Rectal Bleeding: Causes and When to Seek Help

Bowel movements are smooth, but there has been rectal bleeding for three consecutive days?

Hello Doctor, I am 30 years old and have a bowel movement at least once a day.
About a month ago, I experienced pain and bleeding during bowel movements.
After visiting the clinic, the doctor diagnosed me with external hemorrhoids and performed an outpatient procedure to remove it (about the size of a grain of rice).
For three to five days post-surgery, I continued to experience some bleeding and pain during bowel movements.
Upon my follow-up visit, the doctor examined me and found that I had an anal fissure and mild internal hemorrhoids.
I was prescribed suppositories and enzymes for treatment over two weeks, and gradually the pain during bowel movements decreased, and there was less bleeding.
However, three days ago, I had a significant amount of bleeding after a bowel movement, but I did not feel any pain at that time.
I was startled when I saw the blood in the toilet.
For the next two days, I continued to have some bleeding during bowel movements, but it was less than the first day (there was not much pain during the bowel movement, the stool was not hard, but afterward, I felt a vague stabbing pain that sometimes disappeared).
Currently, I am on my menstrual period and unable to seek medical attention.
What could this situation be? What should I do if the bleeding continues? Thank you, Doctor.

Ding Ding, 30~39 year old female. Ask Date: 2015/07/01

Dr. Ke Fangxu reply Surgery

Painless large amounts of blood in the stool are often associated with internal hemorrhoid bleeding, which is usually related to constipation and prolonged straining during bowel movements.
If these factors are ruled out, the condition generally resolves on its own within two to three days.
However, if symptoms persist for three to five days without improvement, it is important to consult a physician for examination and treatment.

Reply Date: 2015/07/01

More Info

Rectal bleeding can be a concerning symptom, and understanding its causes and when to seek medical help is crucial for your health. Based on your description, it appears that you have been dealing with a combination of external hemorrhoids, anal fissures, and possibly internal hemorrhoids. These conditions can lead to rectal bleeding, especially during bowel movements.

Causes of Rectal Bleeding
1. Hemorrhoids: These are swollen veins in the rectal area that can cause pain, itching, and bleeding. External hemorrhoids can be particularly painful, especially if they become thrombosed (clotted). Internal hemorrhoids may not be painful but can still bleed, especially during bowel movements.

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

3. Other Conditions: While hemorrhoids and fissures are the most common causes of rectal bleeding, other conditions such as diverticulosis, colorectal polyps, or even more serious issues like colorectal cancer can also lead to bleeding. However, these are less common in someone your age.

When to Seek Help
Given your situation, here are some guidelines on when to seek medical attention:
- Persistent Bleeding: If you experience rectal bleeding that does not resolve or continues over several days, it is essential to consult a healthcare provider. Even if the bleeding is less than what you experienced initially, any recurrence warrants further evaluation.

- Severe Pain: If you experience significant pain during bowel movements or at rest, this could indicate a more severe issue that needs to be addressed.

- Changes in Bowel Habits: If you notice changes in your bowel habits, such as diarrhea or constipation, along with bleeding, this should be evaluated.

- Associated Symptoms: If you experience other symptoms such as weight loss, changes in appetite, or fatigue, these could indicate a more serious condition.

Management and Treatment
In your case, since you have already been diagnosed with hemorrhoids and anal fissures, here are some management strategies:
1. Dietary Changes: Increasing your fiber intake can help soften stools and reduce straining during bowel movements. Consider incorporating more fruits, vegetables, whole grains, and adequate hydration into your diet.

2. Topical Treatments: Over-the-counter creams or ointments for hemorrhoids can provide relief from pain and itching. Your doctor may also prescribe medications to help with inflammation and pain.

3. Sitz Baths: Taking warm sitz baths can help soothe the anal area and promote healing.

4. Avoid Straining: Try to avoid straining during bowel movements, as this can exacerbate hemorrhoids and fissures.

5. Follow-Up Care: Since you have had a recent procedure and ongoing symptoms, it is crucial to follow up with your healthcare provider. They may recommend further evaluation, such as a colonoscopy, especially if bleeding persists.

Conclusion
While hemorrhoids and anal fissures are common and often manageable, persistent or severe symptoms should not be ignored. If your bleeding continues or worsens, or if you develop new symptoms, it is essential to seek medical attention promptly. Your health is paramount, and addressing these issues early can prevent complications and improve your quality of life.

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