Blood in Stool: IBS, Hemorrhoids, or Colorectal Cancer?

Blood in stool / Irritable bowel syndrome / Internal hemorrhoids / Colorectal cancer / Colitis?

Dear Doctor,
I have been very worried about my condition, so I am writing in detail and hope you can patiently read through it.
Thank you! Over the past few months, I have experienced recurrent episodes of diarrhea, averaging discomfort every two weeks for a few days.
The sequence of events during each episode is generally as follows: overeating (large meals) → feeling the urge to defecate → passing a large amount of loose stool (severe diarrhea) → sometimes with blood streaks in the stool → watery stools with intestinal mucus → leading to daily diarrhea 3 to 4 times (without blood), accompanied by discomfort in the lower abdomen → eventually evolving into stomach pain and bloating with blood in the stool.
Since early October, I have had three instances of blood in my stool, each occurring after overeating and severe diarrhea.
Although the blood streaks appear after defecation, they are also accompanied by watery stools with intestinal mucus.
Regarding my bowel movements: when normal, my stool is about 1.5 to 2 thumbs wide but tends to be soft, with the best shape usually in the first morning bowel movement.
During diarrhea, the stool is completely unformed.

Other details: Each time I have an episode, I visit a doctor.
I have seen two gastroenterologists and a colorectal surgeon, and I have undergone ultrasound and digital rectal examinations.
The doctors have all explained that I have irritable bowel syndrome and internal hemorrhoids.
Each time I take medication, there is improvement, but once I overeat again, the symptoms recur.
I would like to ask the doctor: although the doctors say I am still young and the risk of colon cancer is low, could it also be possible that I have ulcerative colitis? I have seen multiple doctors, and none have suggested a colonoscopy (I am also afraid of the pain...).
I would like to hear your advice.
Should I continue to monitor my condition? Is the blood from internal hemorrhoids always in drops? If the amount of bleeding is small, could it accompany the stool?

Xiao Yin, 20~29 year old female. Ask Date: 2012/11/10

Dr. Ke Fangxu reply Surgery

Indeed, young people have a lower probability of developing colorectal cancer, and ulcerative colitis is more common among younger individuals.
However, what you may not know is that the incidence of ulcerative colitis is significantly lower than that of colorectal cancer in Eastern populations, approximately one in ten thousand.
Of course, a low probability does not mean it cannot happen.
If you are genuinely concerned, you can ask your physician to arrange for a colonoscopy, and they should not refuse.
Based on your description, it seems that irritable bowel syndrome is the most likely diagnosis.
However, if a colonoscopy can alleviate your concerns, it could be a good option.
As for internal hemorrhoid bleeding, as long as it is not severe enough to cause anemia, it is not a major issue.
If the amount of bleeding is so minimal that it is not visible, there is even less need for intervention, as the blood volume we produce daily is sufficient to compensate for it.

Reply Date: 2012/11/10

More Info

Dear Patient,
Thank you for sharing your detailed concerns regarding your gastrointestinal symptoms. It’s understandable to feel anxious about blood in your stool, especially when you have experienced recurrent episodes of diarrhea and discomfort. Based on your description, it seems that your symptoms could be attributed to a combination of Irritable Bowel Syndrome (IBS) and hemorrhoids, rather than colorectal cancer or ulcerative colitis. However, let's explore this further.

Understanding Your Symptoms
1. Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea and constipation. Your pattern of symptoms—episodes of diarrhea following large meals, along with the presence of mucus and occasional blood—aligns with IBS. Stress and dietary choices can exacerbate IBS symptoms, which seems to be the case for you when you eat large meals.

2. Hemorrhoids: The presence of blood in your stool, especially if it appears as bright red streaks on the surface of the stool or on toilet paper, is often associated with hemorrhoids. Hemorrhoids can bleed when irritated, particularly during bowel movements, especially if you are experiencing diarrhea or straining. The blood from hemorrhoids typically does not mix with the stool but may appear on the surface.

3. Colorectal Cancer and Ulcerative Colitis: While you mentioned concerns about colorectal cancer and ulcerative colitis, the likelihood of these conditions seems low given your age and the nature of your symptoms. Colorectal cancer typically presents with more severe symptoms, such as significant weight loss, persistent changes in bowel habits, and often more substantial bleeding. Ulcerative colitis usually involves continuous symptoms, including bloody diarrhea and abdominal pain, and would likely have been identified during a colonoscopy if performed.

Recommendations
1. Dietary Management: Since you have identified that large meals trigger your symptoms, it may be beneficial to adopt a more balanced diet with smaller, more frequent meals. Incorporating fiber gradually can help regulate your bowel movements, but be cautious with high-fiber foods if they exacerbate your symptoms.

2. Monitoring Symptoms: Keep a symptom diary to track your food intake, bowel habits, and any associated symptoms. This can help identify specific triggers and patterns, which can be valuable information for your healthcare providers.

3. Medical Evaluation: Although your doctors have suggested that your symptoms are likely due to IBS and hemorrhoids, if you continue to experience significant changes in your bowel habits, persistent blood in your stool, or if your symptoms worsen, it would be prudent to discuss the possibility of a colonoscopy with your physician. A colonoscopy can provide a definitive diagnosis and rule out any serious conditions.

4. Managing Anxiety: It’s natural to feel anxious about your health, especially with concerning symptoms. Consider discussing your fears with your healthcare provider, who may recommend strategies to help manage your anxiety, including counseling or relaxation techniques.

5. Follow-Up: Regular follow-up with your healthcare provider is essential to monitor your condition. If your symptoms persist or change, further evaluation may be necessary.

Conclusion
In summary, while your symptoms are concerning, they are more indicative of IBS and hemorrhoids rather than colorectal cancer or ulcerative colitis. It is essential to maintain open communication with your healthcare providers and advocate for your health. If you have any further questions or if your symptoms change, do not hesitate to seek medical advice.

Take care, and I hope you find relief from your symptoms soon.

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