Rectal Bleeding: Causes, Symptoms, and Treatment Options

Rectal bleeding

Director Ke: First, thank you for your previous response.
Today, I had three bowel movements.
The first was semi-formed with some watery consistency, the second was entirely watery, and the third was watery with blood.
After the last two, I experienced anal pain, and my anus has been uncomfortable, slightly itchy, and has a dull pain.
In all three bowel movements, I noticed undigested peanut particles from the previous day.
This issue also occurred two weeks ago, but it improved after medication (it has been eight days since I stopped bleeding).

In the evening, I visited a colorectal specialist.
After I explained my symptoms, the doctor reviewed my medical history and did not perform a rectal examination, suggesting it could be an anal fissure or a ruptured hemorrhoid.
The doctor stated the following: 1.
I may have irritable bowel syndrome, causing me to rush to the bathroom after meals.
2.
Undigested peanuts, being high in fat, can lead to poorly formed stools.
3.
Due to a previous hemorrhoid surgery, my anus may be slightly narrowed, making it easier to develop anal fissures or ruptured hemorrhoids with frequent diarrhea or constipation (this has happened to me often in the past).
4.
The significant bleeding may be due to long-term aspirin use, which can exacerbate bleeding from hemorrhoids or anal fissures.
5.
I had a barium enema over four years ago, and after using hemorrhoid medication, I saw improvement, indicating it was effective.
I would like to ask Director Ke if the doctor's statements are correct.
Do you have any additional suggestions? Thank you for your response, Director Ke.

Xiao Pangzi, 40~49 year old female. Ask Date: 2014/12/17

Dr. Ke Fangxu reply Surgery

1.
Correct.
2.
Possible.
3.
An anal examination is necessary to determine if there is anal stenosis; however, diarrhea or constipation can indeed cause rectal bleeding, whether from hemorrhoids or anal fissures.
4.
Long-term use of aspirin can prolong bleeding time, which may exacerbate bleeding from hemorrhoids or anal fissures.
5.
It is recommended that individuals over 40 years old undergo a colonoscopy or double-contrast barium enema every five years; if there are still concerns, an earlier follow-up examination is also acceptable.

Reply Date: 2014/12/17

More Info

Understanding rectal bleeding can be quite complex, as it can stem from a variety of causes, each requiring different approaches to treatment. Based on the symptoms you've described, including the presence of blood in your stool, discomfort in the anal area, and a history of digestive issues, it seems that your doctor has provided a reasonable assessment.

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 or external and often present with itching, discomfort, or pain.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools or prolonged diarrhea. They can lead to sharp pain during bowel movements and may also cause bleeding.

3. Diverticular Disease: This condition involves the formation of small pouches in the colon wall, which can become inflamed or infected, leading to bleeding.

4. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause inflammation of the gastrointestinal tract, leading to symptoms such as diarrhea, abdominal pain, and rectal bleeding.

5. Colorectal Polyps or Cancer: While less common, polyps can bleed and may be precursors to colorectal cancer. Regular screenings are essential for early detection.

6. Dietary Factors: As your doctor mentioned, certain foods, like peanuts, can be hard to digest and may contribute to gastrointestinal distress, leading to symptoms like diarrhea and rectal bleeding.

Symptoms to Monitor
- Consistency of Stool: The presence of watery stools can indicate diarrhea, which may irritate the anal area and lead to bleeding.

- Pain and Discomfort: Persistent pain, itching, or discomfort around the anus can indicate conditions like hemorrhoids or fissures.

- Blood Characteristics: Bright red blood typically indicates bleeding from the lower gastrointestinal tract, while darker blood may suggest a higher source of bleeding.

Treatment Options
1. Dietary Adjustments: Increasing fiber intake can help regulate bowel movements and prevent constipation, which can exacerbate hemorrhoids and fissures. Staying hydrated is also crucial.

2. Topical Treatments: Over-the-counter creams or ointments can relieve symptoms associated with hemorrhoids and anal fissures.

3. Sitz Baths: Soaking in warm water can help soothe the anal area and promote healing.

4. Medications: If you are taking aspirin or other anticoagulants, discuss with your doctor the potential need for adjustments, as these can increase bleeding risk.

5. Surgical Options: In cases of severe hemorrhoids or persistent fissures, surgical intervention may be necessary.

Follow-Up Care
Given your history of gastrointestinal issues and the recent symptoms, it is essential to maintain regular follow-ups with your healthcare provider. They may recommend further diagnostic tests, such as a colonoscopy, to rule out more serious conditions, especially if bleeding persists or worsens.

Conclusion
Your doctor’s assessment appears to be well-founded based on the symptoms you've described. It’s crucial to monitor your symptoms closely and maintain open communication with your healthcare provider. If you notice any changes, such as increased bleeding, severe pain, or changes in bowel habits, seek medical attention promptly. Early intervention can significantly improve outcomes and quality of life.

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