Blood During Bowel Movements: Causes Beyond Hemorrhoids

There is some fresh blood when wiping after a bowel movement. I have seen a doctor, but they said I do not have hemorrhoids?

Hello, doctor.
Recently, I've noticed a small amount of bright red blood when wiping after a bowel movement.
I went to see a doctor, who performed a digital rectal examination and said there were no hemorrhoids.
An ultrasound was also done, which indicated fatty liver and intestinal inflammation, but the doctor mentioned that the bleeding is not related to hemorrhoids.
Is it possible that this could be an issue like colorectal cancer? Can an ultrasound detect symptoms of colorectal cancer, or is a colonoscopy necessary for that? Thank you for your help.

Aqi, 20~29 year old female. Ask Date: 2015/06/07

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, sometimes internal hemorrhoids cannot be detected through a digital rectal examination, and ultrasound cannot check for colorectal cancer.
Generally, to screen for colorectal cancer, one must undergo a colorectal examination, such as a colonoscopy or a barium enema.
Based on your symptoms, you should consult a colorectal surgeon or a gastroenterologist.
Wishing you safety and good health.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/06/07

More Info

Blood during bowel movements can be a concerning symptom, and it’s good that you sought medical attention. While hemorrhoids are a common cause of rectal bleeding, there are indeed other potential causes that should be considered, especially if hemorrhoids have been ruled out.

The presence of blood in your stool can be indicative of several conditions, ranging from benign to more serious issues. Since your doctor performed a physical examination and an ultrasound, and found no signs of hemorrhoids, it’s essential to consider other possibilities. The ultrasound can provide information about the liver and other abdominal organs, but it is not the best tool for diagnosing conditions of the colon, such as colorectal cancer.

Colorectal cancer is a serious concern, especially if you are experiencing other symptoms such as changes in bowel habits, unexplained weight loss, or abdominal pain. However, the only definitive way to diagnose colorectal cancer is through a colonoscopy. A colonoscopy allows the physician to visually inspect the lining of the colon and rectum and to take biopsies of any suspicious areas. This procedure is crucial because it can detect polyps or tumors that may not be visible on imaging studies like ultrasound.

In addition to colorectal cancer, other conditions that could cause rectal bleeding include:
1. Diverticulosis: Small pouches that can form in the colon wall and may bleed.

2. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause inflammation and bleeding.

3. Gastrointestinal infections: Certain infections can lead to inflammation and bleeding in the intestines.

4. Angiodysplasia: Abnormal blood vessels in the gastrointestinal tract that can bleed.

Given that you mentioned having fatty liver and intestinal inflammation, it may be worthwhile to follow up with your healthcare provider about these findings. Fatty liver disease itself is not typically associated with rectal bleeding, but it can indicate a broader metabolic issue that might affect your overall health.

In summary, while hemorrhoids are a common cause of rectal bleeding, there are many other potential causes that need to be considered, especially if you have risk factors for colorectal cancer or other gastrointestinal diseases. A colonoscopy is the most effective way to investigate the cause of your symptoms further. If you have concerns about colorectal cancer or if your symptoms persist, I strongly encourage you to discuss the possibility of scheduling a colonoscopy with your healthcare provider. Early detection is key in managing any potential issues effectively.

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