Rectal Bleeding: When to Worry and Seek Further Testing

Q: Rectal Bleeding: When to Worry and Seek Further Testing

Hello： The pathological formation of hemorrhoids is caused by varicose veins, prolonged sitting, inactivity, or frequent constipation, which makes it easier to develop hemorrhoids or for them to recur. <br>As for whether the current bleeding is caused by hemorrhoids, you can cons

Questions after microscopy examination?

Hello, doctor.
About three years ago, I started noticing blood when wiping after bowel movements.
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, I still experience occasional 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, I've noticed that when 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 another colonoscopy is not necessary.
I would like to know 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 caused by a recurrence of the internal hemorrhoids? I have not noticed any other unusual symptoms during bowel movements.

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

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: The pathological formation of hemorrhoids is caused by varicose veins, prolonged sitting, inactivity, or frequent constipation, which makes it easier to develop hemorrhoids or for them to recur.
As for whether the current bleeding is caused by hemorrhoids, you can consult a physician at the hospital.
Additionally, alternatives to colonoscopy for diagnosing hemorrhoids include digital rectal examination or sigmoidoscopy; however, issues in the upper part of the colon cannot be detected.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2013/12/21

More Info

Rectal bleeding can be a concerning symptom, and understanding when to seek further evaluation is crucial for your health. Based on your description, it seems you have a history of hemorrhoids (internal hemorrhoids) and have undergone a hemorrhoidectomy, which has provided some relief. However, you continue to experience occasional bleeding, particularly when having hard stools, and you have had a colonoscopy in the past that showed a small polyp, which was benign.

First and foremost, it’s important to recognize that rectal bleeding can arise from various causes, including hemorrhoids, anal fissures, diverticular disease, and more serious conditions such as colorectal cancer. Given your history of hemorrhoids, it is quite possible that the bleeding you are experiencing is related to the recurrence of hemorrhoids, especially if the bleeding occurs after passing hard stools. Hemorrhoids can become inflamed and bleed when there is increased pressure during bowel movements, which often occurs with constipation or hard stools.

The fact that you had a colonoscopy two years ago, which revealed only a small benign polyp, is reassuring. However, it is essential to consider that while polyps are typically benign, they can sometimes develop into cancer over time. The general recommendation for colorectal cancer screening is to have a colonoscopy every 10 years starting at age 45 for average-risk individuals. If you have a family history of colorectal cancer or other risk factors, your doctor may recommend more frequent screenings.

In your case, if the bleeding is persistent or worsening, or if you notice any changes in your bowel habits (such as a change in the caliber of your stool, unexplained weight loss, or abdominal pain), it would be prudent to consult your healthcare provider. They may recommend a repeat colonoscopy to rule out any new developments, especially since you have a history of rectal bleeding and polyps.

Additionally, managing your bowel habits is crucial. To prevent hard stools, consider increasing your dietary fiber intake through fruits, vegetables, and whole grains, and ensure you are adequately hydrated. Over-the-counter stool softeners or fiber supplements may also help in maintaining softer stools and reducing the strain during bowel movements.

In summary, while it is possible that your current symptoms are due to the recurrence of hemorrhoids, it is essential to remain vigilant. If the bleeding continues, or if you have any new or concerning symptoms, do not hesitate to seek further evaluation from your healthcare provider. They can assess your situation more thoroughly and determine whether further testing, such as a colonoscopy, is necessary. Your health and peace of mind are paramount, and addressing these symptoms promptly is the best course of action.

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