains. This can help soften your stool and make bowel movements easier, reducing strain.

2. Hydration: Drink plenty of water to help keep your stool soft.

3. Sitz Baths: Taking warm sitz baths for about 10-15 minutes several times a day can help soothe the area and promote healing.

4. Topical Treatments: Over-the-counter creams or ointments that contain hydrocortisone or witch hazel can help reduce inflammation and discomfort.

5. Avoid Straining: Try not to strain during bowel movements. If you feel the urge to go, don’t delay it.

6. Regular Bowel Habits: Establish a regular routine for bowel movements, which can help your body get used to a schedule.

When to See a Doctor
If your symptoms do not improve with these measures, or if you experience severe pain, significant bleeding, or any signs of infection (such as fever or pus), it is important to consult a healthcare professional. A doctor can perform a physical examination and may recommend treatments such as prescription medications, or in some cases, procedures to address the fissures or hemorrhoids.

Conclusion
In summary, while your symptoms may indicate either anal fissures or hemorrhoids, the persistent bleeding and discomfort warrant a closer look by a healthcare provider if home treatments do not yield results. Early intervention can help prevent complications and improve your quality of life. Remember, it’s always better to err on the side of caution when it comes to health concerns, especially those involving bleeding.

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