Persistent Rectal Bleeding: When to Seek Further Medical Evaluation

Doctor, I have been experiencing rectal bleeding for the past three months?

Hello, Doctor.
I have been experiencing rectal bleeding for three months now.
Previously, I underwent a sigmoidoscopy and a colonoscopy, each once.
The sigmoidoscopy was done first, and the doctor said there was nothing serious, diagnosing it as bleeding caused by internal hemorrhoids.
However, it did not improve, so I went to another hospital for a colonoscopy.
The doctor reviewed the images and noted that there was inflammation in one area of my colon, suggesting that the inflammation was causing the bleeding.
I was given a suppository, and after using it for a few days, it seemed like the bleeding had stopped.
I did not closely monitor my stool for blood until recently, when I noticed rectal bleeding again.
The blood is bright red and adheres to the liquid stool, with some also sticking to the stool itself.
In the past few days, I have felt some discomfort around the anal area, with slight pain.
I am very concerned.
Could it be that the colonoscopy did not thoroughly examine my condition, or do I have another issue? Doctor, do I need to undergo another colonoscopy? (P.S.: I had the sigmoidoscopy during the first month of bleeding, and then the colonoscopy in the second month.
Now it has been three months.)

Xiu Dou 123, 20~29 year old female. Ask Date: 2008/04/10

Dr. Hou Yongji reply Surgery

Based on your description, it is difficult to fully understand your condition.
Please return to the original hospital for a more detailed consultation regarding your condition.
If you still cannot obtain appropriate treatment, please copy your report and seek out a nearby colorectal surgeon for evaluation.
Generally, a colonoscopy is a diagnostic tool and does not provide therapeutic effects.
Repeated examinations without appropriate treatment will not be beneficial.
(Attached is a list of colorectal surgeons.) Dr.
Hou Yong-ji.

Reply Date: 2008/04/10

More Info

Persistent rectal bleeding can be concerning, especially when it has lasted for three months, as you described. Given your history of undergoing both sigmoidoscopy and colonoscopy, it is important to evaluate the situation further, especially since you are experiencing fresh rectal bleeding and some discomfort in the anal area.

From your description, it appears that your initial evaluations indicated internal hemorrhoids as the cause of your bleeding. However, the subsequent colonoscopy revealed inflammation in the colon, which was treated with a suppository. The fact that the bleeding seemed to resolve temporarily is a positive sign, but the recurrence of bright red blood in your stool is a cause for concern.

Bright red blood typically indicates that the source of the bleeding is in the lower gastrointestinal tract, such as the rectum or sigmoid colon. This could be due to several reasons, including:
1. Hemorrhoids: These are swollen veins in the rectum or anus that can cause bleeding, especially during bowel movements. They can be internal or external and may cause discomfort or pain.

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. Colitis: Inflammation of the colon, which can be due to various causes, including infections, inflammatory bowel disease (IBD), or ischemic colitis.

4. Polyps or tumors: Although less common, polyps or tumors in the colon can also cause bleeding. These can be benign or malignant, and their presence would necessitate further evaluation.

Given that you have experienced a recurrence of bleeding and some discomfort, it is advisable to seek further medical evaluation. Here are some recommendations:
1. Return to your healthcare provider: Discuss your symptoms in detail, including the recurrence of bleeding and any associated pain. Be sure to mention that the blood is bright red and that you have noticed it on both the stool and the toilet paper.

2. Consider repeat colonoscopy: Given the persistence of your symptoms, a repeat colonoscopy may be warranted. This can help identify any new issues that may have developed since your last examination, such as new polyps, changes in the inflammation, or other abnormalities.

3. Monitor your symptoms: Keep a record of your bowel habits, the frequency and quantity of bleeding, and any changes in your pain levels. This information can be helpful for your healthcare provider in determining the next steps.

4. Diet and hydration: Ensure you are consuming a high-fiber diet and staying well-hydrated, as this can help prevent constipation and reduce strain during bowel movements, which may alleviate some symptoms.

5. Follow-up on treatment: If you were prescribed medications or treatments for the inflammation or hemorrhoids, ensure you are following those recommendations closely.

In summary, while your previous evaluations did not indicate any serious issues, the recurrence of rectal bleeding and discomfort warrants further investigation. It is essential to communicate openly with your healthcare provider about your concerns and to consider a repeat colonoscopy to rule out any new or ongoing issues. Early detection and treatment are crucial for managing any potential complications effectively.

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