Rectal Bleeding: Causes and When to Seek Help

Blood in stool?

Hello Dr.
Ke, today while I was at work, I experienced significant pain in my buttocks after having a bowel movement.
Later, when I wiped, I noticed there was quite a bit of blood, and the toilet paper became soaked quickly.
However, I didn't continue wiping and decided to wait until I got home.
By the time I got home, I found that the bleeding had stopped.
I usually don't have bowel movements every day; it's typically every two to three days, but when I do, the stools are quite large (about the diameter of a 600ml plastic bottle) and long, which often causes minor tears and a little blood.
This time, though, the bleeding was more substantial, which startled me.
I would like to understand what could potentially cause this, as the blood was bright red.
I am considering getting a colonoscopy to investigate further.
Thank you, Dr.
Ke!

Mr. Zhou, 20~29 year old female. Ask Date: 2016/01/18

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
You can also purchase over-the-counter hemorrhoidal suppositories for use.
However, if bleeding persists, it is best to consult a physician for evaluation.
Although the risk of developing colorectal cancer at the age of 26 is not zero, it is generally very low.
If there are still significant concerns, scheduling a colonoscopy is also an option.

Reply Date: 2016/01/18

More Info

Rectal bleeding can be a concerning symptom, and it's important to understand its potential causes and when to seek medical help. Based on your description, it sounds like you experienced a significant amount of bright red blood during a bowel movement, which can be alarming. Here’s a comprehensive overview of possible causes, implications, and recommendations for your situation.

Possible Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of bright red blood in the stool is hemorrhoids. These are swollen veins in the rectum or anus that can bleed during bowel movements, especially if you are straining or have hard stools.

2. Anal Fissures: Given that you mentioned pain and a history of large bowel movements, an anal fissure could be another potential cause. This is a small tear in the lining of the anus, often caused by passing hard stools, which can lead to sharp pain and bleeding.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can lead to diverticulitis, where these pouches become inflamed or infected, potentially causing bleeding.

4. Polyps or Colorectal Cancer: While less common, polyps (growths on the colon lining) or colorectal cancer can also present with rectal bleeding. The blood may appear bright red or darker, depending on where the bleeding originates.

5. Gastrointestinal Conditions: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can also lead to rectal bleeding.

When to Seek Medical Help
You should seek medical attention if:
- The bleeding is persistent or recurrent.

- You experience significant pain or discomfort.

- You notice changes in your bowel habits, such as diarrhea or constipation.

- There are accompanying symptoms like dizziness, weakness, or fainting, which could indicate significant blood loss.

- You have a family history of colorectal cancer or other gastrointestinal diseases.

Diagnostic Approach
Given your symptoms, a colonoscopy is indeed a reasonable next step. This procedure allows a doctor to visualize the inside of your colon and rectum, helping to identify any abnormalities such as hemorrhoids, fissures, polyps, or signs of cancer. Before undergoing a colonoscopy, your doctor will likely recommend a bowel prep to ensure your colon is clear for accurate examination.

Management and Prevention
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

2. Hydration: Drinking plenty of fluids can also help prevent constipation and promote regular bowel movements.

3. Avoid Straining: If you have a tendency to strain during bowel movements, consider using a stool softener or laxative as recommended by your healthcare provider.

4. Topical Treatments: For hemorrhoids or fissures, topical treatments such as hydrocortisone creams or witch hazel pads can provide relief.

5. Regular Check-ups: If you have a history of gastrointestinal issues or rectal bleeding, regular check-ups with your healthcare provider can help monitor your condition and catch any potential issues early.

Conclusion
While rectal bleeding can be caused by various conditions, many of them are treatable. It’s essential to take your symptoms seriously and consult with a healthcare professional for a thorough evaluation. A colonoscopy will provide valuable insights into your gastrointestinal health and help determine the appropriate course of action. Remember, early detection and management are key to preventing potential complications.

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