Rectal Bleeding After Painkillers: Hemorrhoids or More?

Every time I take painkillers, I notice blood in my stool?

Hello, I used to experience rectal bleeding after taking painkillers.
Later, I consulted a proctologist who diagnosed me with internal hemorrhoids and prescribed topical medication for me.
After some time, I didn't have any bleeding.
Recently, after having a tooth extraction, the doctor prescribed me painkillers again, and sure enough, the bleeding resumed with bowel movements.
However, the bleeding improves a few days after stopping the medication.
I'm unsure if this bleeding is caused by a peptic ulcer or internal hemorrhoids.
If it is due to internal hemorrhoids, I would like to know if surgery or laser treatment is an option, and if laser treatment requires hospitalization.
Thank you.

Liao Jiaxing, 30~39 year old female. Ask Date: 2006/10/18

Dr. Cai Yaozhou reply Gastroenterology and Hepatology

Rectal bleeding can be caused by excessive straining during bowel movements or relaxation of the vascular tissue in the anal area, leading to anal fissures or hemorrhoids.
It may also indicate colorectal cancer or the presence of polyps.
Patients often experience significant pain, which some describe as feeling like "passing glass," necessitating treatment to alleviate suffering.

There are various reasons for rectal bleeding due to straining, one of which is anal fissures.
Anal fissures occur when stools lack fiber and moisture, becoming hard and requiring excessive effort to pass.
This excessive straining can tear the vascular tissue in the anal area (external hemorrhoidal tissue), leading to bleeding.
Since external hemorrhoidal tissue is composed of skin and contains nerve endings, the pain can be quite severe.

Individuals with colorectal cancer (malignant tissue) or rectal polyps (benign tissue) may also experience bleeding during bowel movements if these tissues are damaged or scraped, resulting in blood mixed with stool, sometimes appearing as a mucus-like substance.
Hemorrhoids can also cause rectal bleeding.
Hemorrhoids refer to internal hemorrhoidal tissue, which can become relaxed, causing the vessel walls to thin and bleed easily.
During bowel movements, excessive straining can cause these vessels to swell and protrude, resulting in internal hemorrhoids.
In such cases, bleeding may occur, often in significant amounts, but it typically does not mix with the stool.
Increasing fiber intake can help improve this condition, as rectal bleeding is often due to chronic constipation and straining, usually stemming from unhealthy dietary habits, such as a lack of fruits and vegetables.
Doctors recommend improving lifestyle habits by consuming high-fiber foods, which can enhance gastrointestinal motility and facilitate bowel movements.
Additionally, drinking more water can make bowel movements smoother, along with regular exercise and good bowel habits, reducing the likelihood of excessive straining.
However, the development of polyps may have a genetic component; individuals with a family history of polyps should undergo colonoscopy to check for polyps or other conditions in the colon.
If rectal bleeding persists, it is crucial to see a doctor for examination and treatment, as early intervention yields better outcomes.
When rectal bleeding occurs, one should avoid straining to temporarily stop the bleeding and then seek medical evaluation to determine the cause.
There are several examination methods:
- If an anal fissure is suspected, the doctor may perform a direct visual examination.
- An anoscope may be used to inspect the anal canal for any protruding internal or external hemorrhoidal tissue.
- A colonoscopy can be performed to examine the entire colon for the presence of colorectal cancer or polyps.
Treatment for rectal bleeding varies based on the underlying cause.
For anal fissures, pain relief medications and topical ointments can promote faster healing.
If muscle issues affect the anal sphincter's function, surgical intervention may be necessary to partially cut the internal sphincter muscle, preventing uncontrolled opening and closing of the anus.
If rectal cancer is confirmed, patients may opt for surgical resection of the affected bowel segment or laparoscopic surgery through small abdominal incisions to remove the tissue.
However, if the tumor is located in the lower rectum, removal of the anus may be necessary, resulting in the creation of a colostomy for waste elimination.

For polyps, endoscopic surgery can be performed to excise them.
In cases of hemorrhoid-related rectal bleeding, milder cases may be treated with medications to stop bleeding and reduce swelling.
Additionally, sclerotherapy can be used to strengthen the internal hemorrhoidal tissue, or ligation may be performed to cut off blood supply to the weakened areas, causing them to fall off.
"Medications and injections are merely symptomatic treatments; only surgical intervention addresses the root cause." Traditional hemorrhoid surgery involves excising the hemorrhoids and suturing the wound, which can be quite painful, and patients may experience discomfort when sitting or during bowel movements during the initial healing phase, requiring a longer recovery time.

Newer surgical techniques utilize a hemorrhoid stapler (commonly referred to as a hemorrhoid gun), which is inserted into the anus to access the internal hemorrhoidal tissue.
The circular surgical knife on the device removes the tissue while simultaneously repositioning any protruding internal hemorrhoids back to their normal location.
This method is advantageous as it is less painful than traditional surgery, results in smaller wounds, and allows for quicker recovery without significantly impacting daily life.
Rectal bleeding or blood in the stool can occur at any point in a person's life.
However, should it be taken seriously or dismissed? In outpatient settings, 90% of patients with rectal bleeding initially perceive it as hemorrhoidal bleeding, overlooking the potential underlying risks and pathologies in the gastrointestinal tract, which could be serious, including cancer.

Reply Date: 2006/10/18

More Info

Rectal bleeding can be a concerning symptom, especially when it occurs after taking painkillers. In your case, it seems that you have a history of internal hemorrhoids, which are a common cause of rectal bleeding. The fact that you experienced bleeding after taking pain medication suggests that the painkillers may be exacerbating your condition, possibly by causing constipation, which can lead to straining during bowel movements and aggravate hemorrhoids.

When it comes to the relationship between painkillers and rectal bleeding, it’s important to consider the type of medication you are taking. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can sometimes lead to gastrointestinal issues, including ulcers or bleeding, especially if taken in high doses or for prolonged periods. However, if your bleeding is consistently linked to the use of painkillers and resolves when you stop taking them, it is more likely related to your hemorrhoids rather than a more serious condition like a peptic ulcer.

To address your concerns about whether this bleeding could be due to something more serious, such as an ulcer, it’s essential to consider other symptoms you may be experiencing. If you have additional symptoms like severe abdominal pain, weight loss, or changes in your bowel habits, it would be prudent to consult a healthcare professional for further evaluation. A thorough examination, possibly including a colonoscopy, may be warranted to rule out other conditions.

Regarding treatment options for your internal hemorrhoids, there are several approaches. If your symptoms are mild and manageable, conservative treatments such as dietary changes (increasing fiber intake), hydration, and topical treatments may be sufficient. However, if your hemorrhoids are causing significant discomfort or bleeding, more invasive treatments may be necessary.

Laser treatment for hemorrhoids is a minimally invasive option that can be performed on an outpatient basis. This procedure uses laser energy to shrink and remove the hemorrhoidal tissue. Generally, patients do not require hospitalization for this procedure, and recovery times are relatively quick compared to traditional surgical methods. However, it is essential to discuss the risks and benefits of laser treatment with your healthcare provider to determine if it is the right option for you.

In summary, while your rectal bleeding is likely related to your internal hemorrhoids, it is crucial to monitor your symptoms and consult with a healthcare professional if you have any concerns. They can provide a comprehensive evaluation and recommend appropriate treatment options tailored to your specific situation. Additionally, managing your pain effectively while minimizing the risk of exacerbating your hemorrhoids will be key to preventing future episodes of bleeding.

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