Painful Bowel Movements with Blood: A Guide for Patients

Painful bowel movements with blood?

Dr.
Yang: Hello, I have hepatitis B and often seek medical attention due to gastrointestinal discomfort.
My symptoms include bloating, frequent gas, abdominal pain, and diarrhea.
However, after undergoing a colonoscopy (about three years ago), a barium enema (about nine months ago), and liver function tests (annually, with the most recent one in September), all results were normal.
Therefore, most doctors have diagnosed me with irritable bowel syndrome.
Although I still frequently experience abdominal discomfort, I haven't thought much of it.
However, in the past two days, I have experienced difficulty sleeping at night, weight loss (from 46 kg to 45 kg), painful bowel movements, and blood in my stool, which has made me somewhat concerned (I have never experienced constipation).
I would like to ask: (1) Could this be purely a hemorrhoid issue? (2) Is the barium enema from September still valid, or should I undergo further testing to check for any tumor lesions? I would greatly appreciate your clarification on these matters! Sincerely, Yang Xiangrong.

Yang, 40~49 year old female. Ask Date: 2001/05/14

Dr. Yang Guojun reply Gastroenterology and Hepatology

You have irritable bowel syndrome, and further testing may not be necessary.
Please consult a gastroenterologist for treatment and arrange for an ultrasound examination of the liver.

Reply Date: 2001/05/14

More Info

Dear Mr. Yang,
Thank you for reaching out with your concerns regarding your gastrointestinal symptoms. It's understandable to feel anxious, especially with the recent changes in your health. Let's address your questions and provide some guidance based on your situation.

1. Could the symptoms be solely due to hemorrhoids?
While hemorrhoids can cause pain during bowel movements and may lead to blood in the stool, your symptoms of weight loss, persistent abdominal discomfort, and changes in bowel habits warrant further investigation. Hemorrhoids typically do not cause significant weight loss or systemic symptoms like insomnia. The presence of blood in your stool, especially when accompanied by pain and weight loss, raises the possibility of other underlying conditions that should not be overlooked. Conditions such as anal fissures, diverticulitis, inflammatory bowel disease (IBD), or even colorectal cancer could present with similar symptoms. Therefore, while hemorrhoids could be a contributing factor, it is essential to consider a broader differential diagnosis.

2. Is the colon imaging from September still valid, or should it be repeated?
The colon imaging you underwent in September may provide valuable information, but given the new symptoms you are experiencing, it is advisable to discuss with your healthcare provider the need for repeat imaging or additional diagnostic tests. The validity of previous imaging can diminish over time, especially if new symptoms arise. A repeat colonoscopy or imaging study may be necessary to rule out any new developments, such as polyps or tumors, particularly given your history of gastrointestinal discomfort and the recent changes in your health.

In light of your symptoms, I recommend the following steps:
- Consult a Gastroenterologist: Given your history of gastrointestinal issues and the recent onset of concerning symptoms, it would be prudent to see a specialist. A gastroenterologist can perform a thorough evaluation, including a physical examination and possibly repeat imaging or endoscopy, to assess for any abnormalities.

- Monitor Your Symptoms: Keep a detailed record of your symptoms, including the frequency and characteristics of your bowel movements, any associated pain, and any other systemic symptoms like fatigue or changes in appetite. This information can be invaluable for your healthcare provider in making a diagnosis.

- Consider Dietary Changes: While awaiting further evaluation, consider keeping a food diary to identify any potential triggers for your gastrointestinal discomfort. A diet high in fiber may help alleviate some symptoms, but be cautious with any drastic changes, especially if you are experiencing pain.

- Stay Hydrated and Maintain Nutrition: Given your recent weight loss, it’s crucial to ensure you are consuming adequate nutrition and staying hydrated. If you find it challenging to eat solid foods, consider nutritional supplements or smoothies that can provide essential nutrients without exacerbating your symptoms.

- Follow-Up on Your Hepatitis B: Since you have a history of hepatitis B, ensure that your liver function is monitored regularly, as liver health can impact gastrointestinal symptoms. Discuss with your healthcare provider if any adjustments to your management plan are needed.

In conclusion, while hemorrhoids could be a factor in your symptoms, the combination of pain, blood in the stool, and weight loss necessitates further investigation to rule out more serious conditions. Please do not hesitate to seek medical attention promptly, as early diagnosis and intervention can significantly improve outcomes.

Wishing you the best in your health journey.

Sincerely,
Doctor Q&A Teams

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