Blood in Stool: When to Seek Gastrointestinal Care - Gastroenterology and Hepatology

I have been experiencing bloody stools for a year, and I have undergone thorough examinations?

Hello Doctor: Around February 2004, I experienced occasional rectal bleeding (sometimes once a week, sometimes every 2-3 weeks, or even twice a week, with no consistent pattern).
I went to the Gastroenterology Department at Taipei Tzu Chi Hospital for an examination, where I underwent two colonoscopies.
The first one examined up to the rectum, and the second one involved a more thorough examination of the colon.
The doctor reviewed the results with me and stated that there were no issues with the colon, suggesting that the cause was unknown and likely not significant.
After that, I didn't pay much attention to it, but the rectal bleeding continued to occur irregularly (during episodes of bleeding, I did not experience any abdominal discomfort).
For example, it happened once a month, and I thought it might be a stomach issue.
Recently, I noticed rectal bleeding again, and upon closer inspection of my stool, the bleeding was clearly observed after bowel movements, not mixed with the stool.
Some blood was fresh while others were more viscous.
I am not looking for an answer online; I just want to know which specialty I should consult and what direction I should take for a thorough examination.
February 19, 2005.

Bai Man, 30~39 year old female. Ask Date: 2005/02/19

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, it is common for patients with lower gastrointestinal bleeding to undergo a colonoscopy without identifying the source of the bleeding.
It could be due to hemorrhoidal bleeding or bleeding from small vessels that may not be visible after hemostasis.
If you continue to experience bleeding, I recommend that you schedule an appointment with the colorectal surgery clinic on the same day to see if the physician can perform an anoscopy in the office to determine the source of the bleeding.
Sincerely, Dr.
Chen Zhiping, Internal Medicine.

Reply Date: 2005/02/19

More Info

When it comes to the presence of blood in stool, it is essential to approach the situation with caution and seek appropriate medical care. Blood in the stool can be indicative of various gastrointestinal issues, ranging from benign conditions to more serious diseases. Given your history of intermittent blood in stool since 2004, it is crucial to understand the potential causes and the steps you should take moving forward.

Understanding the Symptoms
The fact that you have experienced blood in your stool intermittently over the years, sometimes accompanied by fresh blood and other times by a more tarry appearance, suggests that there may be different underlying causes. Fresh blood typically indicates bleeding from the lower gastrointestinal tract, such as the rectum or colon, while dark, tarry stools (melena) often suggest bleeding from higher up in the gastrointestinal tract, such as the stomach or small intestine.

When to Seek Care
You should seek gastrointestinal care if you experience any of the following:
1. Persistent Blood in Stool: If the blood in your stool continues or worsens, it is crucial to consult a healthcare provider.

2. Changes in Bowel Habits: Any significant changes in your bowel habits, such as increased frequency of blood in stool or changes in stool consistency, should be evaluated.

3. Associated Symptoms: If you experience other symptoms such as abdominal pain, weight loss, fatigue, or changes in appetite, these could indicate a more serious condition that requires immediate attention.

4. Family History: If there is a family history of gastrointestinal diseases, such as colorectal cancer or inflammatory bowel disease, it is advisable to be proactive in seeking care.

Recommended Steps for Evaluation
Given your history and current symptoms, here are the steps you should consider:
1. Consult a Gastroenterologist: Since you have already undergone colonoscopy and other evaluations in the past, it would be prudent to revisit a gastroenterologist. They can review your previous findings and determine if further investigation is warranted.

2. Further Diagnostic Testing: Depending on your symptoms and the gastroenterologist's assessment, additional tests may be recommended. These could include:
- Repeat Colonoscopy: To visualize the colon and rectum again, especially if there are new symptoms or if previous examinations were inconclusive.

- Upper Endoscopy: If there is a suspicion of upper gastrointestinal bleeding.

- Imaging Studies: Such as a CT scan of the abdomen, which can help identify any structural issues in the gastrointestinal tract.

3. Laboratory Tests: Blood tests may be necessary to check for anemia, liver function, and other markers that can provide insight into your gastrointestinal health.

Conclusion
While the intermittent nature of your symptoms may seem benign, it is essential not to ignore them, especially with the recurrence of blood in your stool. The gastrointestinal tract can be complex, and symptoms can sometimes mask underlying conditions. By consulting a gastroenterologist and undergoing appropriate diagnostic testing, you can gain a clearer understanding of your situation and ensure that any potential issues are addressed promptly.

In summary, do not hesitate to seek medical attention, especially if your symptoms persist or worsen. Early intervention can often lead to better outcomes and peace of mind regarding your gastrointestinal health.

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