Blood on Toilet Paper After Bowel Movement: Causes and Concerns

There is blood on the toilet paper after wiping following a bowel movement?

Hello, Doctor: (1) I had become very lazy and my sleep schedule was reversed, sleeping during the day (without eating) and only getting up late at night to have one meal, then studying until dawn and going back to sleep, repeating this cycle.
One night, I woke up with stomach pain after sleeping, and when I got up, I was fasting.
I ate a guava and then had a bowel movement, but my stomach pain worsened to the point of shaking, and my hands felt like they had cerebral palsy.
I was taken to the emergency room, where the doctor diagnosed me with gastroenteritis.
A few days later, my stomach still felt uncomfortable (though I have since changed my lifestyle for the better).
When I started to feel a bit better, I discarded the remaining medication, as it contained painkillers.
In my view, taking painkillers when the body is improving can be harmful.
However, my stomach has still felt somewhat uncomfortable until now, and I don't have much sensation.
I would like to ask Dr.
You what illness I have? The emergency doctor prescribed me pain relief, anti-nausea medication, and medication for dizziness and stomach issues.
(2) I previously visited a colorectal surgeon for constipation, and during that visit, the doctor not only helped me relieve constipation but also diagnosed me with hemorrhoids.
After the constipation was resolved, I did not return for follow-up because I was afraid that treating the hemorrhoids would be painful! Now, after having a bowel movement, I notice blood on the toilet paper when I wipe, and I don't know the cause.
Should I be concerned?

A Yao, 20~29 year old female. Ask Date: 2009/03/21

Dr. You Ligang reply Gastroenterology and Hepatology

1.
Due to abnormal lifestyle or dietary habits, diseases of the digestive system often result in functional disorders, meaning there are no structural issues, but functional problems exist.
Common conditions include dyspepsia, gastroesophageal reflux, diarrhea, constipation, and irritable bowel syndrome.
Your abdominal pain occurred suddenly, and with irregular eating habits, it is likely acute gastroenteritis.
Symptomatic treatment along with proper rest and normalization of diet is usually sufficient, and long-term medication is not necessary.
2.
Many people have hemorrhoids, but not everyone experiences symptoms.
Long-term constipation, insomnia, staying up late, insufficient water intake, irregular diet, and prolonged sitting can all contribute to hemorrhoidal thrombosis, leading to anal itching, pain, or bleeding.
You can start by drinking more water and eating more fruits and vegetables, and then visit an internal medicine clinic for medication treatment; surgery is generally not required.

Reply Date: 2009/03/21

More Info

Experiencing blood on toilet paper after a bowel movement can be concerning and may indicate various underlying issues. Based on the symptoms you've described, it seems that there are a few potential causes that could explain the presence of blood, particularly in the context of your previous history of constipation and hemorrhoids.

1. Hemorrhoids: Given your past diagnosis of hemorrhoids, this is one of the most likely culprits for the blood you are seeing. Hemorrhoids are swollen veins in the lower rectum and anus that can become inflamed and bleed, especially during bowel movements, particularly if you are straining or if your stool is hard. The blood is usually bright red, indicating that it is fresh and likely coming from the anal area rather than deeper in the gastrointestinal tract.

2. Anal Fissures: Another common cause of blood on toilet paper is an anal fissure, which is a small tear in the lining of the anus. This can occur when passing hard stools or straining during bowel movements. The pain associated with fissures can be sharp and may cause you to feel discomfort even after the bowel movement is complete.

3. Gastrointestinal Issues: Your recent history of gastroenteritis could also play a role. While gastroenteritis typically causes diarrhea, it can lead to irritation of the intestinal lining and potentially result in bleeding. However, if the blood is only present after bowel movements and not during diarrhea, this is less likely to be the primary cause.

4. Dietary Factors: Changes in your diet, such as consuming less fiber and experiencing constipation, can exacerbate issues like hemorrhoids and fissures. A diet low in fiber can lead to harder stools, which can cause straining and increase the likelihood of bleeding.

5. Other Conditions: While less common, other conditions such as diverticulosis, inflammatory bowel disease (IBD), or even colorectal cancer could cause rectal bleeding. However, these conditions often present with additional symptoms such as abdominal pain, changes in bowel habits, or weight loss.

Recommendations:
- Dietary Changes: Incorporate more fiber into your diet through fruits, vegetables, and whole grains. Staying hydrated is also crucial, as it helps soften stools and reduce straining during bowel movements.

- Avoid Straining: If you are experiencing constipation, consider using stool softeners or over-the-counter laxatives as needed, but consult with a healthcare provider for long-term management strategies.

- Consult a Specialist: Given your history of hemorrhoids and the current symptoms, it would be wise to consult a colorectal specialist. They can perform a thorough examination, possibly including a colonoscopy, to rule out any serious conditions and provide appropriate treatment for hemorrhoids or fissures.

- Monitor Symptoms: Keep track of any changes in your symptoms, such as the frequency and amount of bleeding, any associated pain, or changes in bowel habits. If you notice significant changes or if the bleeding persists, seek medical attention promptly.

In conclusion, while the presence of blood on toilet paper can be alarming, it is often associated with benign conditions like hemorrhoids or anal fissures, especially in the context of constipation. However, it is essential to address these symptoms with a healthcare provider to ensure proper diagnosis and treatment.

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