Rectal Bleeding: Causes and Solutions for Painful Bowel Movements

Blood in the anus?

Hello doctor, I would like to ask about a situation I've been experiencing.
A few weeks ago, I was eating spicy food almost every day, and I've been having diarrhea almost every time I go to the bathroom.
Afterward, my anus hurts a lot.
This week, I've started to feel pain in my anus when I need to have a bowel movement, and after wiping, I noticed fresh blood on the toilet paper, which lasted for about two or three wipes before it stopped.
Could this be anal fissures, or is it due to insufficient intake of vegetables and water? I often eat out, and I had a similar issue when I was younger, but it resolved on its own.
Thank you for your help!

Liu, 10~19 year old female. Ask Date: 2015/12/09

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the likelihood of an anal fissure is higher.
Common symptoms include pain during bowel movements accompanied by slight bleeding, often with a history of constipation or diarrhea.
Treatment primarily involves topical ointments and rectal suppositories, along with warm sitz baths to effectively alleviate pain.
It is also important to reduce the intake of spicy and irritating foods.
However, addressing the underlying bowel movement issues is crucial; otherwise, it will only treat the symptoms rather than the root cause, potentially leading to chronic anal fissures that can recur.

Reply Date: 2015/12/09

More Info

Based on your description, it seems likely that you are experiencing symptoms consistent with anal fissures or possibly hemorrhoids, particularly given your recent dietary habits and the associated pain and bleeding during bowel movements. Let’s break down the potential causes and solutions for your situation.

Causes of Rectal Bleeding and Painful Bowel Movements
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, as well as bright red blood on the toilet paper or in the stool. Given your history of consuming spicy foods and experiencing diarrhea, the irritation from frequent bowel movements could contribute to fissures.

2. Hemorrhoids: These are swollen blood vessels in the rectal area that can become inflamed and bleed, especially during bowel movements. Symptoms may include pain, itching, and blood on the toilet paper or in the stool. Hemorrhoids can be caused by straining, prolonged sitting on the toilet, or increased pressure from constipation or diarrhea.

3. Dietary Factors: A diet low in fiber and fluids can lead to constipation, which in turn can cause hard stools that are difficult to pass. This can lead to straining and the development of fissures or hemorrhoids. Since you mentioned being an "外食族" (someone who eats out often), it’s possible that your diet lacks sufficient fruits, vegetables, and whole grains.

4. Irritation from Spicy Foods: Consuming spicy foods can irritate the gastrointestinal tract and lead to diarrhea, which can further irritate the anal area and contribute to pain and bleeding.

Recommended Solutions
1. Increase Fiber Intake: Aim to include more fiber-rich foods in your diet, such as fruits, vegetables, whole grains, and legumes. Fiber helps to soften stools and promote regular bowel movements, reducing the risk of straining.

2. Stay Hydrated: Drinking plenty of water is essential for maintaining soft stools. Aim for at least 8 glasses of water a day, or more if you are active or in a hot climate.

3. Avoid Straining: When you feel the urge to have a bowel movement, try not to delay it. Straining can exacerbate fissures and hemorrhoids. If you find yourself straining, it may be a sign that your stool is too hard, which can be alleviated by dietary changes.

4. Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote healing. Soaking for about 10-15 minutes several times a day, especially after bowel movements, can provide relief.

5. Over-the-Counter Treatments: You may consider using topical treatments such as hydrocortisone creams or witch hazel pads to reduce inflammation and discomfort. If you suspect hemorrhoids, there are specific creams and suppositories designed to alleviate symptoms.

6. Consult a Healthcare Provider: If your symptoms persist, worsen, or if you experience significant pain or bleeding, it’s important to seek medical advice. A healthcare provider can perform a thorough examination to rule out other potential causes of rectal bleeding, such as gastrointestinal conditions.

7. Consider a Gastroenterologist: If you continue to have issues with bowel movements, it may be beneficial to consult a gastroenterologist. They can provide more specialized care and may recommend further testing, such as a colonoscopy, if necessary.

Conclusion
In summary, your symptoms of rectal bleeding and pain during bowel movements are likely related to anal fissures or hemorrhoids, exacerbated by dietary choices and possibly insufficient hydration. By making dietary adjustments, increasing fluid intake, and practicing good bowel habits, you can significantly improve your symptoms. However, do not hesitate to seek medical attention if your condition does not improve, as timely intervention can prevent complications and promote healing.

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