Rectal Bleeding: Causes and Diagnostic Insights

Blood in stool

A year ago, I had external hemorrhoids (I could clearly feel a soft protrusion outside the anus, and it was painful to sit and walk).
I gradually improved with sitz baths, and the pain and protrusion disappeared.
At that time, I experienced minor rectal bleeding during bowel movements.
Recently, I have had two episodes of rectal bleeding again, but the bleeding stopped after wiping.
The blood on the toilet paper is bright red, and there is also blood in the toilet water, with the blood separate from the stool (by "separate," I mean that when flushing a squat toilet, I can clearly see the stool and blood are distinct).
There is no pain in the anus, and I have not experienced any discomfort in my body recently, no weight loss, no abdominal pain, the stool has not noticeably narrowed, and there are no unusual symptoms like fever or frequent urges to defecate.
1.
Could this be caused by internal hemorrhoids?
2.
During a comprehensive health check-up, if I take an oral contrast agent and then undergo an X-ray, can it help identify intestinal issues?
3.
During a comprehensive health check-up, can a stool test determine intestinal problems?
4.
What is the definition of intermittent bleeding, doctor?

Acong, 20~29 year old female. Ask Date: 2012/06/26

Dr. Ke Fangxu reply Surgery

1.
It is possible.
2.
This refers to upper gastrointestinal imaging or small bowel imaging, which is suitable for examining lesions in the stomach, duodenum, or small intestine.
I'm not sure which part of the intestine you are referring to; if you mean the large intestine, that cannot be assessed.
3.
A fecal occult blood test can check for abnormal bleeding in the gastrointestinal tract.
4.
Intermittent bleeding refers to sporadic bleeding; essentially, any bleeding is considered abnormal and should be evaluated by a physician.

Reply Date: 2012/06/26

More Info

Rectal bleeding can be a concerning symptom, and understanding its causes is crucial for appropriate diagnosis and management. Based on your description, it seems you have experienced intermittent rectal bleeding, particularly after having previously dealt with external hemorrhoids. Let's break down your questions and provide insights into potential causes, diagnostic methods, and what you might consider moving forward.

1. Possible Causes of Rectal Bleeding: The fresh red blood you observe on toilet paper and in the toilet bowl, especially when it appears separate from the stool, is often indicative of bleeding from the lower gastrointestinal tract. Common causes include:
- Hemorrhoids: Both internal and external hemorrhoids can cause bleeding. Internal hemorrhoids are typically not painful and can lead to bright red blood during bowel movements.

- Anal fissures: These are small tears in the lining of the anus, often caused by passing hard stools, and can also result in bright red bleeding.

- Diverticular disease: Diverticula are small pouches that can form in the colon wall and may bleed.

- Polyps or colorectal cancer: While less common, these can also present with rectal bleeding, especially if there are changes in bowel habits or other concerning symptoms.

Given your history of external hemorrhoids and the absence of pain during bleeding, it is plausible that your current bleeding could be related to internal hemorrhoids or another benign condition. However, it is essential to rule out more serious causes, especially if the bleeding persists or changes in nature.

2. Diagnostic Imaging and Tests:
- X-ray with oral contrast: While this can provide some information about the structure of the intestines, it is not the most effective method for diagnosing rectal bleeding. More specific tests, such as a colonoscopy or flexible sigmoidoscopy, are typically recommended for direct visualization of the colon and rectum.

- Stool tests: A stool test can help detect blood that is not visible to the naked eye (occult blood) and can also be used to check for infections or other gastrointestinal issues.

3. Definition of Intermittent Bleeding: Intermittent bleeding refers to episodes of bleeding that occur sporadically rather than continuously. In your case, it seems you experience bleeding during certain bowel movements but not consistently. This pattern can be associated with conditions like hemorrhoids or fissures, which may flare up based on factors such as stool consistency, straining, or other irritants.

4. Next Steps: Given your symptoms and history, it would be prudent to consult a healthcare provider, preferably a gastroenterologist. They may recommend a physical examination, possibly including a digital rectal exam, and further diagnostic tests like a colonoscopy to assess the source of the bleeding directly. It’s essential to address this issue, especially since you have a history of hemorrhoids and have experienced bleeding again.

In summary, while your symptoms may be related to benign conditions like hemorrhoids, it is crucial to seek medical evaluation to rule out any serious underlying issues. Early diagnosis and management can help prevent complications and improve your overall health.

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