Post-Defecation Bleeding: Causes and When to Seek Help

Bleeding after bowel movements?

Hello, Dr.
Ke:
This afternoon, while I was sleeping, I experienced anal itching and scratched with my hand.
After getting up and having a bowel movement, I noticed bleeding, and there were blood clots as well as drops of blood.
I then used the hemorrhoid suppository prescribed by the hospital, and about a minute after inserting it into the rectum, I felt a slight stinging at the anal opening.
After more than an hour, I went to the bathroom again.
I did not pass any stool, but fresh red blood dripped out.
After another 3 to 4 hours, I went to the bathroom again and passed some stool without any bleeding.

In March, I had a similar situation and consulted a colorectal surgeon.
At that time, the doctor determined that it was either a scratch from scratching the anal area or a rupture of a hemorrhoid, so no digital examination was performed.
The two episodes are somewhat different; during the first occurrence, I had bleeding after a bowel movement and felt pain while sitting on a chair, but today I did not experience any pain.
I had a double-contrast barium enema last year, which showed no issues.

I would like to ask Dr.
Ke if today’s rectal bleeding is similar to the previous scratch? Additionally, should I undergo any further examinations?
PS: I have been taking traditional Chinese medicine anticoagulants, including Danshen, and I also take the Western medication Bokey EM.

Thank you, Dr.
Ke, for taking the time to respond amidst your busy schedule.
Thank you.

Da Lao Shu, 40~49 year old female. Ask Date: 2011/05/07

Dr. Ke Fangxu reply Surgery

Hello, in response to your question, I believe the bleeding is likely caused by skin damage around the anal area due to scratching.
This time, the bleeding is not as severe as it was last time.
I recommend using a topical ointment for treatment.
If you had a barium enema last year, there should be no need for another examination this year unless more severe symptoms arise.
Long-term use of anticoagulants can indeed make hemorrhoids more prone to bleeding; however, based on your current situation, it does not seem to be serious.
Anal itching is a common issue in the summer.
I suggest rinsing with clean water, avoiding spicy and irritating foods, and refraining from scratching to prevent further skin damage.

Reply Date: 2011/05/07

More Info

Post-defecation bleeding can be concerning, and understanding its causes and when to seek medical help is essential for your health. Based on your description, it appears that you have experienced rectal bleeding after a bowel movement, which can be attributed to several potential causes.

Common Causes of Post-Defecation Bleeding
1. Hemorrhoids: This is one of the most common causes of rectal bleeding. Hemorrhoids can be internal or external and may cause bright red blood during bowel movements. They can be aggravated by straining during defecation or by scratching the anal area, as you mentioned.

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 or after bowel movements.

3. Rectal or Anal Trauma: Scratching or any injury to the anal area can lead to bleeding. This could be the result of vigorous scratching or irritation.

4. Diverticular Disease: Diverticula are small pouches that can form in the colon wall. If they become inflamed or infected, they can cause bleeding.

5. Polyps or Colorectal Cancer: While less common, these can also cause rectal bleeding, especially in individuals over 50 or those with a family history of colorectal issues.

When to Seek Medical Help
You should seek medical attention if you experience any of the following:
- Persistent Bleeding: If the bleeding does not stop or recurs frequently.

- Severe Pain: If you experience significant pain during or after bowel movements.

- Changes in Bowel Habits: Such as diarrhea or constipation that lasts more than a few days.

- Other Symptoms: Such as dizziness, fainting, or significant abdominal pain, which could indicate a more serious condition.

Recommended Actions
1. Consult a Specialist: Given your history of similar symptoms and the use of anticoagulant medications, it would be prudent to consult a colorectal surgeon or gastroenterologist. They may recommend a digital rectal exam or other diagnostic tests, such as a colonoscopy, to rule out any serious conditions.

2. Monitor Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, any associated pain, and changes in bowel habits. This information will be valuable for your healthcare provider.

3. Avoid Straining: To prevent further irritation or injury, try to avoid straining during bowel movements. A high-fiber diet and adequate hydration can help soften stools.

4. Medication Review: Since you are on anticoagulant medications, discuss with your healthcare provider whether these could be contributing to your bleeding and if any adjustments are necessary.

5. Topical Treatments: Continue using the prescribed topical treatments, but if you experience increased pain or discomfort, inform your doctor.

Conclusion
While your symptoms may be related to minor issues such as hemorrhoids or anal fissures, it is essential to rule out more serious conditions, especially given your medication history. Regular follow-ups and open communication with your healthcare provider will help ensure that any underlying issues are addressed promptly. If you notice any alarming symptoms or changes, do not hesitate to seek immediate medical attention. Your health and peace of mind are paramount.

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