Blood in Stool: Causes, Symptoms, and Treatments

Blood in the stool?

Hello Doctor: A few months ago, I had a hard stool that seemed to injure my anus.
It was very painful and there was bleeding at that time, which lasted for two to three days, but then it returned to normal.
Could that have been an anal fissure? Two weeks ago, I had another hard stool, which was also very painful and bled, but it returned to normal afterward.
However, since yesterday, I have started to notice bright red blood when I have a bowel movement, similar to menstrual blood, which turns the toilet water red.
There is also a lot of blood when I wipe, almost covering the stool, but there is no significant pain.
Is this a result of the previous hard stool or could it be hemorrhoids? How can I tell if I have hemorrhoids? What treatment options are available? Is there a possibility that this could be colon cancer or something else? If left untreated, will it heal on its own? (My diet is generally balanced.) Thank you, Doctor.

Jie Er, 10~19 year old female. Ask Date: 2015/08/16

Dr. Cai Xingzhi reply Surgery

Hello, based on the symptoms, it appears that the primary issue is an anal fissure.
It is possible that it could be accompanied by an internal hemorrhoid.
Given your age, it is unlikely to be colorectal cancer, but I still recommend consulting a colorectal surgeon or a gastroenterologist nearby.
Thank you.

Reply Date: 2015/08/16

More Info

Understanding blood in stool can be a concerning symptom, and it’s essential to approach it with careful consideration of potential causes, symptoms, and treatments. Based on your description, it seems you have experienced episodes of painful bowel movements with blood present, which raises several possibilities.

Possible Causes
1. Anal Fissures: Given your history of hard stools and the associated pain and bleeding, anal fissures are a likely cause. These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain during bowel movements and may result in bright red blood on the toilet paper or in the toilet bowl.

2. Hemorrhoids: Another common cause of blood in the stool is hemorrhoids, which are swollen veins in the lower rectum or anus. They can be internal or external and may cause bleeding, especially during bowel movements. Symptoms can include itching, discomfort, and visible blood.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can also lead to bleeding. This condition is more common in older adults and may not always present with pain.

4. Colorectal Polyps or Cancer: While less common, it’s crucial to consider the possibility of colorectal polyps or cancer, especially if you have risk factors such as age, family history, or other gastrointestinal symptoms. Blood in the stool, especially if it’s dark or mixed with stool, can be a sign of more serious conditions.

Symptoms to Monitor
- Pain: While you mentioned a lack of significant pain during your recent episodes, the presence of pain can help differentiate between conditions. Anal fissures typically cause sharp pain, while hemorrhoids may cause discomfort but not necessarily severe pain.

- Type of Blood: Bright red blood usually indicates bleeding from the lower gastrointestinal tract, while darker blood may suggest a source higher up in the digestive system.

- Changes in Bowel Habits: Any significant changes in your bowel habits, such as diarrhea or constipation, should be noted.

- Other Symptoms: Weight loss, changes in appetite, or abdominal pain warrant further evaluation.

Diagnosis
To determine the exact cause of your symptoms, a visit to a healthcare professional is essential. They may perform a physical examination, including a digital rectal exam, and possibly recommend further investigations such as:
- Colonoscopy: This procedure allows direct visualization of the colon and rectum, helping to identify any abnormalities such as polyps, fissures, or signs of cancer.

- Anoscopy or Sigmoidoscopy: These are less extensive than a full colonoscopy and can help evaluate the anal canal and lower rectum.

Treatment Options
1. For Anal Fissures: Treatment often includes dietary changes to soften stools (increasing fiber intake and hydration), topical anesthetics, and sometimes medications to relax the anal sphincter. In persistent cases, surgical options may be considered.

2. For Hemorrhoids: Treatment can range from lifestyle changes (increasing fiber and fluid intake) to over-the-counter creams. In more severe cases, procedures such as rubber band ligation or surgical removal may be necessary.

3. For Other Conditions: If polyps or cancer are diagnosed, treatment will depend on the specific findings and may include surveillance, removal, or more extensive surgical intervention.

Conclusion
While it’s possible that your symptoms are due to benign conditions like anal fissures or hemorrhoids, it’s crucial not to overlook the potential for more serious issues. Blood in the stool should always be evaluated by a healthcare professional to rule out significant conditions, including colorectal cancer. Early diagnosis and treatment can lead to better outcomes, so I encourage you to seek medical advice promptly. Additionally, maintaining a balanced diet rich in fiber and staying hydrated can help prevent future episodes.

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