Rectal Bleeding: When to Seek Further Medical Evaluation

Rectal bleeding?

Hello Dr.
Chen: Recently, I noticed some blood on the toilet paper after having a bowel movement.
This happened again a couple of days later.
I then underwent a fecal occult blood test, and the report came back positive with a level of 218, exceeding the standard of 100.
The doctor advised me to go to a larger hospital for further examination, but I haven't seen any blood on the toilet paper during the last two bowel movements, which leaves me uncertain about whether I should still seek further testing.
I have bowel movements every two days, sometimes once a day, and they are within the normal range.
I do not experience any pain, and there is no family history of such cases.
I have scheduled an appointment with a colorectal surgeon; is that the right choice? When I go in, will they perform a colonoscopy directly, or are there other examination methods available? If a colonoscopy is necessary without anesthesia, what kind of sensations can I expect? If a procedure to remove something is required without anesthesia, will it be very painful? Thank you for your hard work, doctor.

Nìmíng zhě, 20~29 year old female. Ask Date: 2015/08/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, if you see blood in your stool, there is actually no need to check for occult blood in the stool.
It is correct to consult a colorectal surgeon.
Sincerely, Dr.
Chen Qi-Feng, Attending Physician, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/08/12

More Info

Rectal bleeding can be a concerning symptom, and it's essential to approach it with caution. Based on your description, you have experienced blood on toilet paper after bowel movements, and a subsequent fecal occult blood test returned a positive result. This indicates the presence of blood in your stool, which warrants further investigation, especially since you mentioned that your family does not have a history of similar issues.

When to Seek Further Medical Evaluation
Given that you have had a positive fecal occult blood test, it is advisable to follow through with the recommended evaluation by a colorectal surgeon. Even though you have not experienced any pain or further bleeding, the presence of blood in the stool can be indicative of various conditions, ranging from benign issues such as hemorrhoids to more serious conditions like polyps or colorectal cancer.

Importance of a Colorectal Evaluation
You mentioned that you have an appointment with a colorectal surgeon, which is indeed the right step. The surgeon may recommend a colonoscopy, which is a procedure that allows for direct visualization of the colon and rectum. During a colonoscopy, the doctor can look for abnormalities, take biopsies if necessary, and potentially remove polyps.

Other Diagnostic Options
Before proceeding to a colonoscopy, the doctor may consider other diagnostic tests, such as:
1. Flexible Sigmoidoscopy: This is similar to a colonoscopy but examines only the lower part of the colon.

2. CT Colonography (Virtual Colonoscopy): This is a non-invasive imaging test that can provide images of the colon.

3. Barium Enema: An X-ray examination of the colon after the introduction of a barium contrast material.

However, a colonoscopy is often the preferred method due to its diagnostic and therapeutic capabilities.

Experience During a Colonoscopy
Regarding your concerns about the colonoscopy procedure, it is typically performed with sedation to ensure patient comfort. If you choose to undergo the procedure without sedation, you may experience discomfort, including cramping and pressure, as the scope is maneuvered through the colon. While some patients opt for no sedation, it is generally recommended to have at least mild sedation to minimize discomfort.

If any polyps or abnormal growths are found during the colonoscopy, the doctor can remove them on the spot. This is done using special tools passed through the colonoscope. While removal of polyps can cause some discomfort, it is usually well-tolerated, especially with sedation.

Conclusion
In summary, it is crucial to follow through with your scheduled evaluation by a colorectal surgeon. The positive fecal occult blood test is a significant indicator that further investigation is warranted, even if you are currently asymptomatic. A colonoscopy is the most effective way to diagnose the underlying cause of rectal bleeding and can also provide therapeutic options if necessary.
If you have any further questions or concerns about the procedure or your symptoms, do not hesitate to discuss them with your healthcare provider. They can provide you with detailed information tailored to your specific situation, ensuring you feel informed and comfortable moving forward.

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