Blood on Toilet Paper After Bowel Movement: Causes and Concerns

Blood on toilet paper after a bowel movement?

Hello Doctor: I previously had a cold and took medication, which caused diarrhea.
After experiencing diarrhea once, I stopped taking that medication.
Later, I had pain in my lower pelvis and went to see a nephrologist.
After an X-ray, the doctor mentioned I had fecal impaction and prescribed medication for me.
I have a bowel movement every morning; the doctor said that when there is fecal impaction, the amount of stool can be less, but I still have regular bowel movements.
The color of my stool is a light coffee brown, and it is not very hard, but I experience pain when the stool first comes out.
The first piece of toilet paper I used was bright red, and after wiping 2-3 times, the red color diminished.
It has been 3 days, and today is the 4th day; I noticed a drop of blood from my rectum into the toilet.
After wiping, I used a handheld shower to rinse my rectum, and I didn't feel any particular pain.
When I wiped again with toilet paper, there was nothing on it.
I usually wash my rectum with clean water while showering.
Could this be internal hemorrhoids, a fistula, or an anal fissure?

a, 30~39 year old female. Ask Date: 2015/06/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, the possibility of hemorrhoids is highest in cases of rectal bleeding accompanied by constipation, especially when there is no pain in the anus.
It is advisable to increase the intake of fruits and vegetables while reducing fried and irritating foods.
If the constipation improves and there is no further bleeding, you may continue to monitor the situation.
However, if symptoms persist, please consult a gastroenterologist.
Wishing you safety and health.
Sincerely, Dr.
Chen Chi-Feng, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/06/17

More Info

Experiencing blood on toilet paper after a bowel movement can be concerning and may indicate various underlying issues. Based on the symptoms you've described, there are several potential causes for the bleeding, and it's essential to understand them to address your concerns effectively.

Common Causes of Blood on Toilet Paper
1. Hemorrhoids: One of the most common causes of bright red blood on toilet paper is hemorrhoids. These are swollen veins in the rectal area that can become irritated and bleed, especially during bowel movements. The blood is usually bright red and may appear on the toilet paper or in the toilet bowl.

2. Anal Fissures: An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools. This can lead to sharp pain during bowel movements and bright red blood on the toilet paper. The pain may be significant, especially when the fissure is fresh.

3. Diverticular Disease: Diverticulosis involves the formation of small pouches in the colon wall, which can become inflamed or infected (diverticulitis). This condition can lead to bleeding, although it is typically associated with other symptoms like abdominal pain and changes in bowel habits.

4. Colorectal Polyps or Cancer: While less common, bleeding can also be a sign of colorectal polyps or cancer. This is particularly concerning if the bleeding is persistent, accompanied by changes in bowel habits, weight loss, or abdominal pain.

5. Infections or Inflammatory Conditions: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease or ulcerative colitis, can cause rectal bleeding. These conditions may also present with diarrhea, abdominal pain, and other gastrointestinal symptoms.

Your Symptoms
From your description, it seems that the blood is bright red and appears primarily after bowel movements. The fact that you have experienced pain during bowel movements and have noted the presence of blood on the toilet paper suggests that hemorrhoids or anal fissures could be the likely culprits. The intermittent nature of the bleeding, along with the fact that it diminishes after a few wipes, aligns with these conditions.

Recommendations
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to soften your stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is also crucial.

2. Avoid Straining: Try not to strain during bowel movements, as this can exacerbate hemorrhoids and fissures. If you feel the urge to go, respond promptly rather than delaying.

3. Over-the-Counter Treatments: You may consider using over-the-counter topical treatments for hemorrhoids, which can help alleviate discomfort and reduce swelling.

4. Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote healing if you have fissures or hemorrhoids.

5. Consult a Specialist: Given that you have experienced persistent symptoms, it is advisable to consult a healthcare professional, preferably a gastroenterologist or a colorectal surgeon. They can perform a thorough examination, possibly including a colonoscopy, to rule out more serious conditions and provide a definitive diagnosis.

Conclusion
While the presence of blood on toilet paper can often be attributed to benign conditions like hemorrhoids or anal fissures, it is essential to monitor your symptoms closely. If the bleeding persists, worsens, or is accompanied by other concerning symptoms, seek medical attention promptly. Early diagnosis and treatment can significantly improve outcomes and alleviate discomfort.

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