Blood in Stool: When to Seek Further Evaluation

Blood in stool?

Hello Doctor, I have recently noticed blood in my stool at times.
Just now, there was blood on the stool, and there was also blood around my anus.
It might be hemorrhoids.
A particular situation I experienced was once seeing dark red mucus on the stool, but that only happened once and hasn't recurred.
Previously, I felt there was mucus in my stool and underwent a sigmoidoscopy, where the doctor said my rectum looked good, but I had hemorrhoids, and that applying medication would help.
Recently, I have been experiencing frequent bleeding from the hemorrhoids and discomfort.
I had a health check-up six months ago, and the fecal occult blood test was normal, with tumor markers also within safe limits.
Given this situation, do I need to undergo a colonoscopy again, or how should I proceed? Thank you!

QQ, 20~29 year old female. Ask Date: 2015/12/31

Dr. Ke Fangxu reply Surgery

This situation is likely indicative of a higher possibility of hemorrhoidal bleeding, although anal fissures can also cause anal pain.
As long as there is no further bleeding, it should not be a major concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
You may also consider purchasing over-the-counter hemorrhoidal suppositories for use.
If bleeding persists, it is advisable to consult a physician for evaluation.

Reply Date: 2015/12/31

More Info

When it comes to blood in the stool, it is essential to approach the situation with caution and a thorough understanding of potential underlying causes. The presence of blood can be alarming, and while it may often be attributed to benign conditions such as hemorrhoids, it can also indicate more serious issues that require further evaluation.

From your description, it seems that you have experienced blood in your stool, particularly with the presence of bright red blood, which is often associated with bleeding from the lower gastrointestinal tract, such as hemorrhoids or anal fissures. The dark red mucus you mentioned could also be a sign of bleeding, possibly from the rectum or lower colon, but it is important to note that the characteristics of the blood can provide clues about its source.

Given that you have previously undergone a flexible sigmoidoscopy (or colonoscopy) and were told that your rectum appeared healthy, along with the fact that your fecal occult blood test was negative, it is reassuring. However, the recurrence of blood, especially if it is frequent or accompanied by other symptoms such as pain, changes in bowel habits, or weight loss, warrants further investigation.

Here are some considerations regarding your situation:
1. Hemorrhoids: If you have a history of hemorrhoids, they can indeed cause bright red blood on the toilet paper or in the stool. Treatment often involves topical medications, dietary changes to increase fiber intake, and sometimes procedures to remove the hemorrhoids if they are severe.

2. Anal Fissures: These are small tears in the lining of the anus that can cause pain and bleeding during bowel movements. They are often associated with hard stools and can be treated with topical anesthetics and stool softeners.

3. Colorectal Polyps or Cancer: While your previous tests were normal, it is important to remember that conditions such as polyps or colorectal cancer can develop over time. If you have a family history of colorectal cancer or if you are over the age of 50, regular screening is recommended.

4. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause blood in the stool, along with other symptoms such as abdominal pain and diarrhea. If you experience these symptoms, further evaluation may be necessary.

5. Further Evaluation: Given your ongoing symptoms, it may be prudent to consult with a gastroenterologist for a more comprehensive evaluation. A colonoscopy may be recommended to visualize the entire colon and rectum, especially if there are changes in your symptoms or if the bleeding persists.

6. Lifestyle Modifications: In addition to seeking medical advice, consider making dietary changes to increase fiber intake, stay hydrated, and avoid straining during bowel movements. These measures can help alleviate symptoms associated with hemorrhoids and promote overall digestive health.

In summary, while your previous evaluations have been reassuring, the recurrence of blood in your stool, especially with the frequency you describe, should not be ignored. It is advisable to seek further evaluation from a healthcare professional who can assess your symptoms in detail and determine if additional diagnostic procedures, such as a colonoscopy, are warranted. Early detection and intervention are key to managing any potential gastrointestinal issues effectively.

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