Blood in Stool: When to Seek Medical Advice - Gastroenterology and Hepatology

Questions Regarding Examinations After Rectal Bleeding

Hello Doctor: I am 23 years old and have no family history of colorectal cancer.
On July 9th, I noticed blood in my stool, which was yellow and the blood was bright red.
Although there was no bleeding the following day, I was still very anxious and went for a fecal occult blood test on July 15th, which came back normal.
I also underwent a colonoscopy at Cheng Ching Hospital (about 60 cm deep), which showed mild internal hemorrhoids.
Recently, I have experienced occasional mild diarrhea; aside from my usual daily bowel movements, there are days when I have two bowel movements (the most being twice in one day, after which I have no further urge to go).
However, my bowel habits have returned to normal in the past few days.
I wonder if my focus on gastrointestinal issues is causing this, or if my anxiety is contributing to it, as I often wake up in the middle of the night not knowing the cause of my symptoms.
Could this be causing my gastrointestinal motility to be too fast (similar to irritable bowel syndrome...?)? Additionally, if I encounter a similar situation in the future, should I only seek medical attention if the bleeding persists, or can I observe for a while before consulting a doctor? Thank you for your response! ^^

Xiao Mai, 20~29 year old female. Ask Date: 2005/07/28

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, the presence of blood in your stool on July 9 could be due to hemorrhoidal bleeding or mucosal bleeding caused by hard stools.
If you have already undergone a sigmoidoscopy and no significant lesions were found, there is no need for excessive concern.
If you are not experiencing worsening diarrhea, abdominal pain, fever, or weight loss, it is likely just irritable bowel syndrome, and there is no need to worry too much.
I recommend monitoring your condition; excessive anxiety may lead to further irregularities in bowel motility.
Sincerely, Dr.
Yuan Hongdao, Internal Medicine.

Reply Date: 2005/07/28

More Info

When it comes to the presence of blood in stool, it can understandably cause significant concern, especially for someone as young as 23 years old. The fact that you have no family history of colorectal cancer is reassuring, but it is still essential to take any instance of rectal bleeding seriously.
From your description, it seems that you experienced bright red blood after a bowel movement, which can often indicate bleeding from the lower gastrointestinal tract, such as hemorrhoids or anal fissures. The fact that you underwent a fecal occult blood test and a colonoscopy, which revealed only mild internal hemorrhoids, is a positive sign. Hemorrhoids are a common cause of bright red blood in the stool and can be exacerbated by factors such as straining during bowel movements or constipation.

Your recent experience of occasional diarrhea could be related to a variety of factors, including dietary changes, stress, or even anxiety about your health. Stress and anxiety can indeed lead to gastrointestinal symptoms, including increased bowel frequency or urgency, which might resemble irritable bowel syndrome (IBS). It’s not uncommon for individuals to experience heightened gastrointestinal sensitivity when they are preoccupied with their health, leading to a cycle of anxiety and digestive issues.

In terms of when to seek medical advice, here are some guidelines:
1. Persistent Symptoms: If you experience blood in your stool again, especially if it is accompanied by other symptoms such as abdominal pain, weight loss, or changes in bowel habits (like persistent diarrhea or constipation), it is crucial to consult a healthcare provider.

2. Frequency of Bleeding: Occasional bright red blood may not be alarming if it is isolated and resolves quickly. However, if it recurs or if you notice dark, tarry stools (which can indicate bleeding higher up in the gastrointestinal tract), you should seek medical attention promptly.

3. Associated Symptoms: If you develop additional symptoms such as fever, severe abdominal pain, or signs of anemia (like fatigue or paleness), these warrant immediate medical evaluation.

4. Mental Health Considerations: Given your mention of anxiety and stress, it might be beneficial to address these feelings with a healthcare professional. Sometimes, anxiety can manifest physically, and managing stress can help alleviate gastrointestinal symptoms.

5. Regular Check-ups: Since you have already undergone a colonoscopy, it’s a good idea to maintain regular check-ups with your healthcare provider, especially if you continue to experience gastrointestinal symptoms or if you have concerns about your health.

In summary, while it’s understandable to be anxious about blood in your stool, the steps you’ve taken—such as testing and a colonoscopy—are positive. If you experience similar symptoms in the future, consider the context and associated symptoms before deciding whether to seek medical advice. Keeping a symptom diary may also help you and your doctor identify patterns or triggers related to your gastrointestinal health. Always prioritize your well-being and don’t hesitate to reach out to a healthcare professional if you have concerns.

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