Rectal Bleeding: Causes, Concerns, and When to Seek Help

Bleeding during bowel movements is concerning?

Hello Doctor: I have had a habit of constipation since childhood.
Sometimes I struggle to have a bowel movement, and when it’s difficult, my stools come out in small pellets.
Over the past few months, I have noticed that sometimes after I have a bowel movement, I see fresh blood.
This happens particularly when my stools are very hard or difficult to pass.
Sometimes it feels like I am dripping blood, and after a bowel movement, I can see blood on the stool and also when I wipe.
Whenever I experience bleeding, I tend to have blood again for the next two to three days.
I also feel a persistent pain and discomfort around my anus.
A few days ago, I visited a colorectal specialist who examined me with an anoscope.
He diagnosed me with anal fissures and noted some internal hemorrhoids.
He prescribed a suppository, which I have been using diligently, but I still feel some discomfort and pain in my anus.
Is this because my anal fissure hasn’t healed completely? I am very worried about having cancer, but I am afraid to undergo a colonoscopy because I experience blood in my stool two to three times a month.
Recently, my stools have not been formed but rather a puddle.
Doctor, could this situation really be a sign of cancer? I am very concerned.

amy, 20~29 year old female. Ask Date: 2013/07/30

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, the likelihood of anal fissures or hemorrhoids is the highest.
Considering the age and clinical signs, it is recommended to undergo a colon X-ray examination.
Wishing you good health, Dr.
Chen Chi, Taoyuan Hospital, Department of Health.

Reply Date: 2013/07/30

More Info

Rectal bleeding can be a concerning symptom, and it's understandable that you are worried about the potential for serious conditions such as cancer. However, it's important to note that not all rectal bleeding is indicative of cancer, especially when associated with conditions like anal fissures and hemorrhoids, which are quite common.

Based on your description, it seems that you have been experiencing rectal bleeding primarily associated with hard stools and difficulty during bowel movements. This is often a sign of anal fissures, which are small tears in the lining of the anus that can occur when passing hard or large stools. The presence of blood on the stool or toilet paper, as well as pain during bowel movements, is typical of this condition. The fact that you have been diagnosed with an anal fissure and some internal hemorrhoids by a specialist is consistent with your symptoms.

Here are some key points to consider regarding your situation:
1. Causes of Rectal Bleeding: Common causes of rectal bleeding include hemorrhoids, anal fissures, diverticular disease, and inflammatory bowel disease. While colorectal cancer can cause rectal bleeding, it is less common in younger individuals, especially if there are no other alarming symptoms such as significant weight loss, changes in bowel habits, or a family history of colorectal cancer.

2. Concerns About Cancer: Your concern about cancer is valid, but it is essential to approach this with a balanced perspective. The symptoms you describe, particularly the hard stools and pain, are more indicative of anal fissures and possibly hemorrhoids rather than cancer. However, if you have persistent symptoms or if your bleeding worsens, it is crucial to follow up with your healthcare provider.

3. When to Seek Help: You should seek immediate medical attention if you experience:
- Significant or persistent rectal bleeding.

- Severe abdominal pain.

- Changes in bowel habits (e.g., diarrhea or constipation lasting more than a few days).

- Unexplained weight loss.

- A family history of colorectal cancer.

4. Management and Treatment: To help manage your symptoms and promote healing of the anal fissure, consider the following:
- Dietary Changes: Increase your fiber intake through fruits, vegetables, and whole grains to help soften your stool and make bowel movements easier.

- Hydration: Drink plenty of water to help prevent constipation.

- Stool Softeners: Over-the-counter stool softeners can be beneficial.

- Warm Sitz Baths: Soaking in warm water can help relieve pain and promote healing.

- Follow-Up Care: Continue to follow up with your healthcare provider, especially if your symptoms do not improve or if they worsen.

5. Colonoscopy Consideration: While you may feel apprehensive about undergoing a colonoscopy, it is a valuable diagnostic tool that can help rule out more serious conditions, including cancer. If your symptoms persist or if your doctor recommends it based on your history and symptoms, it may be worth considering for your peace of mind.

In conclusion, while rectal bleeding can be alarming, the presence of anal fissures and hemorrhoids is a more likely explanation for your symptoms. Continue to manage your condition with the guidance of your healthcare provider, and do not hesitate to seek further evaluation if your symptoms do not improve. Remember, early detection and treatment of any condition are key to better outcomes.

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