Rectal Bleeding: Fissures vs. Hemorrhoids and Dietary Impact

Anal fissure or hemorrhoidal bleeding?

Hello, Dr.
Ke: Three months ago, my cardiologist changed my hypertension medication, and since then, I have been experiencing irregular bowel movements.
Although I have a bowel movement once a day, the stools are large and hard, and I often have to strain to pass them.
After my follow-up appointment last week, I informed my cardiologist, who switched me to another antihypertensive medication, which has improved the situation.
However, after eating peanuts and fava beans last week, I had diarrhea three times the next day, followed by bleeding two days later, and then more bleeding.
Since Monday of this week, I have been experiencing painful bowel movements with bleeding for four consecutive days, although the amount of blood has decreased.
For the past two days, I often have to rush to the bathroom after meals or drinking water, and my stools are watery and unformed.
Today, there was also bleeding, but it was not painful.
Currently, I am using a hemorrhoid ointment and a suppository prescribed by the internal medicine department at the hospital.
When using the hemorrhoid ointment, there were blood traces on the tube, and using the suppository causes pain at the anal opening.
The bleeding has been bright red.

My first question is whether this is due to an anal fissure or a ruptured hemorrhoid? If it is an anal fissure or a ruptured hemorrhoid, how long will it take to heal? My second question is why do I have to rush to the bathroom after meals or drinking water, resulting in watery and unformed stools? How can I improve this? My third question is that I have noticed that after eating peanuts or fava beans, my bowel movements the next day are either unformed or take shape but dissolve in water.
Why is this happening?
P.S.
I have previously had hemorrhoids that have recurred.
Thank you, Dr.
Ke, for your response.

Xiao Pangzi, 40~49 year old female. Ask Date: 2014/12/05

Dr. Ke Fangxu reply Surgery

1.
It is possible that with proper treatment and improved bowel habits, recovery may occur in about a week.
However, if there are recurrent bleeding episodes, it is advisable to undergo a colonoscopy, especially considering your age.

2.
First, it is important to determine whether the symptoms are related to adjustments in antihypertensive medication.
Additionally, we should consider if there has been a history of similar symptoms, as it sounds like irritable bowel syndrome.
A lack of dietary fiber could also contribute to such symptoms.
Changes in bowel habits are usually complex and require a comprehensive evaluation, including medication review and diagnostic tests, to identify the underlying cause.

3.
It is not necessarily caused by eating peanuts or fava beans; it is generally more related to irritable bowel syndrome or overall dietary habits.

Reply Date: 2014/12/05

More Info

Understanding rectal bleeding can be quite complex, especially when differentiating between conditions like anal fissures and hemorrhoids, as well as considering dietary impacts. Based on the symptoms you've described, let's address your questions systematically.

1. Is it an anal fissure or a ruptured hemorrhoid?
The presence of bright red blood during bowel movements is typically indicative of bleeding from the lower gastrointestinal tract, which can arise from either anal fissures or hemorrhoids.
- Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can cause sharp pain during and after bowel movements, and the blood is usually bright red, appearing on the surface of the stool or on toilet paper.

- Hemorrhoids: These are swollen veins in the rectal area that can bleed, especially during bowel movements. The bleeding is also bright red and may be accompanied by discomfort, itching, or a feeling of fullness.

Given that you have experienced pain during bowel movements and have noted blood on the applicator of the ointment, it is plausible that you may have an anal fissure, especially if the pain is sharp and localized. However, if you have a history of hemorrhoids, they could also be contributing to the bleeding.

In terms of healing, anal fissures can take a few weeks to heal with proper care, including dietary adjustments to soften stools and possibly topical treatments. Hemorrhoids can also improve with similar measures, but persistent or severe cases may require medical intervention.

2. Why are you experiencing watery stools after meals?
The occurrence of watery stools after eating could be attributed to several factors:
- Dietary Intolerance: Certain foods, like peanuts and fava beans, can cause gastrointestinal upset in some individuals, leading to diarrhea or loose stools. This may be due to an intolerance or sensitivity to these foods.

- Irritable Bowel Syndrome (IBS): If you have a history of gastrointestinal issues, it’s possible that you may be experiencing symptoms of IBS, which can cause changes in bowel habits, including diarrhea after meals.

- Gastrointestinal Infection: If the diarrhea is persistent and accompanied by other symptoms, it could indicate an infection or another underlying condition.

To improve this situation, consider keeping a food diary to identify any specific triggers and discuss these findings with your healthcare provider. They may recommend dietary adjustments or further testing if necessary.

3. Why do peanuts and fava beans cause loose stools?
Peanuts and fava beans are high in fiber and can be difficult for some individuals to digest, especially if consumed in large quantities. They can also contain certain compounds that may irritate the gastrointestinal tract in sensitive individuals, leading to loose stools or diarrhea.
If you notice a consistent pattern of gastrointestinal upset after consuming these foods, it may be wise to limit or avoid them and consult with a healthcare professional for further evaluation.

Conclusion
Given your symptoms, it is crucial to maintain open communication with your healthcare provider. If the bleeding persists or worsens, or if you experience significant pain or changes in bowel habits, further evaluation may be necessary. They may recommend a colonoscopy or other diagnostic tests to rule out more serious conditions.
In the meantime, focus on a high-fiber diet, adequate hydration, and possibly the use of stool softeners to ease bowel movements. Avoiding known irritants and keeping track of your symptoms will also be beneficial in managing your condition.

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