Rectal Bleeding: Causes, Symptoms, and Treatment Options

Rectal bleeding

Hello, doctor: Last week I experienced rectal bleeding.
The first and second times, the blood was bright red on the surface of the stool, but during the third episode, there was a large amount of bright red blood, and I felt pain in the anus.
The next day, there was no bleeding, but the day after that, just before my visit to the colorectal surgeon, I noticed dark red blood (dripping after a bowel movement).
After the examination, the doctor asked about my diet and mentioned that he observed a fissure with dark red blood, so he recommended a colonoscopy.
I told him that I had a colonoscopy two years ago when I had hemorrhoid surgery, and it was very painful, which is why I didn't complete it.
He then suggested a barium enema instead and scheduled it for next Thursday.
I asked him what might be causing my symptoms, and he said it was likely due to the fissure.
I further inquired why I had bright red blood and significant pain during my bowel movement the previous day, while today there was only slight pain and dark red blood afterward.
He explained that the blood might have been retained in the intestines for a while, turning dark red.
I have not had any bleeding for two days, but today I experienced bleeding again after a bowel movement, which was also dark red and appeared to drip down.
During the bowel movement, I felt a slight pain as if the stool was irritating the rectum, and I also feel some discomfort while sitting.
Doctor, could this situation be caused by an anal fissure? If it is an anal fissure, how long does it typically take to heal?

Lao Shu, 40~49 year old female. Ask Date: 2010/04/24

Dr. Ke Fangxu reply Surgery

Hello, based on your description, it is likely that you are experiencing anal fissures.
Since you had a colonoscopy just two years ago, there should be no need for another one at this time.
Anal fissures are often caused by constipation or diarrhea.
The solution is to address the bowel movement issues.
By improving your bowel habits, along with topical treatments and regular warm sitz baths, you should see significant improvement within one to two weeks.
During this time, it is advisable to avoid spicy and irritating foods.
Wishing you a speedy recovery!

Reply Date: 2010/04/24

More Info

Understanding rectal bleeding can be concerning, especially when it presents with varying colors and associated symptoms. Based on your description, it seems you are experiencing rectal bleeding that has changed in color and intensity over a short period. Let's break down the potential causes, symptoms, and treatment options for your situation.

Causes of Rectal Bleeding
1. Hemorrhoids: These are swollen veins in the lower rectum or anus that can cause bright red blood during bowel movements. They are often associated with pain and discomfort, especially if they become thrombosed (clotted).

2. Anal Fissures: As your doctor mentioned, anal fissures are small tears in the lining of the anus, which can cause sharp pain during and after bowel movements, often accompanied by bright red blood. The pain can lead to a fear of bowel movements, which may exacerbate constipation and further aggravate the fissure.

3. Diverticular Disease: This includes diverticulitis and diverticulosis, where small pouches form in the colon wall and can become inflamed or bleed.

4. Colorectal Polyps or Cancer: While less common, these can also cause rectal bleeding. Polyps are growths on the inner lining of the colon that can bleed, and some can develop into cancer over time.

5. Gastrointestinal Conditions: Conditions like inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can also lead to rectal bleeding.

Symptoms
- Bright Red Blood: Typically indicates bleeding from the lower gastrointestinal tract, such as hemorrhoids or anal fissures.

- Dark Red Blood: This may suggest that the blood has been in the gastrointestinal tract longer, possibly indicating bleeding from higher up in the colon.

- Pain: The presence of pain during bowel movements often points towards anal fissures or hemorrhoids.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which is crucial for healing fissures and preventing hemorrhoids. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also essential.

2. Topical Treatments: Over-the-counter creams or ointments can help relieve pain and inflammation associated with hemorrhoids and fissures. These may include hydrocortisone creams or topical anesthetics.

3. Warm Sitz Baths: Soaking the anal area in warm water can help soothe pain and promote healing.

4. Medications: If constipation is an issue, stool softeners or mild laxatives may be recommended to ease bowel movements.

5. Surgical Options: If conservative treatments fail, surgical options may be considered, especially for persistent fissures or severe hemorrhoids.

Prognosis
For anal fissures, healing can take a few weeks to several months, depending on the severity and whether you can avoid straining during bowel movements. Most fissures heal with conservative treatment, but chronic fissures may require surgical intervention.

Conclusion
Given your symptoms and the examination findings of an anal fissure, it is likely that this is the source of your rectal bleeding. It is essential to follow up with your healthcare provider for the scheduled imaging studies, as they will help rule out other potential causes of bleeding. In the meantime, focus on dietary modifications, proper hydration, and pain management strategies to facilitate healing. If you experience worsening symptoms or new concerns, do not hesitate to seek medical attention promptly.

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