Internal Hemorrhoids: When to Consider a Follow-Up Colonoscopy

Regarding internal hemorrhoids?

Hello, doctor.
A year and a half ago, I experienced significant bleeding during bowel movements and went to the hospital for an examination.
The doctor diagnosed me with internal hemorrhoids and I underwent a rubber band ligation procedure, which improved my symptoms considerably.
Six months later, I still occasionally noticed some blood when wiping after a bowel movement, but the amount was small.
Sometimes, when my stool was very hard or if I had diarrhea, the bleeding would be a bit more pronounced.
Last year, I went for a colonoscopy, and the results showed no significant issues, just a small polyp that was removed and tested, with normal results.

It's been a year since then, and I find that if my stool is too hard or if I go two to three days without a bowel movement, I experience slight bleeding.
After the colonoscopy, I had a follow-up appointment with the doctor, who noted that I still had mild internal hemorrhoids.
I underwent another ligation procedure, but on the day of the surgery, I couldn't resist the urge to have a bowel movement, and it seemed the procedure was not very effective.

Now, as long as I have a bowel movement every day, wiping the anal area is generally normal, but if the stool is a bit hard, I notice some blood on the toilet paper, and I also experience anal pain (especially since I tend to wipe vigorously, worried about not being clean, and sometimes I even dig into the anal area).
This morning, after not having a bowel movement yesterday, I held it in for a long time, and the stool was pressing against my anus.
When I finally went, I noticed quite a bit of blood on the stool, and when I wiped, there was a noticeable amount of blood about the size of a ten-dollar coin.
Subsequent wiping showed less blood.

I usually work in positions that require either prolonged standing or sitting, but not both for long periods.
Given that it has been a year since my last colonoscopy, should I undergo another examination? Is there a possibility of other pathological changes?

A Zhe, 30~39 year old female. Ask Date: 2013/03/11

Dr. Ke Fangxu reply Surgery

Mild bleeding after bowel movements is a common occurrence associated with hemorrhoids.
Diarrhea and constipation can exacerbate this issue, so it is essential to improve your bowel habits rather than maintaining irregular bowel movements and worrying about bleeding.
If the bleeding is severe, it is advisable to consult a physician for treatment.
If you have undergone a colonoscopy within the past three to five years, there is generally no need for another unless there are specific symptoms.
Some physicians may recommend a follow-up examination a year after polyp removal.

Reply Date: 2013/03/11

More Info

When it comes to understanding the necessity of follow-up colonoscopy after experiencing symptoms related to internal hemorrhoids, it is essential to consider several factors, including your medical history, the nature of your symptoms, and the results of previous examinations.

In your case, you have a history of significant rectal bleeding associated with internal hemorrhoids, which were treated with rubber band ligation. Following the procedure, you noted improvements, but occasional bleeding persisted, particularly when experiencing hard stools or constipation. You also underwent a colonoscopy a year ago, which revealed a small polyp that was removed and found to be benign. Given that you have had a follow-up visit with your doctor, who confirmed the presence of mild internal hemorrhoids, it is clear that your condition is being monitored.

The presence of blood on toilet paper after bowel movements, especially when associated with hard stools, is quite common in individuals with hemorrhoids. Hemorrhoids can become irritated and bleed when there is increased pressure during bowel movements, particularly if the stool is hard or if there is straining involved. It is important to manage your bowel habits to minimize this risk. Increasing dietary fiber, staying hydrated, and possibly using stool softeners can help prevent constipation and reduce the likelihood of hemorrhoid-related bleeding.

Regarding the need for another colonoscopy, the general recommendation is that if you have had a normal colonoscopy within the last 10 years and are not experiencing alarming symptoms (such as significant changes in bowel habits, unexplained weight loss, or persistent abdominal pain), a follow-up colonoscopy may not be immediately necessary. However, since you have experienced recurrent bleeding, it would be prudent to discuss this with your healthcare provider. They may recommend a repeat colonoscopy sooner than the standard interval to rule out any other potential issues, especially considering your history of significant bleeding.

It is also worth noting that while hemorrhoids are a common cause of rectal bleeding, other conditions such as diverticulosis, inflammatory bowel disease, or even colorectal cancer can also present with similar symptoms. Therefore, if your bleeding persists or worsens, or if you develop new symptoms, it is crucial to seek medical advice promptly. Your healthcare provider may suggest further evaluation, including imaging studies or additional diagnostic procedures, to ensure that there are no other underlying conditions contributing to your symptoms.

In summary, while your current symptoms may be related to your known internal hemorrhoids, the recurrence of bleeding warrants a discussion with your healthcare provider about the need for further evaluation, including the possibility of a follow-up colonoscopy. Regular monitoring and proactive management of your bowel health can help mitigate symptoms and improve your quality of life. Always prioritize open communication with your healthcare team to ensure that any changes in your condition are appropriately addressed.

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