Blood in Stool: When to Seek Medical Attention

Blood in the stool?

I apologize for your discomfort.
On December 23rd, I experienced severe pain in my anus while having a bowel movement, and I noticed three drops of black blood.
Subsequently, my stools have been streaked with bright red blood, and upon inspection, it appeared that only one side of the stool was affected.
About a week later, on December 31st, I had no pain during bowel movements, but again, my stool was streaked with blood.
The blood appeared to be bright red and seemed to be attached to the outside of the stool.
Out of concern, I examined it and noticed that it also seemed to be only one side that had blood.
Should I undergo any specific tests? Currently, is a colonoscopy the only examination available for the colon?

Yǐlì, 20~29 year old female. Ask Date: 2016/01/01

Dr. Ke Fangxu reply Surgery

First, to clarify, the examination of the colon should be done using a colonoscopy rather than an upper endoscopy.
Additionally, there are barium enema studies and virtual colonoscopy, but in terms of accuracy, colonoscopy remains the mainstream method.
Based on your description, the likelihood of an anal fissure seems higher, which commonly presents with pain during bowel movements accompanied by slight bleeding.
Typically, there is a history of constipation or diarrhea.
Treatment primarily involves topical ointments and suppositories, along with warm sitz baths to effectively relieve pain.
Although the risk of developing colorectal cancer at the age of 24 is not zero, it is generally very low.
It is advisable to maintain a light diet and good lifestyle habits.
If symptoms persist without improvement, you may consult a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.

Reply Date: 2016/01/01

More Info

When it comes to the presence of blood in stool, it is essential to take this symptom seriously and seek medical attention promptly. The fact that you have experienced both black and red blood in your stool, along with pain during bowel movements, raises several concerns that warrant further investigation.

Firstly, the color of the blood can provide clues about its source. Black, tarry stools (known as melena) typically indicate bleeding from the upper gastrointestinal tract, such as the stomach or duodenum. This could be due to conditions like peptic ulcers, gastritis, or even esophageal varices. On the other hand, bright red blood (hematochezia) usually suggests bleeding from the lower gastrointestinal tract, such as the colon or rectum. This could be caused by hemorrhoids, anal fissures, diverticulosis, or more serious conditions like colorectal cancer.

Given your symptoms of pain and the presence of blood, it is crucial to consult a healthcare professional. They may recommend several diagnostic tests to determine the cause of the bleeding. While a colonoscopy is a common procedure for examining the lower gastrointestinal tract, there are other tests that might be appropriate depending on your specific situation. These could include:
1. Upper Endoscopy (EGD): If there is a concern about upper GI bleeding, this procedure allows doctors to visualize the esophagus, stomach, and duodenum.

2. CT Scan: A CT scan of the abdomen can help identify any abnormalities in the gastrointestinal tract, such as tumors, diverticula, or other structural issues.

3. Stool Tests: These can help identify the presence of blood or pathogens in the stool.

4. Blood Tests: These can assess for anemia, which may indicate significant blood loss.

In your case, since you have already experienced symptoms for over a week and they have not resolved, it is advisable to seek medical attention as soon as possible. The healthcare provider will take a detailed history, perform a physical examination, and decide on the appropriate tests based on your symptoms and findings.

Additionally, if you have any risk factors for gastrointestinal diseases, such as a family history of colorectal cancer, inflammatory bowel disease, or if you are over the age of 50, it becomes even more critical to get evaluated.

In summary, the presence of blood in your stool, especially when accompanied by pain, should not be ignored. It is essential to consult a healthcare professional who can guide you through the necessary evaluations and determine the appropriate course of action. Early diagnosis and treatment are key to managing any potential underlying conditions effectively.

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