Do I Need a Colonoscopy After Rectal Exams for Blood in Stool?

If a patient has experienced rectal bleeding and has undergone a flexible sigmoidoscopy, is it still necessary to perform a colonoscopy?

Hello doctor, I previously experienced blood in my stool, and doctors have said it is due to internal hemorrhoids.
I have undergone a sigmoidoscopy and a rectoscopy, and the doctors said there were no issues.
Do I need to undergo a colonoscopy? Also, my stool is formed, but one side is light-colored and the other side is dark brown; is this normal?

Chen, 20~29 year old female. Ask Date: 2014/12/10

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Mr./Ms.
Chen,
Hello, you are 27 years old.
Most cases of blood in the stool are likely caused by anal fissures or hemorrhoids, and the chance of cancer is relatively low.
You can start with a fecal occult blood test, and if the result is positive, a colonoscopy can be arranged.
Additionally, if there is a family history of colorectal cancer, further evaluation by a physician may be warranted for additional testing.
Thank you for your inquiry.
Changhua Hospital cares about your health.
Dr.
Yang Zhi-Chao

Reply Date: 2014/12/10

More Info

When it comes to the presence of blood in the stool and the need for further colonoscopy after previous examinations, it is essential to consider several factors. Based on your history of rectal exams and the diagnosis of internal hemorrhoids, it seems that your healthcare providers have assessed your condition and found no significant issues during previous procedures, such as the sigmoidoscopy and rectal exams. However, the presence of blood in the stool, even if attributed to hemorrhoids, can be concerning and warrants careful monitoring.

1. Need for Repeat Colonoscopy: If your doctors have previously diagnosed you with internal hemorrhoids and confirmed that there are no other significant findings, you may not need to undergo another colonoscopy immediately. However, if you experience a change in your symptoms, such as an increase in the frequency or amount of blood, or if you develop new symptoms like unexplained weight loss, changes in bowel habits, or abdominal pain, it would be prudent to consult your healthcare provider again. They may recommend a repeat colonoscopy to ensure that there are no new developments or complications.

2. Stool Color Variation: Regarding your observation of stool that is formed but has one side lighter in color and the other side darker brown, this can be normal. Stool color can vary due to several factors, including diet, hydration levels, and the speed at which food moves through your digestive system. For instance, if you have consumed foods that are high in fiber or certain pigments (like beets or leafy greens), this can affect the color of your stool. However, if you notice persistent changes in color, especially if accompanied by other symptoms such as pain or blood, it would be wise to discuss this with your doctor.

3. Monitoring Symptoms: It's crucial to keep track of your symptoms. If you notice any changes, such as increased bleeding, changes in stool consistency, or any new gastrointestinal symptoms, you should reach out to your healthcare provider. They may recommend further evaluation, which could include imaging studies or repeat endoscopic examinations.

4. Understanding Hemorrhoids: Internal hemorrhoids can cause bleeding, especially during bowel movements. They are often associated with straining, constipation, or prolonged sitting. While they are generally not serious, they can lead to discomfort and complications if not managed properly. Treatment options may include dietary changes, topical treatments, or in some cases, surgical intervention.

5. Regular Screening: For individuals with a history of gastrointestinal issues or those over a certain age (typically 45 or older), regular screening for colorectal cancer is recommended. This may include colonoscopy every 10 years or other screening methods depending on individual risk factors. If you have a family history of colorectal cancer or other risk factors, your doctor may recommend more frequent screenings.

In conclusion, while your previous examinations have indicated no significant issues, it is essential to remain vigilant about any changes in your symptoms. Regular communication with your healthcare provider and adherence to recommended screening guidelines will help ensure your gastrointestinal health is monitored effectively. If you have any concerns or questions about your symptoms or the need for further testing, do not hesitate to reach out to your doctor for personalized advice.

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