Blood in Stool: When to Seek Colonoscopy for Peace of Mind

Q: Blood in Stool: When to Seek Colonoscopy for Peace of Mind

Hello： Examinations are conducted to corroborate clinical suspicions. <br>The necessity of the examination should be assessed, especially for invasive procedures. <br>It is advisable to trust the recommendations of your clinician; if the examination is warranted, proceed with it,

Blood in the stool?

I often experience flatulence, and it has a strong odor.
I have both internal and external hemorrhoids, and for the past few days, I've noticed bright red blood in my stool.
Initially, there was a small amount of blood on the toilet paper after a bowel movement, and blood at the front of the stool, but the amount was manageable.
The second time was similar, but this time the blood mixed with the stool, and there was blood when I wiped as well, all bright red.
However, there was no pain during bowel movements, just slight discomfort in my abdomen afterward.
This situation doesn't happen frequently; it just suddenly occurs for a few days with blood in my stool, and there was one instance where there was blood, but the next day it was gone.

Two years ago, I went to Kaohsiung Medical University Hospital, and after explaining my situation, the doctor performed a digital rectal examination and determined it was hemorrhoidal bleeding.
He advised me not to worry too much and suggested using hemorrhoid suppositories to reduce the bleeding.
I expressed my desire for a colonoscopy, but the doctor said it wasn't necessary.
Later, I had a fecal occult blood test, but when I went home, my stool returned to normal—long and unbroken, with no blood, and no blood when wiping.
Eventually, I submitted my stool sample to the hospital, and the test result was positive, indicating no occult blood.
I want to ask the doctor why my stool was free of blood later, yet the fecal occult blood test showed a reaction.
Additionally, my father had a colonoscopy that revealed polyps, but they were benign.
This year, my mother underwent a colonoscopy at Tzu Chi Hospital, where polyps were also found.
However, she mentioned that they were malignant, but the doctor removed the polyps immediately and advised her to continue monitoring.
I really want to have a colonoscopy, but the doctors keep saying it's unnecessary.
However, I am genuinely worried about the possibility of colon cancer.
What should I do? I've heard that insurance will cover the procedure if the doctor deems it necessary.
If I insist on having it done, I would have to pay out of pocket, which I heard costs around 4,000 NT dollars.
By the way, I had a colonoscopy when I was 26, but I couldn't tolerate it halfway through, and the doctor had to stop the procedure.
I've heard there are painless colonoscopy options now, but I'm very concerned since I've never been under general anesthesia before.
I'm afraid of waking up suddenly during the procedure or of an overdose of anesthesia.
However, I feel anxious about not getting checked.
What should I do? Please help clarify my concerns.
Thank you.

Wang Dashu, 30~39 year old female. Ask Date: 2014/10/01

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Examinations are conducted to corroborate clinical suspicions.
The necessity of the examination should be assessed, especially for invasive procedures.
It is advisable to trust the recommendations of your clinician; if the examination is warranted, proceed with it, and if not, refrain from it.
If an invasive examination is performed solely for peace of mind, and complications arise, it would not be worth it.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun

Reply Date: 2014/10/01

More Info

When it comes to the presence of blood in your stool, it can understandably cause a great deal of anxiety. The fact that you have experienced fresh red blood during bowel movements, especially mixed with stool, is a symptom that should not be ignored. Given your history of hemorrhoids (both internal and external), it is possible that these could be the source of the bleeding. Hemorrhoids can indeed cause bright red blood, especially if they are inflamed or irritated.

However, the intermittent nature of your symptoms, along with the fact that you have had a positive fecal occult blood test, raises some important considerations. A positive fecal occult blood test indicates that there is blood in your stool that is not visible to the naked eye, which can be a sign of various gastrointestinal issues, including polyps, ulcers, or even malignancies. Although your previous doctor suggested that a colonoscopy was unnecessary, your ongoing symptoms and family history of polyps and cancer warrant further investigation.

Colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify any abnormalities such as polyps, tumors, or signs of inflammatory bowel disease. Given that your father has had polyps and your mother has had a malignant polyp, you may be at an increased risk for colorectal cancer, especially if there is a family history of such conditions. The general recommendation is that individuals with a family history of colorectal cancer or polyps should begin screening earlier than the standard age of 45.

Regarding your concerns about the procedure itself, it is important to communicate these with your healthcare provider. Many facilities now offer sedation options that can make the experience more comfortable. You can discuss your fears about anesthesia and the possibility of waking up during the procedure. Most patients do not remember the procedure due to the sedation used, and it is generally safe when performed by trained professionals.
If your doctor continues to dismiss your concerns about needing a colonoscopy, you have the right to seek a second opinion. It is crucial to advocate for your health, especially when symptoms persist and there is a family history of colorectal issues. If you feel strongly about having a colonoscopy, you could consider discussing the possibility of self-paying for the procedure if insurance does not cover it.
In summary, while hemorrhoids can cause bright red blood in the stool, the combination of your symptoms, family history, and positive fecal occult blood test suggests that a colonoscopy is warranted. It is essential to address your concerns with a healthcare professional who will take your symptoms seriously and provide you with the necessary care. Remember, early detection is key in managing potential colorectal issues effectively.

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