Bleeding Diarrhea: Is It Hemorrhoids or Anal Fissures?

Bloody diarrhea

Hello Dr.
Ke: I started experiencing diarrhea the day before yesterday, with bowel movements approximately every 1 to 2 hours, totaling 4 times.
The first time, I had abdominal cramps, and the stool was not much.
The second time, I felt some discomfort in the lower abdomen and a slight pain in the anal area, with little stool.
The third time, I felt a bloated and painful sensation at the anal opening, and the stool was shaped like squeezed cream.
The fourth time, after the bowel movement, I noticed some bleeding.
Yesterday, I only went to the bathroom once, did not see any blood, and the stool was minimal.
Today, my abdomen feels uncomfortable again, and I went to the bathroom twice, both times with bleeding and slight anal pain.
Currently, I am using the suppositories and hemorrhoid ointment prescribed by the proctologist.
Dr.
Ke, could you please advise if this is a ruptured hemorrhoid or an anal fissure? Should I return for a follow-up, or should I observe for a while longer? PS: I have previously undergone hemorrhoid surgery, and my anal canal is somewhat narrow.
Thank you, Dr.
Ke, for taking the time to respond.

Da Xiong, 40~49 year old female. Ask Date: 2012/06/14

Dr. Ke Fangxu reply Surgery

Whether it's hemorrhoids or anal fissures, the treatment approach typically starts with the use of suppositories, which can be combined with oral medications to control bleeding.
If bleeding stops within two to three days, there is usually no cause for concern.
However, if there is persistent and significant bleeding, it is important to seek medical attention promptly to prevent excessive blood loss.

Reply Date: 2012/06/14

More Info

When it comes to gastrointestinal issues, particularly in the context of Irritable Bowel Syndrome (IBS), the presence of bleeding and changes in stool consistency can be concerning. Based on your description, it seems you are experiencing a range of symptoms including diarrhea, abdominal pain, and rectal bleeding. Let's break down the potential causes of these symptoms and discuss whether they might be related to hemorrhoids, anal fissures, or other conditions.

Firstly, the fact that you have IBS can contribute to fluctuations in bowel habits, including diarrhea and constipation. This condition often leads to increased sensitivity of the intestines, which can result in abdominal pain and discomfort. The changes in stool consistency you mentioned—ranging from soft and thin to more formed and even golden in color—are not uncommon in IBS patients. However, the presence of blood in your stool is a symptom that should not be overlooked.

The blood you are observing could potentially be due to several causes:
1. Hemorrhoids: These are swollen veins in the lower rectum or anus that can cause bleeding, especially during bowel movements. If you have a history of hemorrhoids, it is possible that they could be exacerbated by straining during diarrhea or by the irritation caused by frequent bowel movements.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to passing hard stools or straining. Symptoms typically include sharp pain during bowel movements and can be accompanied by bleeding. Given that you mentioned experiencing pain and a sensation of pressure in the anal area, this could also be a possibility.

3. Inflammatory Bowel Disease (IBD): While less likely given your IBS diagnosis, conditions such as Crohn's disease or ulcerative colitis can also cause bleeding and changes in stool. These conditions are characterized by inflammation of the gastrointestinal tract and may require more extensive evaluation.

4. Infections: Gastrointestinal infections can lead to diarrhea and may also cause bleeding, particularly if there is significant inflammation or ulceration of the intestinal lining.

5. Other Causes: Less commonly, tumors or polyps in the colon can cause bleeding, but these are typically associated with other symptoms and risk factors.

Given your symptoms and history, it is advisable to consult with a healthcare professional, particularly a gastroenterologist, for a thorough evaluation. They may recommend diagnostic tests such as a colonoscopy to visualize the intestinal lining and rule out any serious conditions.
In the meantime, it is important to monitor your symptoms. If the bleeding persists, increases in volume, or is accompanied by other concerning symptoms such as severe abdominal pain, fever, or changes in your overall health, you should seek medical attention promptly.

Regarding your current treatment with rectal medications and ointments for hemorrhoids, it is crucial to follow your doctor's instructions. If you find that your symptoms do not improve or worsen, a follow-up appointment may be necessary to reassess your condition and adjust your treatment plan accordingly.

In summary, while hemorrhoids and anal fissures are common causes of rectal bleeding, especially in the context of IBS, it is essential to rule out other potential causes through proper medical evaluation. Your health and comfort are paramount, so do not hesitate to seek further medical advice if needed.

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