Rectal Bleeding: Is It Hemorrhoids or Something More?

Rectal bleeding

On Monday morning, I had three bowel movements (including one diarrhea), which caused discomfort in my anus and started to itch.
On Tuesday, my anus felt itchy all day, and before bed, I strained to have a bowel movement (the stool volume was very small).
On Wednesday, the itching sensation disappeared, but I noticed slight bleeding in the morning stool.
In the evening, the blood in the stool increased, with some mixed in and some on the surface.
On Thursday, I continued to have bleeding during my morning and evening bowel movements, with both mixed and surface blood.
On Friday morning, the bleeding persisted, and during a midday bowel movement, I noticed that the first segment of stool (about 5-6 cm) had no blood, the second segment had a little, and the third segment had more, with blood mixed in with the stool.
Hello, doctor.
I am a stage I colorectal cancer patient, and it has been a year and a half since my surgery.
I had a follow-up colonoscopy last month, which did not reveal any abnormalities.
I have a strong concern regarding the above symptoms: if it were hemorrhoidal bleeding, how could the first part of the stool be blood-free while the later parts have blood, and why is the blood mixed with the stool each time? Is this typical for hemorrhoids? If it is not hemorrhoids, what could it be? I have already had two hemorrhoids ligated and still have one left (ligated every two weeks).
Additionally, taking stool softeners seems to reduce or even eliminate the bleeding symptoms; would this happen if it were a tumor? The third hemorrhoid was ligated yesterday, and I noticed that the second one still has a 3mm scar that has not healed.
The doctor said to observe it further.
I am really concerned and am considering having another colonoscopy after the New Year (the last colonoscopy was done at a different hospital from where the ligation was performed).
I would like to ask the doctor if it is necessary to have another one.

Mr. Chen, 40~49 year old female. Ask Date: 2016/01/29

Dr. Ke Fangxu reply Surgery

If you are undergoing regular follow-up examinations after colon cancer surgery, there is no need to be overly concerned about bleeding issues.
Hemorrhoidal bleeding does not necessarily indicate a specific cause or type, and there is no need for repeated rubber band ligation.
It is advisable to avoid constipation and shorten the time spent on bowel movements during this period.
Warm sitz baths may also help alleviate symptoms, and you can purchase over-the-counter hemorrhoidal suppositories for use.
It is best to have follow-ups at the same hospital to maintain a consistent record of examination data.
If you just had a colonoscopy last month, there is truly no need to undergo another one.

Reply Date: 2016/01/29

More Info

Understanding rectal bleeding can be a complex issue, especially for someone with a history of colorectal cancer. Given your situation, it is crucial to approach this matter with caution and thoroughness.

Firstly, it is essential to differentiate between hemorrhoidal bleeding and other potential causes of rectal bleeding. Hemorrhoids typically cause bright red blood, which may be seen on the toilet paper or on the surface of the stool. The bleeding is often associated with straining during bowel movements, which can lead to discomfort, itching, and sometimes pain. However, the pattern of bleeding you described—where the first part of the stool is free of blood and the latter part is mixed with blood—raises some concerns that may not be typical for hemorrhoids alone.

In your case, the fact that you have a history of stage I colorectal cancer and have recently undergone a colonoscopy that showed no abnormalities is reassuring, but it does not completely rule out the possibility of other issues. The presence of blood mixed with stool could indicate several conditions, including:
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to bleeding and significant discomfort.

2. Diverticular Disease: Diverticulosis can lead to diverticulitis, which may cause bleeding. This condition is characterized by the formation of small pouches in the colon wall.

3. Colorectal Polyps: While you have had a recent colonoscopy, it's important to note that some polyps can be missed, especially if they are small or flat.
4. Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis or Crohn's disease can cause rectal bleeding and should be considered if other symptoms are present.

5. Tumors: Although you have had a recent colonoscopy, any new growths or changes in the bowel could potentially lead to bleeding.

Regarding your question about whether softening your stool with medication could reduce bleeding if it were due to a tumor, the answer is nuanced. While softening the stool can alleviate strain during bowel movements and potentially reduce bleeding from hemorrhoids or fissures, it would not necessarily stop bleeding from a tumor. Tumors may bleed regardless of stool consistency.

Given your ongoing symptoms and the fact that you are still experiencing bleeding, it is advisable to consult with your healthcare provider again. You mentioned that you are considering another colonoscopy; this could be a prudent decision, especially if your symptoms persist or worsen. A repeat colonoscopy can provide a more comprehensive evaluation of your colon and rectum, ensuring that any potential issues are identified and addressed promptly.

In summary, while hemorrhoids could be a contributing factor to your symptoms, the pattern of bleeding you described warrants further investigation. It is essential to communicate openly with your healthcare provider about your concerns and symptoms. Regular follow-ups and monitoring are crucial, especially given your medical history. Your health and peace of mind are paramount, and taking proactive steps to address these symptoms is the best course of action.

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