Persistent Blood in Stool: What to Do After Negative Hemorrhoid Exam?

After undergoing a rectal examination and confirming that it is not hemorrhoids, but there is still persistent rectal bleeding?

I have been experiencing bloody stools for a week.
The blood is bright red and the amount is significant (the toilet is filled with blood).
Most of my stools are pellet-like and somewhat hard (though there are also some normal cylindrical shapes).
I have been having regular bowel movements, but on the third day of having bloody stools, I visited a clinic specializing in hemorrhoids for a digital rectal examination.
The doctor diagnosed it as not hemorrhoids, but mentioned there is a slight fissure (the fissure is near the anal opening, and there is mild pain during bowel movements).
The doctor also said that the large amount of bleeding is due to the fissure being near a blood vessel.
I have been using an ointment for three days, but there has been no improvement.
What could these symptoms indicate? Should I go to a larger hospital for a more detailed examination?

rebecca, 30~39 year old female. Ask Date: 2009/05/11

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, based on your condition, there is a higher likelihood of hemorrhoids or anal fissures.
If the bleeding persists, please visit the colorectal surgery department at the hospital for an endoscopic examination.
Wishing you good health.
Sincerely, Dr.
Chen Qi-Feng, Taoyuan Hospital, Department of Health.

Reply Date: 2009/05/11

More Info

Persistent blood in the stool can be a concerning symptom, especially when it has lasted for a week and is accompanied by significant bleeding. Given the details you've provided, it’s essential to take this situation seriously and seek further medical evaluation.

Firstly, the fact that you have bright red blood in your stool suggests that the bleeding is likely coming from the lower gastrointestinal tract, which includes the rectum and anus. The presence of hard, pellet-like stools indicates that you may be experiencing constipation, which can lead to anal fissures (tears in the lining of the anus) and contribute to bleeding. The doctor you visited diagnosed you with a fissure and prescribed a topical ointment, which is a common treatment for such injuries. However, if you have not seen any improvement after three days of treatment, it may be time to consider further evaluation.

Here are some important steps and considerations:
1. Follow-Up with a Specialist: Since the bleeding has persisted and the initial treatment has not resolved the issue, it would be prudent to follow up with a gastroenterologist. They can perform more comprehensive diagnostic tests, such as a colonoscopy, to examine the entire colon and rectum for any other potential sources of bleeding, such as polyps, diverticulosis, or inflammatory bowel disease.

2. Monitor Symptoms: Keep track of any additional symptoms you may experience, such as abdominal pain, changes in bowel habits, weight loss, or fatigue. These could provide important clues to your healthcare provider about the underlying cause of your symptoms.

3. Dietary Adjustments: In the meantime, consider dietary changes to help alleviate constipation. Increasing your fiber intake through fruits, vegetables, and whole grains, as well as staying well-hydrated, can help soften your stools and reduce straining during bowel movements, which may help heal the fissure.

4. Avoid Straining: Straining during bowel movements can exacerbate anal fissures and lead to further bleeding. If you are experiencing constipation, consider using stool softeners or mild laxatives as recommended by your healthcare provider.

5. Emergency Care: If you experience any signs of severe bleeding (such as passing large amounts of blood, dizziness, or fainting), seek emergency medical attention immediately.

6. Consider Other Causes: While hemorrhoids are a common cause of rectal bleeding, other conditions such as colorectal cancer, especially in individuals over 50 or with a family history of colorectal issues, should be ruled out. Early detection is crucial for effective treatment.

In summary, while anal fissures can cause significant bleeding, the persistence of your symptoms warrants further investigation to rule out other potential causes. Consulting with a gastroenterologist for a thorough evaluation and possibly a colonoscopy is the best course of action to ensure your health and peace of mind.

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