Rectal Bleeding: When to Consider a Colonoscopy

Q: Rectal Bleeding: When to Consider a Colonoscopy

Hello： In response to your question, the presence of blood in the stool before the age of 40 is often related to anal disorders. <br>If both the digital rectal examination and the fecal occult blood test show no abnormalities, and there are no other symptoms of colorectal cancer

Blood after bowel movements?

Hello Doctor: After changing jobs (about two and a half years ago), I have been sitting more often and have started experiencing intermittent rectal bleeding, mostly when my stools are harder.
I feel a sharp pain near the anus as the stool passes, and there is blood on the toilet paper.
I can usually sense the bleeding before it happens.
When I visit the doctor, they often perform a digital rectal exam and an anoscopy, and they usually diagnose me with hemorrhoids or anal fissures.
Since this occurs periodically, I have asked the doctor whether I should undergo a colonoscopy, but they have said it is not necessary, as it does not seem to be anything serious.
Additionally, last year during a company health check, my stool test results were negative.
Should I consider getting a colonoscopy, or should I follow the doctor's advice and not proceed? Thank you.

Wei Bo, 30~39 year old female. Ask Date: 2013/05/12

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, the presence of blood in the stool before the age of 40 is often related to anal disorders.
If both the digital rectal examination and the fecal occult blood test show no abnormalities, and there are no other symptoms of colorectal cancer or family history, then a colonoscopy is not necessary.
However, if you are still concerned, undergoing a colonoscopy for peace of mind is acceptable, although it is not medically required.

Reply Date: 2013/05/12

More Info

When it comes to rectal bleeding, understanding the underlying causes and determining when to consider a colonoscopy is crucial for your health. Based on your description, it seems that you have been experiencing rectal bleeding primarily associated with hard stools, which can lead to anal fissures or hemorrhoids. These conditions are common and often result in bright red blood on toilet paper or in the toilet bowl, especially after a bowel movement.

Given your history of bleeding and the fact that your doctors have attributed it to hemorrhoids or anal fissures, it is understandable that you might feel reassured. However, it is essential to consider several factors when deciding whether to pursue a colonoscopy.

1. Duration and Frequency of Symptoms: If you have been experiencing rectal bleeding consistently over an extended period, it may warrant further investigation. While hemorrhoids and fissures are common causes, persistent bleeding should not be ignored, especially if it occurs frequently or worsens.

2. Change in Bowel Habits: Any significant changes in your bowel habits, such as a change in the frequency, consistency, or shape of your stools, should be taken seriously. For instance, if you notice that your stools are becoming narrower or if you experience unexplained weight loss, these could be signs of a more serious condition that requires a colonoscopy.

3. Age and Risk Factors: As you age, the risk of colorectal cancer increases. The American Cancer Society recommends that individuals at average risk begin screening for colorectal cancer at age 45. If you have a family history of colorectal cancer or other risk factors, you may need to start screening earlier.

4. Negative Fecal Occult Blood Test: While a negative fecal occult blood test (FOBT) is reassuring, it does not entirely rule out the possibility of other issues, such as polyps or early-stage cancers that may not bleed consistently. Therefore, if you continue to have symptoms, a colonoscopy may still be warranted.

5. Doctor's Recommendations: It is essential to communicate openly with your healthcare provider about your concerns. If you feel that your symptoms are not being adequately addressed, seeking a second opinion or requesting a colonoscopy may be appropriate. Your health is paramount, and you have the right to advocate for further testing if you feel it is necessary.

In summary, while your symptoms may currently be attributed to hemorrhoids or anal fissures, the persistence of rectal bleeding, changes in bowel habits, and your age should be considered when deciding on further evaluation. A colonoscopy is a valuable tool for diagnosing potential issues in the colon and rectum, and if you have ongoing concerns, it may be worth discussing with your healthcare provider. Remember, early detection is key in managing any potential gastrointestinal issues effectively.

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