Rectal Bleeding: Causes Beyond Hemorrhoids and Diagnosis - Internal Medicine

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Rectal bleeding can be a concerning symptom, and while hemorrhoids are a common cause, there are numerous other potential reasons for this issue. Understanding the underlying causes and obtaining an accurate diagnosis is crucial for effective treatment and management.

Firstly, it’s important to note that rectal bleeding can stem from various gastrointestinal conditions. Besides hemorrhoids, other common causes include anal fissures, diverticular disease, inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis, colorectal polyps, and colorectal cancer. Each of these conditions has distinct characteristics and may require different diagnostic approaches.

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

2. Diverticular Disease: This condition involves the formation of small pouches (diverticula) in the colon wall, which can become inflamed or infected, leading to diverticulitis. This can result in rectal bleeding.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause inflammation of the gastrointestinal tract, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding.

4. Colorectal Polyps and Cancer: Polyps are growths on the inner lining of the colon that can sometimes bleed. Some polyps can develop into colorectal cancer, which is a serious condition that requires prompt diagnosis and treatment.

Given your situation, where you have undergone multiple examinations including a colonoscopy (referred to as "腸鏡" in your message) and electronic scans, it is reassuring that these tests have shown normal results. However, if you are still experiencing rectal bleeding, it is essential to continue investigating the cause.

Diagnosis and Further Evaluation:
If initial tests have not revealed the cause of your bleeding, further evaluation may be necessary. This could include:
- Repeat Colonoscopy: Sometimes, lesions or abnormalities can be missed, especially if they are small or located in hard-to-see areas.

- CT Scan or MRI: These imaging techniques can help visualize the intestines and identify issues that may not be apparent during a colonoscopy.

- Endoscopy: If the bleeding is suspected to originate from the upper gastrointestinal tract, an upper endoscopy may be warranted.

Lifestyle and Management:
In the meantime, consider lifestyle modifications that can help manage symptoms and prevent further bleeding. This includes:
- Dietary Changes: A high-fiber diet can help prevent constipation and reduce straining during bowel movements, which can exacerbate conditions like hemorrhoids and fissures.

- Hydration: Drinking plenty of fluids can help keep stools soft.

- Regular Exercise: Engaging in regular physical activity can promote healthy bowel function.

When to Seek Immediate Care:
If you experience significant changes in your bleeding pattern, such as increased frequency, volume, or associated symptoms like severe pain, dizziness, or changes in bowel habits, it is crucial to seek medical attention promptly.

In conclusion, while hemorrhoids are a common cause of rectal bleeding, it is essential to consider other potential causes, especially if you have undergone tests that have returned normal results. Continuous monitoring and communication with your healthcare provider will be key in managing your symptoms and ensuring that any underlying conditions are addressed effectively.