Rectal Bleeding: Insights on Tubular Adenoma and Symptoms

Blood in stool issue?

Hello doctor, I noticed pink blood on the toilet paper after having a bowel movement one day, and I do not have hemorrhoids.
On that day, I went to the bathroom three times, and there was blood on the stool's surface, but when I opened the stool, there was no blood inside.
The next day, the bleeding stopped, and I have not seen any blood for the past eight days.
I have regular bowel movements every morning, about 1-2 times a day.
After two days, I went to the hospital for a colonoscopy, which revealed a tubular adenoma measuring 0.6 cm in the rectal area with low-grade dysplasia.
I would like to know if a 0.6 cm tubular adenoma can cause bleeding.
Below is the pathology report:
Intestine, large, rectum, polypectomy, tubular adenoma.

Description: The specimen submitted consists of 1 tissue fragment measuring 0.6 x 0.5 x 0.3 cm in size, fixed in formalin.
Grossly, it is brownish and elastic.
All sections are labeled as A1; Jar: 0 SColon Neoplastic polyp checklists.

Microscopic summary:
1.
Location: rectum
2.
Histological diagnosis: Tubular adenoma
3.
Histological grade: Low-grade dysplasia (including mild and moderate dysplasia)
4.
Deep submucosal margins status: cannot be assessed.

Xiao Yue, 30~39 year old female. Ask Date: 2024/06/18

Dr. Lin Minghui reply Gastroenterology and Hepatology

Possible causes of bloody stools include hemorrhoids, anal fissures, inflammation, polyps, tumors, and cancer.
A colonoscopy revealed a 0.6 cm tubular adenoma in the rectum, which may be the cause of the bloody stools.
If there are any other concerns, it is recommended to follow up in an outpatient clinic.
Wishing you good health!

Reply Date: 2024/06/18

More Info

Rectal bleeding can be concerning, and it's understandable that you're seeking clarity regarding your diagnosis of a tubular adenoma. A tubular adenoma is a type of polyp found in the colon or rectum, and while it is generally considered benign, it can have implications for your health, particularly if it undergoes changes over time.

Firstly, regarding your question about whether a 0.6 cm tubular adenoma can cause bleeding: yes, it is possible for a tubular adenoma to cause rectal bleeding, even if it is small. The bleeding you experienced, characterized by pink blood on toilet paper and in your stool, could be attributed to the adenoma, especially if it is located in the rectal area where it can be irritated during bowel movements. The fact that you did not see blood after the initial episodes may indicate that the adenoma was not consistently bleeding or that it was not significantly irritated during subsequent bowel movements.

The pathology report you provided indicates that the adenoma is classified as low-grade dysplasia. This means that while the cells in the adenoma appear abnormal, they are not yet cancerous. Low-grade dysplastic adenomas are generally considered to have a lower risk of progression to colorectal cancer compared to high-grade dysplastic adenomas. However, it is essential to monitor such polyps because they can still develop into more serious conditions over time.

Regarding the management of your tubular adenoma, the standard approach typically involves regular surveillance colonoscopies to monitor for any changes in size or histological characteristics. The frequency of these follow-up colonoscopies can vary based on several factors, including the number of polyps found, their size, and any personal or family history of colorectal cancer. For a single low-grade tubular adenoma like yours, follow-up colonoscopy is often recommended every 5 to 10 years, but your healthcare provider will give you specific recommendations based on your overall health and risk factors.

In terms of lifestyle modifications to support your colon health, consider the following:
1. Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can promote digestive health. High-fiber foods can help regulate bowel movements and may reduce the risk of developing new polyps.

2. Hydration: Staying well-hydrated is essential for maintaining healthy bowel function.

3. Regular Exercise: Engaging in regular physical activity can help reduce the risk of colorectal issues.

4. Avoiding Tobacco and Limiting Alcohol: Smoking and excessive alcohol consumption are associated with an increased risk of colorectal cancer.

5. Regular Screening: Adhering to recommended screening guidelines is crucial for early detection and prevention of colorectal cancer.

If you experience any new symptoms, such as increased bleeding, changes in bowel habits, or abdominal pain, it is essential to consult your healthcare provider promptly. They may recommend further evaluation or additional imaging studies to ensure that there are no complications or new developments.

In summary, while a 0.6 cm tubular adenoma can potentially cause rectal bleeding, it is generally manageable with regular surveillance and lifestyle modifications. Maintaining open communication with your healthcare provider about your symptoms and follow-up care is vital for your ongoing health and well-being.

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