Blood in Stool: Causes, Concerns, and Next Steps

Blood in the stool?

Recently, I experienced blood in my stool.
The night before, I had sashimi for dinner, which may have caused my stool to be somewhat loose, resembling diarrhea.
Initially, I noticed some unusual redness on the toilet paper, and then I discovered that the last piece of stool was distinctly different in color from the others, which were all yellow-brown.
That particular piece was darker, and when I wiped with toilet paper, I noticed blood mixed with the stool.
It didn't seem to be bright red.
That evening, I immediately went to the National Taiwan University Hospital in Hsinchu for an examination.
After the doctor performed a digital rectal exam, he suggested a fecal occult blood test.
I provided a small sample, and the results indicated a high level of blood.
The doctor recommended a colonoscopy because my maternal grandmother had passed away from colon cancer, which made me very anxious.
However, I wondered if the same-day examination after noticing blood was reliable.

Additionally, I sometimes experience a painful sensation in my anus, particularly after not having a bowel movement for two to three days.
I had previously shown this to a doctor, who performed a digital rectal exam and told me there was no issue, suggesting it might be due to a tight or sensitive anal sphincter.
Since the beginning of this year, I have experienced this discomfort two or three times.
I also pay close attention to the condition of my stool, which I pass almost daily, and its color is mostly normal with no significant changes over time.
My only relevant medical history is a period of irritable bowel syndrome during middle school.

orz, 20~29 year old female. Ask Date: 2014/06/27

Dr. Ke Fangxu reply Surgery

1.
Whether blood in the stool necessitates an immediate colonoscopy depends on the patient's age and accompanying symptoms.
For younger patients with isolated hematochezia, the likelihood of cancer is generally lower, and the decision can be left to the patient's discretion.
If there are concerns, scheduling an examination and monitoring the situation for a while is also an option.
2.
Abnormal sensations in the anus are often caused by anal fissures or hemorrhoids.
It is recommended to reduce the intake of spicy and irritating foods, as well as to avoid prolonged sitting and staying up late.

Reply Date: 2014/06/27

More Info

Understanding blood in stool can be a concerning issue, and it’s important to approach it with a clear understanding of potential causes, implications, and necessary next steps. Blood in the stool can arise from various sources within the gastrointestinal tract, and it can range from benign to serious conditions.

In your case, you mentioned that the day before noticing blood in your stool, you had sushi, which could potentially lead to gastrointestinal upset, including diarrhea. The presence of blood, especially if it’s mixed with stool or appears on toilet paper, should always be taken seriously. The fact that you observed a darker stool compared to your usual yellow-brown color could indicate the presence of digested blood, which may suggest a source of bleeding higher up in the gastrointestinal tract, such as the stomach or small intestine.

The initial examination by your doctor and the subsequent fecal occult blood test (FOBT) showing elevated levels is a crucial step in evaluating the cause of the bleeding. Elevated levels of blood in the stool can indicate various conditions, including hemorrhoids, diverticulosis, inflammatory bowel disease (IBD), or even colorectal cancer, especially given your family history of a relative who passed away from colon cancer.

Regarding your concern about the accuracy of the test due to the timing of the blood presence, it’s important to note that while a fresh bleed can sometimes lead to false negatives in certain tests, the FOBT is designed to detect even small amounts of blood that may not be visible to the naked eye. Therefore, it is still a valid indicator of potential issues.

The recommendation for a colonoscopy is a standard procedure in such cases, especially considering your family history. A colonoscopy allows for direct visualization of the colon and rectum, and it can help identify any abnormalities such as polyps, tumors, or signs of inflammation. It is understandable to feel anxious about this procedure, but it is a critical step in ruling out serious conditions.

As for the pain you experience in your rectal area, especially after periods of not having a bowel movement, it could be related to anal fissures or increased tension in the anal sphincter. This is not uncommon, especially in individuals with a history of constipation or irritable bowel syndrome (IBS). While this pain is likely not directly related to the blood in your stool, it is worth discussing with your healthcare provider during your upcoming evaluations.

In summary, the presence of blood in your stool warrants further investigation, particularly with your family history. While it is natural to feel anxious, the steps you are taking—such as undergoing a colonoscopy—are essential for ensuring your health. It’s also important to maintain open communication with your healthcare provider about any symptoms you experience, including changes in bowel habits, pain, or any other concerns. Early detection and intervention are key in managing gastrointestinal health effectively.

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