Abnormal Fecal Occult Blood Test Results: Causes and Concerns - Surgery

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Understanding abnormal fecal occult blood test (FOBT) results can be concerning, especially when accompanied by symptoms such as rectal pain and the presence of blood on toilet paper. Your reported FOBT result of 500 ng/ml is indeed elevated, indicating that there is blood present in your stool, which warrants further investigation.

First, it's important to understand what a fecal occult blood test measures. This test is designed to detect hidden (occult) blood in the stool, which can be a sign of various gastrointestinal issues, including polyps, hemorrhoids, diverticular disease, or malignancies such as colorectal cancer. The presence of blood in the stool can arise from many sources, and not all of them are serious.

In your case, you mentioned experiencing anal pain and occasional blood streaks on toilet paper, which could be indicative of anal fissures or hemorrhoids. Anal fissures are small tears in the lining of the anus that can occur due to passing hard stools, and they often cause sharp pain during bowel movements. Hemorrhoids, on the other hand, are swollen veins in the rectal area that can bleed, especially during bowel movements. Both conditions can indeed lead to the presence of blood in the stool or on toilet paper, but they typically do not cause a significant elevation in FOBT results.

The fact that you had a colonoscopy in November, during which a small polyp was removed, is reassuring. Polyps can sometimes bleed, and their removal often alleviates that source of bleeding. However, the FOBT result still being elevated suggests that there may be another source of bleeding that needs to be investigated further.
While internal hemorrhoids and anal fissures can cause some bleeding, they usually do not account for such a high level of blood detected in the FOBT. It's essential to consider other potential causes, such as:
1. Gastrointestinal lesions: Other polyps or lesions in the colon that may not have been detected during the colonoscopy could be a source of bleeding.

2. Diverticular disease: Diverticulosis can lead to diverticulitis, which may cause bleeding.

3. Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause significant bleeding.

4. Malignancies: Although less common, colorectal cancer can present with occult blood in the stool.

Given your symptoms and the elevated FOBT result, it is advisable to follow up with your healthcare provider. They may recommend repeating the FOBT, conducting additional imaging studies, or performing another colonoscopy to ensure that no new lesions or sources of bleeding have developed since your last examination.

In summary, while conditions like hemorrhoids and anal fissures can cause some bleeding, they are unlikely to be the sole reason for a significantly elevated FOBT result. It is crucial to investigate further to rule out more serious conditions. Always communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you through the necessary steps for diagnosis and treatment.