Blood in Stool: When to Seek Colonoscopy and What to Expect

Blood in the stool?

I often experience flatulence, which is quite foul-smelling.
I have both internal and external hemorrhoids.
For the past few days, I have noticed fresh red blood in my stool each time I have a bowel movement.
Initially, there was a small amount of blood on the toilet paper after wiping, and the blood was bright red, appearing at the front of the stool.
The second time was similar, but this time the stool was mixed with blood, and there was blood when I wiped as well, all bright red.
However, I do not experience pain during bowel movements; I only feel slight discomfort in my abdomen afterward.
This situation does not occur frequently; it just suddenly happens for a few days with blood in my stool, and there was one instance where I had blood, but the next day there was none.
Two years ago, I went to Kaohsiung Medical University Hospital for this issue.
The doctor listened to my symptoms and performed a digital rectal examination, concluding that it was hemorrhoidal bleeding and advised me not to worry too much.
He recommended using hemorrhoid suppositories to alleviate the bleeding.
I expressed my desire for a colonoscopy, but the doctor said it was unnecessary.
Later, I had a fecal occult blood test, but when I went home, my bowel movements returned to normal, with no blood and a solid stool.
However, when I submitted my stool sample to the hospital, the test result was positive for occult blood.
I would like to ask the doctor why my stool had no 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 immediately removed the polyps and advised her to have follow-up monitoring.
I am very eager to have a colonoscopy, but the doctors keep saying it is unnecessary.
However, I am genuinely worried about the possibility of colon cancer.
What should I do? I have heard that health 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 TWD.
By the way, I had a colonoscopy when I was 26, but I could not tolerate it halfway through, and the doctor had to stop the procedure.
I have heard that there are painless colonoscopy options available, but I am very concerned because I have never been under general anesthesia before.
I am afraid of waking up suddenly during the procedure or of an overdose of anesthesia.
However, I feel anxious about not having the examination.
What should I do? Please help clarify my concerns.
Thank you.

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

Dr. Ke Fangxu reply Surgery

Although colorectal cancer is more common in individuals aged 50 and older, there is still a possibility of developing colorectal cancer at younger ages, albeit at a lower probability.
If there are persistent symptoms of bleeding, individuals of any age can undergo a colonoscopy covered by health insurance.
However, the anesthesia for the colonoscopy is not covered by insurance, and the out-of-pocket costs vary slightly between hospitals, typically ranging from $2,000 to $5,000.
These anesthetics should be administered by dedicated anesthesiologists, ensuring that patients do not wake up during the procedure.

Reply Date: 2014/10/01

More Info

When it comes to the presence of blood in your stool, it's understandable to feel anxious, especially given your family history of polyps and your own symptoms. Let's break down your situation and discuss the importance of a colonoscopy, what it entails, and when it is necessary.

Understanding Your Symptoms
You mentioned experiencing bright red blood in your stool, which can be alarming. The fact that you have hemorrhoids (both internal and external) is significant, as they are a common cause of rectal bleeding. Hemorrhoids can lead to bright red blood on the toilet paper or mixed with stool, especially during bowel movements. However, the presence of blood can also indicate other conditions, including polyps or even colorectal cancer, particularly if there is a change in your bowel habits or if the bleeding persists.

When to Seek a Colonoscopy
Given your symptoms—especially the recurring bright red blood in your stool over several days—it is advisable to seek further evaluation through a colonoscopy. While your previous doctor may have deemed it unnecessary, your ongoing symptoms and family history of polyps warrant a more thorough investigation. A colonoscopy allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as polyps, inflammation, or tumors.

What to Expect During a Colonoscopy
A colonoscopy is typically performed under sedation, which can range from mild sedation to general anesthesia, depending on the facility and your preference. Many patients report that they do not remember the procedure due to the sedation. If you are concerned about waking up during the procedure, communicate this with your healthcare provider; they can adjust the sedation to ensure your comfort.

During the procedure, a flexible tube with a camera (the colonoscope) is inserted through the rectum to examine the lining of the colon. If polyps are found, they can often be removed during the same procedure and sent for biopsy to determine if they are benign or malignant.

Addressing Your Concerns
1. Family History: Given that your mother has had a malignant polyp, it is essential to be proactive about your health. Family history can increase your risk for colorectal cancer, and regular screenings are crucial.

2. Previous Experiences: Your discomfort during the last colonoscopy is valid, but advancements in sedation techniques have made the procedure more tolerable for many patients. Discuss your past experiences with your doctor to find a suitable approach for your next colonoscopy.

3. Health Insurance: In the U.S., insurance coverage for colonoscopies typically depends on the indication for the procedure. If your doctor believes that a colonoscopy is medically necessary due to your symptoms, it is likely to be covered. If you feel strongly about needing the procedure, consider seeking a second opinion from a gastroenterologist.

4. Potential for False Negatives: You mentioned a previous fecal occult blood test that was positive, yet you did not see blood during subsequent bowel movements. This can happen; sometimes, blood can be intermittent or not visible during certain bowel movements. The fecal occult blood test can also yield false negatives, especially if the bleeding is not continuous.

Conclusion
In summary, your symptoms and family history suggest that a colonoscopy is a prudent step to rule out any serious conditions. While hemorrhoids are a likely cause of your bleeding, it is essential to ensure that there are no other underlying issues. Communicate openly with your healthcare provider about your concerns, and do not hesitate to seek a second opinion if you feel your worries are not being adequately addressed. Your health is paramount, and being proactive about screenings can lead to early detection and better outcomes.

Similar Q&A

Should You Get a Colonoscopy for Blood in Stool and Abdominal Pain?

Hello, doctor. For the past three months, I have noticed blood in my stool about once a month. The amount is small, but it is bright red and somewhat sticky. There is no blood when I wipe after using the toilet. I usually experience abdominal pain in the morning before going to w...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: You can first consult a gastroenterologist or a colorectal specialist for an evaluation to determine if a colonoscopy is necessary. Changhua Hospital cares about your health. Dr. Tsai An-Shun.

Understanding Blood in Stool and Frequent Diarrhea: When to Seek Colonoscopy

1. Occasional bright red blood appears during bowel movements, and today I noticed that the blood seems to come out only after finishing the stool. When I wipe with toilet paper, it is fresh blood, and there is a burning sensation in the anus. 2. After eating certain foods, I imm...

Dr. Ke Fangxu reply Surgery
This situation is likely a higher possibility of irritable bowel syndrome combined with hemorrhoidal bleeding. As long as there is no further bleeding, it should not be a concern. It is recommended to avoid constipation during this period and to shorten the time spent on bowel mo...

Understanding Blood in Stool: When to Seek Colonoscopy Evaluation

First, I would like to describe my recent health condition. At the beginning of October, I experienced rectal bleeding due to hard stools for about two weeks. After improving my diet, this issue resolved. On the evening of October 23, I suddenly developed a fever. I had taken a h...

Dr. Ke Fangxu reply Surgery
Hello: Generally speaking, blood in the stool is a fairly common issue, and whether further examination is needed depends on several related factors: 1. Age: If the patient is over 50 years old, as this is the age group where colorectal cancer is more prevalent, a colonoscopy is ...

Blood in Stool: Should You Worry and When to Get a Colonoscopy?

Today, I noticed a small blood spot about 0.2 centimeters in size in my stool, and there were also blood streaks about the size of a grain of sand in the intestinal fluid. I would like to know what this condition might indicate. Do I need to undergo another colonoscopy? I had a c...

Dr. Hu Guozheng reply Gastroenterology and Hepatology
Colonoscopy is generally recommended every 3 to 5 years. You can consult your physician regarding the frequency of follow-up examinations. It is advisable to monitor if straining during bowel movements causes harder stools to scrape against the anal canal, which may lead to minor...