Rectal Bleeding: Hemorrhoids or Anal Fissures?

Blood in stool

I had a colonoscopy about two years ago, but it only examined around 60 cm and there were no significant issues found, except for mild internal hemorrhoids.
Last year, I had an anal examination, which also indicated the presence of internal hemorrhoids.
Recently, I noticed that if my stool is too hard at the front, I experience a slight sharp pain at the anal opening before passing it.
After I finish, there are traces of bright red blood on the toilet paper, and occasionally, there are blood streaks on the end of the stool, resembling marks as if the stool dragged along the anal canal.
Sometimes, I have soft stools without bleeding, but other times, when the stool is harder and bulkier, I experience bleeding.
Is my condition indicative of anal fissures combined with bleeding from internal hemorrhoids? Do I need to undergo another colonoscopy?

Chen, 30~39 year old female. Ask Date: 2016/01/03

Dr. Ke Fangxu reply Surgery

Based on your description, it seems likely that you are experiencing an anal fissure combined with hemorrhoidal bleeding.
Common symptoms include pain during bowel movements accompanied by slight bleeding, often following a history of constipation or diarrhea.
Treatment primarily involves topical ointments and rectal suppositories, along with warm sitz baths to effectively alleviate pain.
However, it is essential to address the underlying bowel movement issues; otherwise, this will only treat the symptoms and not the root cause, potentially leading to chronic anal fissures and recurrent episodes.
Since you have already undergone a colonoscopy within the past year, there should be no need for a repeat examination at this time.

Reply Date: 2016/01/03

More Info

Rectal bleeding can be a concerning symptom, and it’s important to understand the potential causes and implications. Based on your description, it seems likely that you may be experiencing a combination of hemorrhoids and anal fissures, particularly given your history of internal hemorrhoids and the symptoms you are currently experiencing.

Understanding the Symptoms
1. Hemorrhoids: These are swollen veins in the rectal area that can cause bleeding, especially during bowel movements. The blood is typically bright red and may be seen on toilet paper or in the toilet bowl. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus). Given that you have a history of internal hemorrhoids, it is plausible that they could be contributing to your current symptoms.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. Symptoms include sharp pain during and after bowel movements, and bleeding that may appear as bright red streaks on the stool or toilet paper. The pain you describe before and during bowel movements, particularly when the stool is hard, aligns with the typical presentation of an anal fissure.

Potential Causes of Your Symptoms
- Hard Stools: The fact that you experience bleeding more frequently when your stools are hard suggests that the strain during bowel movements could be causing both hemorrhoids to bleed and fissures to form or worsen.

- Inconsistent Bowel Movements: The variability in your stool consistency (sometimes soft, sometimes hard) can lead to fluctuating symptoms. Soft stools may not cause bleeding, while hard stools can exacerbate both hemorrhoids and fissures.

Recommendations
1. Dietary Changes: To prevent hard stools, consider increasing your fiber intake through fruits, vegetables, and whole grains. Staying well-hydrated is also crucial, as it helps soften the stool and makes bowel movements easier.

2. Topical Treatments: Over-the-counter creams or ointments designed for hemorrhoids can provide relief and help reduce inflammation. If you suspect an anal fissure, topical anesthetics or medications that promote healing may also be beneficial.

3. Sitz Baths: Taking warm sitz baths can help soothe the area and promote healing. This involves sitting in a few inches of warm water for about 15-20 minutes, several times a day, especially after bowel movements.

4. Monitoring Symptoms: Keep track of your symptoms, including the frequency and severity of bleeding, pain, and any changes in bowel habits. If you notice any significant changes or worsening symptoms, it’s important to seek medical attention.

5. Consulting a Specialist: Given your history and current symptoms, it may be advisable to consult a gastroenterologist. They can perform a thorough examination and may recommend a colonoscopy if there are concerns about other underlying conditions, especially if the bleeding persists or worsens.

When to Seek Immediate Medical Attention
- If you experience significant amounts of blood in your stool or toilet bowl.

- If you have severe pain that does not improve with home treatments.

- If you notice any changes in your bowel habits, such as diarrhea or constipation lasting more than a few days.

Conclusion
In summary, your symptoms are consistent with a combination of hemorrhoids and anal fissures, particularly exacerbated by hard stools. While dietary and lifestyle modifications can significantly help manage your symptoms, it’s essential to consult with a healthcare provider for a definitive diagnosis and tailored treatment plan. Regular follow-ups and monitoring will ensure that any potential complications are addressed promptly.

Similar Q&A

Understanding Rectal Bleeding: Is It Hemorrhoids or Anal Fissures?

Hello, doctor. I have a question. I originally had hemorrhoids and every time I have a bowel movement, I need to use my finger to push the hemorrhoids back in. Recently, I have been experiencing rectal bleeding for a month. The blood does not fill the toilet; it only appears as a...

Dr. Zhang Shuhao reply Surgery
If there is no pain and bowel movements do not require much effort, it is less likely to be an anal fissure and more indicative of symptoms related to internal hemorrhoids. It is recommended to drink plenty of water during the episode, maintain a light diet, and take warm sitz ba...

Understanding Rectal Bleeding: Causes, Symptoms, and Treatment Options

Recently, I have been experiencing bleeding from both my anus and rectum, regardless of whether it's a bowel movement or not. The blood is dark red and there are also small blood clots. I am also prone to diarrhea. Thank you for your response, doctor.

Dr. He Zhenming reply Surgery
It is most likely that the anal fissure is caused by hemorrhoids. Please see a colorectal clinic. He Zhenming.

Understanding Rectal Bleeding: Hemorrhoids or Anal Fissures?

Hello doctor, I would like to ask about a situation I've been experiencing for about a week. After having a bowel movement, I sometimes notice blood dripping from my anus, but usually, it stops as soon as I leave the toilet. I've also observed that sometimes just sittin...

Dr. Zhang Shuhao reply Surgery
Anal fissures are typically associated with pain during or after bowel movements; internal hemorrhoids may cause more significant bleeding but are not necessarily painful. During the acute phase, it is advisable to take warm sitz baths, reduce the time spent in the bathroom, avoi...

Understanding Rectal Bleeding: Is It Hemorrhoids or Anal Fissures?

For the past three months, there has been rectal bleeding due to hard stools. Since then, there are occasional instances of blood on the stool (blood at the end of the stool) occurring about once a week. On one occasion, while straining to have a bowel movement, blood dripped out...

Dr. Chen Shidian reply Gastroenterology and Hepatology
If there is no pain, it is likely an issue with internal hemorrhoids; a rectoscopy may be necessary for confirmation.