Rectal Bleeding: Causes and When to Seek Help

Blood in the anus?

Seven days ago, I suddenly noticed bright red blood from my anus.
There was no bowel movement! Later, two days passed without a bowel movement, and there was blood again.
After that, I had a bowel movement with blood; sometimes there's a little blood (not much), and sometimes there isn't any! Initially, I had a lump at the anus, which might have been an external hemorrhoid, but it's gone now! There is no pain or burning sensation in the anus, and everything feels normal.
Additionally, I previously felt the urge to have a bowel movement, but I couldn't.
What could be happening? I'm a bit scared.

A-Hua, 70~79 year old female. Ask Date: 2016/02/11

Dr. Ke Fangxu reply Surgery

Although rectal bleeding is often caused by hemorrhoids, it is advisable for older patients to undergo a colonoscopy first, as they are at an age where colorectal cancer is more prevalent.
If the bleeding is mistakenly attributed to hemorrhoids and treated with over-the-counter medications, it could delay the diagnosis of a malignant tumor and worsen the condition.
It is recommended that you consult a gastroenterologist or a colorectal surgeon, who should arrange for a colonoscopy.

Reply Date: 2016/02/11

More Info

Rectal bleeding can be concerning, and it's important to understand its potential causes and when to seek medical help. Based on your description, it seems you have experienced bright red blood from the rectum, sometimes with bowel movements and sometimes without. You also mentioned a previous external hemorrhoid that has since resolved, and you are not experiencing pain or discomfort.

Possible Causes of Rectal Bleeding
1. Hemorrhoids: The most common cause of bright red blood in the stool is hemorrhoids, which are swollen veins in the rectum or anus. They can cause bleeding, especially during bowel movements, and may not always be painful. Since you mentioned a previous external hemorrhoid, this could be a likely cause.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to bleeding and discomfort, but you noted that you are not experiencing pain, which makes this less likely.

3. Diverticular Disease: Diverticulosis can lead to diverticulitis, which may cause rectal bleeding. This condition involves small pouches that form in the colon wall and can become inflamed or infected.

4. Polyps or Colorectal Cancer: While less common, polyps (growths on the colon lining) or colorectal cancer can also cause rectal bleeding. These conditions often present with other symptoms, such as changes in bowel habits or abdominal pain.

5. Gastrointestinal Infections: Certain infections can cause inflammation of the intestines, leading to bleeding.

When to Seek Medical Help
Given that you have experienced rectal bleeding, it is advisable to consult a healthcare professional, especially if:
- The bleeding persists or worsens.

- You notice a significant change in your bowel habits.

- You experience any abdominal pain, cramping, or discomfort.

- You have other symptoms such as weight loss, fatigue, or changes in appetite.

Diagnostic Steps
When you visit a healthcare provider, they may perform several evaluations, including:
- Physical Examination: A thorough examination of the rectal area to check for hemorrhoids or fissures.

- Digital Rectal Exam (DRE): This allows the doctor to feel for abnormalities in the rectum.

- Colonoscopy: If necessary, a colonoscopy may be recommended to visualize the colon and rectum directly, especially if there are concerns about polyps or cancer.

- Blood Tests: To check for anemia or other underlying conditions.

Management and Prevention
If hemorrhoids are confirmed as the cause, treatment options may include:
- Dietary Changes: Increasing fiber intake to soften stools and reduce straining during bowel movements.

- Hydration: Drinking plenty of fluids to help prevent constipation.

- Topical Treatments: Over-the-counter creams or ointments can help relieve symptoms.

- Sitz Baths: Soaking in warm water can provide relief from discomfort.

If the bleeding is due to other causes, treatment will depend on the underlying condition. Regular check-ups and screenings, especially if you have a family history of colorectal issues, are essential for early detection and management.

Conclusion
While occasional rectal bleeding can be benign, it is crucial to take it seriously and seek medical advice to rule out more serious conditions. Early intervention can lead to better outcomes and peace of mind. Remember, your health is paramount, and addressing these symptoms with a healthcare professional is the best course of action.

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