Rectal Bleeding: When to Worry About Hemorrhoids and Polyps

Q: Rectal Bleeding: When to Worry About Hemorrhoids and Polyps

Hello： The principle for monitoring colorectal polyps is that after polyp removal, a follow-up colonoscopy should be performed one year later. <br>If polyps are found again, another colonoscopy should be done one year after their removal, continuing this process until no polyps a

Bowel issues

Hello, doctor.
About three years ago, I started noticing blood when wiping after a bowel movement.
It later became more severe.
After a digital rectal examination at the hospital, I was diagnosed with internal hemorrhoids and underwent a ligation procedure, which improved my condition.
However, occasionally I experience hard stools and some bleeding.
Two years ago, I underwent a colonoscopy because I was concerned, and only a small polyp (0.5 cm) was found, which was normal upon biopsy.
In the past six months, whenever I have harder stools, I experience some anal pain during bowel movements, and there is slight bleeding when wiping afterward.
I consulted another physician who performed a digital rectal examination and mentioned that there is still mild internal hemorrhoid formation.
The physician who performed the colonoscopy said that no further colonoscopy is needed.
I would like to ask if it is possible that what was normal two years ago could have worsened now? Do I need to undergo another colonoscopy, or is the bleeding likely just due to a recurrence of the internal hemorrhoids? There are no other unusual symptoms with my bowel movements.

Guang, 30~39 year old female. Ask Date: 2013/12/21

Dr. Ke Fangxu reply Surgery

Hello: The principle for monitoring colorectal polyps is that after polyp removal, a follow-up colonoscopy should be performed one year later.
If polyps are found again, another colonoscopy should be done one year after their removal, continuing this process until no polyps are detected.
If no polyps are found, screenings can be spaced out every 3-5 years.
During this interval, fecal occult blood testing can be used as an alternative; if the result is positive, a colonoscopy should be scheduled.

Reply Date: 2013/12/21

More Info

When it comes to rectal bleeding, understanding the underlying causes and when to seek further medical evaluation is crucial. In your case, you have a history of hemorrhoids and a previously identified polyp, which adds complexity to your symptoms.

Firstly, it's important to recognize that rectal bleeding can arise from various sources, including hemorrhoids, anal fissures, diverticular disease, and colorectal polyps or cancer. Given your history of internal hemorrhoids and the fact that you have undergone a colonoscopy that revealed a benign polyp, it is reasonable to consider that your current symptoms may be related to your hemorrhoids, especially if the bleeding occurs primarily with hard stools or during bowel movements.

The fact that you have experienced some improvement after your hemorrhoid ligation surgery suggests that the procedure was effective in addressing the more severe symptoms at that time. However, the recurrence of mild bleeding and discomfort during bowel movements indicates that there may still be some residual hemorrhoidal tissue or that new hemorrhoids have developed. This is not uncommon, as hemorrhoids can recur, particularly if there are ongoing factors such as constipation or straining during bowel movements.

Regarding your concern about the potential for a more serious condition, such as colorectal cancer, it is essential to consider the following points:
1. Polyp and Cancer Risk: The small polyp you had two years ago was benign, and the risk of developing new polyps or cancer can increase with age and certain risk factors. However, the presence of a benign polyp does not automatically indicate that you will develop cancer.

2. Symptoms Monitoring: If your bleeding is infrequent and associated with hard stools, it is likely related to hemorrhoids. However, if you notice a change in the pattern of bleeding (e.g., increased frequency, change in color, or associated with other symptoms like weight loss or changes in bowel habits), this would warrant further investigation.

3. Colonoscopy Recommendations: The decision to undergo another colonoscopy should be based on your current symptoms and risk factors. The American College of Gastroenterology recommends that individuals with a history of polyps undergo surveillance colonoscopy at regular intervals. If you have concerns about your symptoms or if they have changed, discussing the need for a follow-up colonoscopy with your healthcare provider is advisable.

4. Management of Hemorrhoids: To alleviate your symptoms, consider dietary modifications to prevent constipation, such as increasing fiber intake and staying hydrated. Over-the-counter treatments for hemorrhoids, such as topical creams or suppositories, may also provide relief.

5. Consultation with a Specialist: If you remain concerned about your symptoms or if they worsen, seeking a second opinion from a gastroenterologist or a colorectal specialist can provide reassurance and help determine the best course of action.

In summary, while your current symptoms may be related to hemorrhoids, it is essential to remain vigilant about any changes in your condition. Regular follow-ups with your healthcare provider and appropriate lifestyle modifications can help manage your symptoms effectively. If there is any doubt or concern, do not hesitate to seek further evaluation to ensure your health and peace of mind.

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