Gastrointestinal Issues: Blood in Stool and Abdominal Discomfort

Distressing gastrointestinal issues and bloody stools?

Dear Doctor: Since July of last year, I have experienced blood in my stool approximately ten times.
The blood appears as about 5 c.c.
of bright red blood on top of my stool, which is typically sticky in consistency.
Only once was my stool more formed, with the blood surrounding the edges.
I have daily bowel movements, ranging from 1 to 4 times.
I also frequently feel bloated in my lower abdomen, and sometimes, in addition to the bloating, I feel gas rolling around inside, which makes me feel like I need to have diarrhea.
Occasionally, I also experience a sensation of food getting stuck in my esophagus.
I would appreciate your thoughts and recommendations on this matter.
Thank you very much! Additionally, I would like to ask if there are any other examination methods besides colonoscopy and gastroscopy, which I find quite daunting.
Thank you!

Chen, 20~29 year old female. Ask Date: 2005/05/21

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, based on your description, it seems more like rectal or anal bleeding, with the most common cause being hemorrhoids.
However, other conditions such as colitis, tumors, or anal fissures cannot be ruled out.
If you experience constipation at times, diarrhea at other times, with stools that are sometimes hard and sometimes soft, and abdominal pain before bowel movements that resolves after, these symptoms resemble Irritable Bowel Syndrome (IBS).
The cause is abnormal intestinal motility and increased sensitivity of the intestines, rather than a problem with the intestines themselves.
IBS can sometimes be accompanied by discomfort in the upper abdomen and abnormal esophageal motility, which may lead to a sensation of food getting stuck.
A colonoscopy and upper endoscopy are the most definitive tests for examining the gastrointestinal mucosa.
If these procedures are intolerable, you might consider an upper gastrointestinal series to examine the esophagus, stomach, and duodenum, and a lower gastrointestinal series for the colon, although the sensitivity and specificity of these tests are not as good as those of endoscopy.
Sincerely, Dr.
Yuan Hong-Dao, Internal Medicine.

Reply Date: 2005/05/21

More Info

Understanding gastrointestinal issues, particularly those involving blood in the stool and abdominal discomfort, is crucial for identifying potential underlying health problems. Based on your description, it appears that you have been experiencing recurrent episodes of blood in your stool, along with abdominal bloating and discomfort. These symptoms can be indicative of various gastrointestinal conditions, and it is essential to approach them with caution.

Potential Causes of Your Symptoms
1. Hemorrhoids: One of the most common causes of blood in the stool, especially if the blood is bright red and appears on the surface of the stool, is hemorrhoids. These are swollen veins in the lower rectum or anus that can bleed during bowel movements.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain and bleeding during bowel movements.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can lead to diverticulitis if these pouches become inflamed or infected. This condition can cause abdominal pain, bloating, and changes in bowel habits, including blood in the stool.

4. Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease or ulcerative colitis can cause chronic inflammation of the gastrointestinal tract, leading to symptoms like abdominal pain, diarrhea, and blood in the stool.

5. Gastrointestinal Infections: Certain infections can cause gastrointestinal symptoms, including diarrhea and blood in the stool, often accompanied by fever and abdominal pain.

6. Polyps or Colorectal Cancer: While less common, polyps in the colon can bleed, and in some cases, they can be precursors to colorectal cancer. Given your history of blood in the stool, this is a consideration that should not be overlooked.

Recommendations for Evaluation
Given the recurrent nature of your symptoms, it is crucial to seek medical evaluation. While you mentioned a reluctance to undergo invasive procedures like colonoscopy or endoscopy, these tests are often the most effective way to diagnose the underlying cause of gastrointestinal bleeding and discomfort. However, there are alternative diagnostic methods that can be considered:
1. Stool Tests: These can help identify infections, blood, or other abnormalities in the stool.

2. Imaging Studies: Non-invasive imaging techniques such as abdominal ultrasound or CT scans can provide insights into the structure of your gastrointestinal tract and identify issues like diverticulitis or tumors.

3. Capsule Endoscopy: This is a less invasive option where you swallow a small camera that takes pictures of your digestive tract, particularly useful for examining the small intestine.

4. Barium Swallow or Enema: These radiological tests can help visualize abnormalities in the esophagus, stomach, and intestines.

Lifestyle and Dietary Considerations
In addition to seeking medical evaluation, consider the following lifestyle and dietary changes that may help alleviate some of your symptoms:
- Increase Fiber Intake: A diet rich in fruits, vegetables, and whole grains can help regulate bowel movements and reduce straining, which may alleviate hemorrhoids and fissures.

- Stay Hydrated: Drinking plenty of water can help soften stools and prevent constipation.

- Regular Exercise: Physical activity can promote healthy digestion and regular bowel movements.

- Avoid Trigger Foods: If certain foods exacerbate your symptoms, consider keeping a food diary to identify and avoid these triggers.

Conclusion
In summary, your symptoms warrant a thorough evaluation by a healthcare professional. While there are non-invasive tests available, a definitive diagnosis often requires procedures like colonoscopy. It is essential to address these gastrointestinal issues promptly to rule out serious conditions and to receive appropriate treatment. Please consult with a gastroenterologist to discuss your symptoms and the best course of action for your health.

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