Post-Defecation Bleeding: When to Seek Medical Help

Bleeding after bowel movements..?

I have been struggling with constipation for a long time, and every time I have a bowel movement, I have to struggle for a long time with hard stools.
Sometimes there is bleeding, but I usually don't pay much attention to it since it's just a small amount of blood on the anus, which I thought was due to the hard stools causing a rupture of the blood vessels near the anus.
However, recently, I have been experiencing bleeding almost every time I have a bowel movement, and the amount is significant, often flowing into the toilet, resembling the situation during menstruation.
Additionally, on the same day after a bowel movement (the night of the bowel movement), I also notice blood when urinating, which I suspect is due to blood accumulating in the rectum and flowing out when relaxing the sphincter.
Where is this blood coming from? If I need to seek medical attention, which specialty should I consult?

Xiao Xue, 10~19 year old female. Ask Date: 2006/07/28

Dr. Cai Jueren reply Family Medicine

Hello, rectal bleeding is commonly seen in patients with hemorrhoids.
Some cases are severe, while others may be mild enough not to require a doctor's visit.
Patients with hemorrhoids often have irregular diets or spend long hours sitting in office chairs; however, there are also a few cases with unknown causes.
Based on your age and the symptoms you described, it is likely that the rectal bleeding is caused by hemorrhoids rather than conditions more commonly seen in older adults, such as colitis or colorectal cancer.
Hemorrhoid patients often complain of constipation and may need to take stool softeners or laxatives; addressing both issues together is usually necessary for a lasting solution.
Additionally, in rare cases, rectal bleeding may not be caused by hemorrhoids but rather by severe microvascular abnormalities due to anal intercourse, which may even require surgical intervention.
I recommend starting with dietary changes: 1.
Increase your intake of high-fiber foods.
2.
Consume more green vegetables (currently, it is recommended that everyone eat at least one serving of green vegetables daily).
3.
Develop good eating habits—chew your food thoroughly.
4.
Establish a regular bowel habit—try to have a bowel movement at the same time each day.
I hope these suggestions are helpful to you.
Thank you for your message!

Reply Date: 2006/07/28

More Info

Understanding post-defecation bleeding is crucial, especially when it becomes frequent or severe. Based on your description, it seems that you have been experiencing constipation, which has led to straining during bowel movements. This can indeed cause minor bleeding due to the rupture of small blood vessels in the anal region, often referred to as hemorrhoids or anal fissures. However, the fact that you are now experiencing significant bleeding that resembles menstrual flow is concerning and warrants further investigation.

Potential Causes of Your Symptoms
1. Hemorrhoids: These are swollen veins in the lower rectum or anus that can cause bleeding, especially during bowel movements. They can be internal or external and may be exacerbated by straining due to constipation.

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

3. Diverticular Disease: This condition involves the formation of small pouches in the colon wall, which can become inflamed or infected, leading to bleeding.

4. Colorectal Polyps or Cancer: While less common, significant bleeding can also be a sign of polyps or colorectal cancer, especially if you have a family history of these conditions or if you are over the age of 50.

5. Infections or Inflammatory Conditions: Conditions such as inflammatory bowel disease (IBD) or infections can also lead to rectal bleeding.

When to Seek Medical Help
Given that you are experiencing bleeding with each bowel movement and that the amount of blood is significant, it is important to seek medical attention promptly. Here are some guidelines on when to see a doctor:
- Frequent Bleeding: If you notice blood in your stool or on the toilet paper consistently, especially if it is bright red or dark red, you should consult a healthcare provider.

- Associated Symptoms: If you experience additional symptoms such as severe abdominal pain, changes in bowel habits (such as diarrhea or constipation), weight loss, or fatigue, these could indicate a more serious condition.

- Duration: If the bleeding persists for more than a few days, it is advisable to seek medical evaluation.

Which Specialist to See
For your symptoms, the most appropriate specialist to consult would be a gastroenterologist. They specialize in disorders of the digestive system and can perform necessary diagnostic tests, such as a colonoscopy, to determine the source of the bleeding. If hemorrhoids or fissures are suspected, a proctologist may also be involved in your care.

Conclusion
In summary, while minor bleeding due to hemorrhoids or anal fissures can be common, the significant bleeding you are experiencing is concerning and should not be ignored. It is essential to seek medical attention to rule out any serious conditions and to receive appropriate treatment. In the meantime, managing your constipation through dietary changes, increased fiber intake, and hydration can help alleviate some of the strain during bowel movements. However, do not delay in seeking professional advice, as timely intervention can prevent complications and improve your overall health.

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