Should You Get a Colonoscopy After Finding Blood in Stool?

Should a colonoscopy be performed directly?

Hello, doctor! Last year during a health check, I had a positive fecal occult blood test and subsequently underwent a colonoscopy where a small benign polyp was removed.
The physician advised me to return for a follow-up in a year, but I am quite anxious about it.
Can I first perform a fecal occult blood test to see the results before proceeding? Additionally, I would like to ask, will a small polyp definitely grow larger? Is it possible for it to be absorbed by the body and disappear on its own? How quickly do polyps typically grow?

candy, 30~39 year old female. Ask Date: 2005/05/13

Dr. Hou Yongji reply Surgery

1.
Generally, it takes about 1 year for colorectal mucosa to develop into a polyp, and approximately 5 years for a polyp to progress to colorectal cancer.
Therefore, if colorectal cancer arises from a polyp, it typically forms over a period of around 15 years.
Based on this timeline, it is currently recommended that individuals begin screening for colorectal cancer with a colonoscopy or barium enema at age 50, especially if there is a family history of colorectal cancer occurring before age 70.
2.
About 75% of colorectal cancers develop from colorectal polyps.
Therefore, if polyps are found, regardless of whether they are removed, follow-up screening should be conducted within one year.
If no polyps are present, screening can be done every three years.
3.
For small polyps, the fecal occult blood test may not necessarily yield a positive result.
Thus, the best examination remains a colonoscopy, as it has a high accuracy rate and allows for therapeutic removal of polyps.
4.
If you are concerned about pain, there is a procedure known as painless colonoscopy available.
I have attached an informational document from our hospital for your reference.

Reply Date: 2005/05/13

More Info

Finding blood in your stool can be alarming, and it’s understandable to have concerns about what steps to take next. In your case, since you have a history of a positive fecal occult blood test and a subsequent colonoscopy that revealed a small benign polyp, it is crucial to follow up appropriately.
First and foremost, if you notice blood in your stool, it is generally recommended to consult with a healthcare provider promptly. Blood in the stool can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, or more serious conditions such as colorectal cancer. Given your previous findings, a colonoscopy is a prudent step to ensure that any potential issues are addressed early.

Regarding your question about whether you can perform a fecal occult blood test (FOBT) before undergoing another colonoscopy, it is indeed possible. However, it is essential to understand that while a negative FOBT can provide some reassurance, it does not replace the need for a colonoscopy, especially considering your previous history. The FOBT can sometimes yield false negatives, and if there are any concerns about the presence of polyps or other abnormalities, a colonoscopy remains the gold standard for diagnosis.

As for your concerns about the polyp you had removed, it is important to note that while some small polyps may not grow or may even regress, many can grow over time. The growth rate of polyps can vary significantly based on their type and individual patient factors. Generally, adenomatous polyps (the type that can become cancerous) have a potential for growth, while hyperplastic polyps are often benign and less likely to grow. Regular surveillance through colonoscopy is essential to monitor for any changes in polyp size or number.

The recommendation for follow-up colonoscopy after polyp removal is typically based on the size, number, and type of polyps found. If your doctor advised a follow-up in one year, it likely reflects a standard protocol based on your specific situation. It is crucial to adhere to these recommendations, as they are designed to catch any potential issues early, reducing the risk of developing colorectal cancer.

In summary, while it is understandable to feel apprehensive about undergoing another colonoscopy, it is a vital tool for monitoring your gastrointestinal health, especially after a history of polyps. If you have concerns about the procedure or your health, discussing them with your healthcare provider can help alleviate anxiety and provide clarity on the best course of action. Regular screenings and follow-ups are key components of preventive healthcare, particularly in individuals with a history of polyps or other gastrointestinal issues.

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