Bowel Issues: Blood in Stool and Digestive Discomfort

Q: Bowel Issues: Blood in Stool and Digestive Discomfort

Hello： Basically, the symptoms described are not unusual. <br>Having a slightly hard stool at the front and soft, mushy stool at the end is generally considered normal. <br>If there has been a history of internal hemorrhoids, then the bleeding observed a few days ago at the front

Constipation

Hello Doctor: Last Thursday, I noticed bright red blood attached to the tip of my stool during a bowel movement.
The stool was somewhat hard at the front and softer at the back, but I was able to pass it without difficulty.
Since then, my bowel movements have not been smooth; the initial part is narrower (about the thickness of an adult male's thumb, whereas it used to be banana-sized), followed by a more watery consistency, and finally some mucus, which occasionally contains solid food remnants.
Both the narrow stool and mucus are a yellowish-brown color, and I haven't observed any other unusual colors or significant bleeding.
I used to have a bowel movement about once a day, but over the past few days, I've frequently felt the urge to go, only to pass a small amount of soft, poorly formed stool, sometimes just mucus, and occasionally nothing at all.
I wonder if soaking in hot water has contributed to this, as the urge to go has diminished in the last couple of days.
However, I still experience a tingling, uncomfortable sensation inside the anus, and occasionally passing gas (which seems less frequent and with less volume than before) or stretching my buttocks provides some relief.
I also feel bloated in my upper abdomen (possibly gastric bloating?), which is uncomfortable but not painful; forcing a burp helps a lot.
I had a colonoscopy last June, which revealed internal hemorrhoids but no polyps.
My meals are generally normal, with a diet leaning towards meat and less vegetables.
Currently, I am taking medication for gastroesophageal reflux (Mochu Gastric Clear, Gas-X, and Nexium).
I would like to ask the doctor what might be going on.
Thank you.

Mr. Zhang, 40~49 year old female. Ask Date: 2015/12/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Basically, the symptoms described are not unusual.
Having a slightly hard stool at the front and soft, mushy stool at the end is generally considered normal.
If there has been a history of internal hemorrhoids, then the bleeding observed a few days ago at the front of the stool can likely be explained by hemorrhoidal bleeding.
As for the sensation of needing to have a bowel movement but only passing a small amount, this could be a case of tenesmus, possibly due to retained stool or a lack of fiber intake.
It could also be a result of rapid gastrointestinal motility caused by the use of certain medications like Motilium.
If you have any concerns, you can consult a gastroenterologist.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2015/12/23

More Info

It sounds like you are experiencing a combination of gastrointestinal symptoms that can be concerning, especially with the presence of blood in your stool and changes in your bowel habits. Let's break down your symptoms and explore potential causes and solutions.

Blood in Stool
The presence of bright red blood on the stool or on toilet paper can often indicate bleeding from the lower gastrointestinal tract, particularly the rectum or anus. Common causes include:
1. Hemorrhoids: These are swollen veins in the rectal area that can bleed, especially during bowel movements. Given that you have a history of internal hemorrhoids, this could be a likely cause of the blood you are seeing.

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

3. Diverticular Disease: This condition involves small pouches that can form in the colon wall and may become inflamed or infected, leading to bleeding.

4. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause inflammation and bleeding in the gastrointestinal tract.

5. Infections: Certain infections can lead to gastrointestinal bleeding, especially if accompanied by diarrhea.

Changes in Bowel Habits
You mentioned that your stools have become thinner and sometimes more liquid, with occasional mucus. This could indicate:
1. Irritable Bowel Syndrome (IBS): Given your history of gastrointestinal issues, IBS could be a possibility. It often presents with alternating patterns of diarrhea and constipation, along with abdominal discomfort.

2. Dietary Factors: A diet low in fiber and high in meat can lead to constipation and harder stools, which may contribute to hemorrhoids and fissures. Increasing your intake of fruits, vegetables, and whole grains can help improve stool consistency.

3. Gastroesophageal Reflux Disease (GERD): Since you are already taking medication for acid reflux, it’s important to consider how this might be affecting your overall digestive health. Sometimes, medications can alter gut motility.

Recommendations
1. Dietary Adjustments: Focus on a balanced diet rich in fiber. This can help soften stools and reduce straining during bowel movements. Aim for at least 25-30 grams of fiber daily.

2. Hydration: Ensure you are drinking plenty of water throughout the day, as this can also help with stool consistency.

3. Medication Review: Since you are on medications for acid reflux, discuss with your doctor whether these might be contributing to your gastrointestinal symptoms.

4. Regular Exercise: Physical activity can help stimulate bowel function and reduce symptoms of IBS.

5. Follow-Up with a Specialist: Given your symptoms and history, it may be beneficial to consult a gastroenterologist for further evaluation. They may recommend additional tests, such as a colonoscopy, especially if your symptoms persist or worsen.

6. Monitor Symptoms: Keep track of your symptoms, including any changes in bowel habits, the presence of blood, and any associated pain or discomfort. This information will be valuable for your healthcare provider.

Conclusion
While some of your symptoms may be related to benign conditions like hemorrhoids or dietary factors, it is essential to rule out more serious issues. Regular follow-ups with your healthcare provider and maintaining a healthy lifestyle can significantly improve your gastrointestinal health. If you notice any alarming symptoms, such as significant weight loss, persistent abdominal pain, or worsening bleeding, seek medical attention promptly.

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