Post-ESD Recovery: Rectal Bleeding and Changes in Bowel Habits

Endoscopic submucosal dissection for tumor removal and rectal bleeding?

On January 30th of this year, I underwent endoscopic submucosal dissection (ESD) for a rectal submucosal lesion, and the pathology report indicated a grade 1 neuroendocrine tumor measuring 0.7 cm, which was benign.
As of February 18th, I am still experiencing slight rectal bleeding.
I would like to ask the physician the following questions:
1.
Is it normal for my stool to continue to be thin and shorter after the surgery? (Prior to the surgery, my stool was banana-shaped.)
2.
I have a pre-existing constipation issue, with an average of one bowel movement every 3 to 4 days.
Sometimes there is blood in my stool and sometimes there isn't.
The color of the blood has changed from pink, with a band-like distribution (covering about 1/6 of the surface area), to today, February 18th, where it appears as small red spots (covering about 1/10 of the surface area).
Although it is not bright red blood, it has been three weeks since the surgery.
Is this normal? How long can I expect it to take before the bleeding completely stops?
3.
I do not have any other discomfort.
Should I schedule another colonoscopy to identify the source of the bleeding?

Cai Cai, 40~49 year old female. Ask Date: 2024/02/18

Dr. Zhang Shuhao reply Surgery

1.
Rectal wounds, unless very close to the anus, typically do not affect the shape of stools.
If examinations show no strictures and there is no recurrence of tumors, the absence of persistent urgency or tenesmus is not a concern.

2.
Postoperative bowel movements may result in slight bleeding, especially if the wound cannot be completely closed with hemostatic clips.
In this case, it is necessary to wait for the mucosal wound to fully heal, which generally takes a few weeks.
If the amount of bleeding increases or persists, or if accompanied by other symptoms such as abdominal pain or discomfort, it is advisable to seek medical evaluation again.
3.
Rectal Endoscopic Submucosal Dissection (ESD) is not likely to cause perforation.
If there is significant bleeding, it can be easily observed in daily life, such as passing blood clots or continuous fresh blood.
If there are no symptoms, follow-up can be done as originally scheduled.

Reply Date: 2024/02/18

More Info

After undergoing Endoscopic Submucosal Dissection (ESD) for the removal of a submucosal lesion in the rectum, it is understandable to have concerns regarding post-operative recovery, particularly with symptoms like rectal bleeding and changes in bowel habits. Here’s a comprehensive overview addressing your questions and providing additional insights into your situation.

1. Changes in Bowel Habits: It is not uncommon for patients to experience changes in their bowel habits following ESD. The procedure can lead to temporary alterations in bowel movements, including the size and shape of stools. The fact that your stools have become thinner and shorter post-surgery may be attributed to several factors, including inflammation or scarring in the rectal area. While the typical banana-shaped stool is considered normal, variations can occur after surgical interventions. If the changes persist or worsen, it would be prudent to discuss this with your healthcare provider.

2. Rectal Bleeding: The presence of blood in your stool, especially after a procedure like ESD, can be concerning. The color and consistency of the blood can provide clues about its source. The transition from pinkish streaks to bright red spots may indicate that the bleeding is coming from a more superficial area, possibly related to irritation or minor trauma in the rectal mucosa. It is essential to monitor the amount and frequency of bleeding. While some post-operative bleeding can be expected, especially within the first few weeks, it should gradually decrease. If you continue to experience bleeding beyond three weeks or if it increases in volume, it is advisable to consult your physician. They may recommend a follow-up colonoscopy to identify the source of the bleeding and ensure that there are no complications from the surgery.

3. Need for Follow-Up Procedures: Given that you have had a history of rectal bleeding and are experiencing ongoing symptoms, it may be beneficial to schedule a follow-up colonoscopy. This procedure can help visualize the rectal area and identify any potential sources of bleeding, such as residual lesions, ulcers, or other complications. Your healthcare provider will consider your symptoms, the amount of bleeding, and your overall health before making a recommendation.

4. Recovery Timeline: The timeline for complete recovery and cessation of bleeding can vary significantly among individuals. Generally, minor bleeding should resolve within a few weeks post-surgery, but factors such as the extent of the procedure, individual healing rates, and any underlying conditions (like constipation) can influence recovery. It is crucial to maintain a diet high in fiber and stay hydrated to help manage constipation, which can exacerbate rectal bleeding.

5. Monitoring Symptoms: In addition to monitoring the bleeding, keep an eye out for other symptoms such as increased pain, changes in bowel habits, or any signs of infection (fever, chills, or worsening abdominal pain). These could indicate complications that require immediate medical attention.

In conclusion, while some changes in bowel habits and minor bleeding can be expected after ESD, it is essential to remain vigilant and communicate with your healthcare provider about any concerning symptoms. Regular follow-ups and open discussions about your recovery will help ensure that any potential issues are addressed promptly, leading to a smoother recovery process.

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