Should You Consider Further Colonoscopy for Ongoing Rectal Bleeding?

Q: Should You Consider Further Colonoscopy for Ongoing Rectal Bleeding?

Hello： In response to your question, at the age of 31, we generally do not consider the possibility of colorectal cancer, although it cannot be completely ruled out. <br>However, the likelihood of hemorrhoidal bleeding is higher. <br>If the bleeding is not severe and occurs repea

Is there a need to proceed with a colonoscopy?

Hello… Last October, I experienced rectal bleeding and consulted a doctor.
At that time, the doctor performed a sigmoidoscopy and diagnosed me with internal and external hemorrhoids, which were causing the bleeding.
Since then, I have had monthly episodes of bleeding (accompanied by constipation and straining).
When I followed up with the doctor, he confirmed that it was still internal hemorrhoids causing the bleeding and mentioned that if my lifestyle habits did not change, it would continue.
In mid-May of this year, I experienced bleeding again due to diarrhea, and the doctor said it was caused by enteritis.
Although my enteritis has resolved, the bleeding has persisted.
Yesterday, I visited a colorectal surgeon for an examination, and after a digital rectal exam, the doctor also indicated that it is likely caused by hemorrhoids.
I would like to ask whether it would be advisable to undergo a colonoscopy for further evaluation (note: I had a colonoscopy two years ago, which also indicated the presence of internal and external hemorrhoids).
If the bleeding continues, would surgical intervention be necessary to resolve the issue? Thank you for your assistance.

Xiao Q, 30~39 year old female. Ask Date: 2009/05/26

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, at the age of 31, we generally do not consider the possibility of colorectal cancer, although it cannot be completely ruled out.
However, the likelihood of hemorrhoidal bleeding is higher.
If the bleeding is not severe and occurs repeatedly, it would be advisable to undergo a colonoscopy to rule out the possibility of colorectal cancer, which would provide peace of mind.
If medication is ineffective, it is typically recommended to consider hemorrhoid ligation or surgical excision.
Hemorrhoid ligation can be performed in an outpatient setting and is not painful.
If the bleeding is severe enough to cause anemia or significantly disrupt daily life, surgical treatment may be the more definitive solution.
Dr.
Ke Fang-Hsu, Chief of Surgery at Keelung Hospital.

Reply Date: 2009/05/26

More Info

When it comes to ongoing rectal bleeding, especially in the context of a history of hemorrhoids and previous gastrointestinal issues, it is essential to approach the situation with caution and thoroughness. Your concerns are valid, particularly given your history of rectal bleeding and the potential for underlying conditions that may not have been fully addressed.

Based on your description, it seems that your rectal bleeding has been attributed to internal hemorrhoids, which is a common cause of such symptoms. Hemorrhoids can cause bleeding during bowel movements, especially if there is straining involved due to constipation or diarrhea. The fact that you have experienced bleeding intermittently, particularly after episodes of constipation or diarrhea, suggests that your hemorrhoids may be exacerbated by these conditions.
However, it is crucial to note that while hemorrhoids are a frequent cause of rectal bleeding, they are not the only cause. Other potential causes include anal fissures, diverticular disease, colorectal polyps, and even colorectal cancer, particularly given your family history of colorectal issues. Therefore, even if your doctor has previously diagnosed your bleeding as being due to hemorrhoids, it is prudent to consider further evaluation, especially if the bleeding persists or changes in character.

Given that you had a colonoscopy two years ago, which showed hemorrhoids but did not identify any other significant issues, it is understandable to feel reassured. However, the medical community generally recommends that individuals with a history of rectal bleeding, especially those with risk factors such as a family history of colorectal cancer, undergo regular screenings. The American Cancer Society suggests that individuals at average risk begin screening at age 45, but those with a family history may need to start earlier or have more frequent screenings.

In your case, if the bleeding continues despite treatment for hemorrhoids or if you experience any new symptoms such as changes in bowel habits, weight loss, or abdominal pain, it would be advisable to discuss the possibility of a repeat colonoscopy with your healthcare provider. A colonoscopy can help rule out other potential causes of bleeding and ensure that any polyps or other abnormalities are identified and managed appropriately.

Regarding the surgical options, if hemorrhoids are confirmed to be the cause of your bleeding and conservative measures (such as dietary changes, increased fiber intake, and topical treatments) do not provide relief, surgical intervention may be necessary. Procedures such as rubber band ligation or hemorrhoidectomy can be effective in treating persistent or severe hemorrhoids.

In summary, while your ongoing rectal bleeding may be related to hemorrhoids, it is essential to remain vigilant and consider further evaluation through a colonoscopy, especially if the bleeding persists or worsens. Open communication with your healthcare provider about your symptoms and concerns will help ensure that you receive appropriate care and peace of mind. Regular monitoring and proactive management are key to maintaining gastrointestinal health, particularly in the context of your medical history.

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