Rectal Bleeding: Causes, Symptoms, and Treatment Options

Rectal bleeding

Hello, doctor.
I have a history of internal hemorrhoids and previously underwent rubber band ligation surgery, but they have recurred.
I have had a sigmoidoscopy, and I still have issues with internal hemorrhoids.
This morning, during bowel movement, I felt a sharp, cutting pain at the anal opening when the stool was passing.
After wiping, the toilet paper was stained with quite a bit of blood, so I washed the area with warm water.
My anus felt somewhat hot and swollen, and I experienced mild, vague pain while sitting.
In the afternoon, I considered using a xylomel suppository and applying Proctosedyl ointment.
However, when I touched the anal folds deeper inside, it started bleeding again, as if there was a wound at a specific point.
Finally, I took a warm sitz bath, which helped a lot.
Could this be caused by an anal fissure, or is it due to the internal hemorrhoids? In the past, I occasionally had rough or hard stools, which would cause similar issues, but this time the bleeding was more significant.
Could there be other problems? What is the treatment, and could this lead to an anal abscess in the long term?

Zhe, 30~39 year old female. Ask Date: 2014/07/29

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be an anal fissure combined with hemorrhoidal bleeding rather than an anal abscess.
Temporary treatment with topical medications is acceptable, but if you want a definitive diagnosis or if symptoms persist for more than a week, you should see a physician for a personal examination to avoid delaying the condition.

Reply Date: 2014/07/29

More Info

Rectal bleeding can be a concerning symptom, especially for individuals with a history of hemorrhoids or anal fissures. Based on your description, it seems that you are experiencing pain and bleeding during bowel movements, which could be attributed to several potential causes, including anal fissures, hemorrhoids, or even other gastrointestinal issues. Let’s explore these possibilities in detail.

Causes of Rectal Bleeding
1. Hemorrhoids: These are swollen veins in the lower rectum and anus that can cause bleeding, especially during bowel movements. They can be internal (inside the rectum) or external (under the skin around the anus). Given your history of hemorrhoids and the fact that you have had rubber band ligation, it is possible that they have recurred.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard or large stools. The sharp pain you described during bowel movements, along with the bleeding, suggests that an anal fissure could be a likely cause. Fissures can also lead to a cycle of pain and constipation, making the problem worse.

3. Other Gastrointestinal Issues: While less likely given your symptoms, other conditions such as diverticulosis, inflammatory bowel disease (IBD), or even colorectal polyps could also cause rectal bleeding. However, these conditions typically present with additional symptoms such as abdominal pain, changes in bowel habits, or weight loss.

Symptoms to Monitor
- Pain: The sharp pain during bowel movements is a significant symptom. If it persists or worsens, it could indicate a more severe fissure or another issue.

- Bleeding: The amount of blood and its appearance (bright red usually indicates fresh bleeding from the lower gastrointestinal tract) is important. If you notice significant changes, such as dark or tarry stools, seek medical attention immediately.

- Other Symptoms: Keep an eye out for any signs of infection, such as fever, increased swelling, or pus discharge, which could indicate an abscess.

Treatment Options
1. Home Care:
- Sitz Baths: As you mentioned, warm sitz baths can help soothe the area and promote healing.

- Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Consider incorporating more fruits, vegetables, and whole grains into your diet.

- Hydration: Drinking plenty of water is crucial to prevent constipation.

- Topical Treatments: Over-the-counter creams or ointments for hemorrhoids can provide relief from pain and itching.

2. Medications:
- Laxatives: If you are experiencing constipation, a gentle laxative may help ease bowel movements.

- Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain.

3. Medical Intervention:
- If symptoms persist or worsen, it may be necessary to consult a healthcare provider. They may recommend further evaluation, such as a colonoscopy, to rule out other conditions.

- In cases of severe fissures or hemorrhoids, surgical options may be considered.

Long-term Considerations
If left untreated, chronic anal fissures or hemorrhoids can lead to complications such as anal abscesses or chronic pain. It is essential to address these symptoms early to prevent further issues. Regular follow-ups with your healthcare provider can help monitor your condition and adjust treatment as necessary.

In conclusion, while your symptoms may be related to anal fissures or hemorrhoids, it is crucial to consult with a healthcare professional for a thorough evaluation and appropriate management. Early intervention can significantly improve your quality of life and prevent complications.

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