Rectal Bleeding: Risks of Cancer vs. Hemorrhoid Recurrence

Q: Rectal Bleeding: Risks of Cancer vs. Hemorrhoid Recurrence

Hello： The rate of tumor development varies, and it is uncertain whether there is a possibility of tumor occurrence within two years. <br>It is recommended to consult a clinical physician or undergo a digital rectal examination and a sigmoidoscopy to determine if there is a recur

Concern for bleeding

Hello, doctor.
Two years ago, I experienced bleeding during bowel movements and was diagnosed with internal hemorrhoids at the hospital.
I underwent a ligation procedure, and the post-operative bleeding symptoms decreased.
However, I still occasionally have some bleeding, which made me concerned, so I had a colonoscopy.
The results showed no malignant changes, only a small hyperplastic polyp less than 0.5 cm, and the biopsy was normal.
Recently, over the past six months, I still occasionally experience bleeding after bowel movements, especially when the stool is hard.
Sometimes there is blood on the toilet paper after wiping, and in severe cases, there are drops in the toilet.
The stool itself does not appear to be mixed with blood.
I have also had a digital rectal examination, and the doctor mentioned that I have internal hemorrhoids.
I would like to ask: since the last colonoscopy was two years ago, is there a possibility of suddenly developing a malignant tumor? What is the likelihood? Or is the chance of recurrence of internal hemorrhoids higher? Do I need to undergo another colonoscopy?

Zhe, 30~39 year old female. Ask Date: 2014/01/13

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: The rate of tumor development varies, and it is uncertain whether there is a possibility of tumor occurrence within two years.
It is recommended to consult a clinical physician or undergo a digital rectal examination and a sigmoidoscopy to determine if there is a recurrence of internal hemorrhoids.
As for whether to perform another colonoscopy, it should be assessed by the clinical physician for its necessity.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2014/01/13

More Info

When it comes to rectal bleeding, it is essential to understand the potential causes and the associated risks. In your case, you have a history of hemorrhoids (internal hemorrhoids) and have undergone a ligation procedure, which typically alleviates symptoms. However, the recurrence of bleeding, especially when passing hard stools, raises valid concerns.

Firstly, the presence of bright red blood on toilet paper or in the toilet bowl after a bowel movement often indicates a lower gastrointestinal issue, commonly associated with hemorrhoids or anal fissures. Given your previous diagnosis of internal hemorrhoids, it is quite plausible that the bleeding you are experiencing is a result of this condition. Hemorrhoids can indeed recur, especially if there are factors such as constipation or straining during bowel movements, which can exacerbate the symptoms.

However, it is also crucial to consider the possibility of other conditions, including colorectal cancer, particularly if there is a change in your bowel habits, the appearance of your stool, or if the bleeding persists or worsens. Although your previous colonoscopy showed no malignancy and only a small hyperplastic polyp, it is important to recognize that new symptoms can arise over time. The risk of developing colorectal cancer increases with age and can be influenced by family history, personal medical history, and lifestyle factors.

In your case, since it has been two years since your last colonoscopy and you are experiencing new symptoms, it would be prudent to consult your healthcare provider about the need for a repeat colonoscopy. While the likelihood of suddenly developing a malignant tumor in such a short time frame is relatively low, especially given your previous normal findings, it is not impossible. The best approach is to err on the side of caution and have a thorough evaluation to rule out any serious conditions.

In summary, while the recurrence of bleeding is likely related to your internal hemorrhoids, it is essential to monitor your symptoms closely. If the bleeding continues or if you experience any other concerning symptoms such as changes in bowel habits, weight loss, or abdominal pain, you should seek medical attention promptly. A repeat colonoscopy may be warranted to ensure that there are no new developments, and your healthcare provider can provide guidance on managing your hemorrhoids effectively. Maintaining a high-fiber diet, staying hydrated, and avoiding straining during bowel movements can also help reduce the risk of hemorrhoid recurrence and associated bleeding.

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