Rectal Bleeding: Risks of Malignancy vs. Hemorrhoid Recurrence

Bleeding concerns

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, but I still occasionally have some bleeding.
Out of concern, I had a colonoscopy, which showed no malignant changes, only a small hyperplastic polyp less than 0.5 cm, and the biopsy results were normal.
However, in the past six months, I still occasionally notice 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 by a doctor, who confirmed the presence of 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: 2014/01/14

Dr. Xu Kaixi reply Surgery

"Since you underwent a colonoscopy two years ago, which revealed only benign polyps, the most likely cause of your current bleeding symptoms is related to hemorrhoids.
The probability of bleeding caused by a tumor is extremely low.
However, due to the discovery of benign polyps during the colonoscopy two years ago, regardless of whether the polyps were removed at that time, it is still recommended to have a follow-up colonoscopy."

Reply Date: 2014/01/14

More Info

Rectal bleeding can be a concerning symptom, especially for individuals with a history of hemorrhoids or other gastrointestinal issues. In your case, you have a history of internal hemorrhoids treated with a ligation procedure, and you have undergone a colonoscopy that revealed no malignancy, only a small hyperplastic polyp. However, you are still experiencing occasional rectal bleeding, particularly after bowel movements.

Risks of Malignancy vs. Hemorrhoid Recurrence
1. Understanding Rectal Bleeding: The presence of bright red blood on toilet paper or in the toilet bowl after a bowel movement is often associated with hemorrhoids, especially if the blood is not mixed with stool. This is because hemorrhoids can cause bleeding due to straining during bowel movements, particularly if the stool is hard. The fact that your bleeding occurs intermittently and is associated with hard stools suggests that your hemorrhoids may be recurring.

2. Malignancy Concerns: While it is understandable to be concerned about the possibility of colorectal cancer, especially after experiencing rectal bleeding, the likelihood of developing a malignancy within two years of a normal colonoscopy is relatively low. Colonoscopies are effective at detecting polyps and cancers, and if your previous colonoscopy was clear, the risk of sudden development of a malignancy is not high. However, it is important to note that certain factors, such as family history, age, and other risk factors, can influence this risk.

3. Recurrence of Hemorrhoids: It is quite common for hemorrhoids to recur after treatment. The ligation procedure may have alleviated your symptoms temporarily, but lifestyle factors such as diet, hydration, and bowel habits can contribute to the recurrence of hemorrhoids. If you are experiencing hard stools, it may be beneficial to increase your fiber intake and ensure adequate hydration to prevent straining during bowel movements.

Recommendations
1. Follow-Up Colonoscopy: Given that it has been two years since your last colonoscopy, and considering your ongoing symptoms, it would be prudent to discuss with your healthcare provider the possibility of undergoing another colonoscopy. This is especially important if your symptoms persist or worsen, as it can help rule out any new developments.

2. Management of Hemorrhoids: In the meantime, consider implementing lifestyle changes to manage your hemorrhoids. Increasing dietary fiber, staying hydrated, and avoiding prolonged sitting on the toilet can help reduce the strain during bowel movements. Over-the-counter treatments, such as topical creams or suppositories, may also provide relief from symptoms.

3. Consultation with a Specialist: If your symptoms continue or if you have any new concerning symptoms (such as significant changes in bowel habits, weight loss, or severe pain), it may be beneficial to consult with a gastroenterologist or a colorectal specialist. They can provide a thorough evaluation and recommend appropriate diagnostic tests or treatments.

In conclusion, while the risk of malignancy is low given your previous clear colonoscopy, the recurrence of hemorrhoids is a more likely explanation for your symptoms. Monitoring your condition and maintaining open communication with your healthcare provider is essential for managing your health effectively.

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