Rectal Bleeding: Causes, Treatments, and Lifestyle Changes

Q: Rectal Bleeding: Causes, Treatments, and Lifestyle Changes

Hello Mr. <br>Chang： The diagnosis should be correct, so there is no need to worry. <br>You can visit the gastroenterology outpatient clinic to obtain laxatives to maintain regular bowel movements, in order to prevent hard stools from causing anal fissures or bleeding from intern

Hemorrhoids, rectal bleeding, anal fissures?

Hello Doctor: Since childhood, my bowel movement cycle has been longer, about every three to five days.
Currently, it is normal about every three days, but I have occasionally experienced blood in my stool since I was 17 or 18 years old when I was preparing for college.
At that time, I thought it was just due to hard stools and didn't pay much attention.
For two to three years, it has been fluctuating.
There was a period when I would see blood whenever I had a bowel movement, or there would be blood on the toilet paper.
The first time I saw a gastroenterologist, they performed a digital rectal exam and diagnosed me with anal fissures, which are difficult to heal and tend to fluctuate.
I was advised to pay more attention to my habits and was prescribed an ointment.
I accepted this as the cause, and using the ointment provided some improvement.
Therefore, I didn't pay much attention to the blood in my stool afterward.

During a health check-up two years ago, I was informed that there was occult blood in my stool.
I went to a large hospital for a colonoscopy, and the results were good, but I was found to have mild hemorrhoids, for which I was also prescribed an ointment.
Last year, the occult blood test was normal.
Recently, however, the bleeding has become somewhat frequent again, but dietary changes seem to only affect stool hardness, and my bowel movement cycle hasn't shortened...
Sometimes, I may go several days without feeling the urge to use the restroom.
My situation is that the first stool is usually quite large, and I often have to exert some effort.
The subsequent stools tend to be smaller and softer or unformed.
If there is bleeding, it usually occurs after passing the first large stool, with a few drops of bright red blood, but there is no pain.
If there is no bleeding after the first stool, I can generally feel reassured, although sometimes the amount can be quite significant, which looks alarming.
There are times when I might not have a bowel movement for one or two months, thinking I am fine, but then I discover the same old problem again.
I would like to ask, besides eating more fruits and vegetables and drinking water to improve stool hardness, what other methods or habits can help shorten the bowel movement cycle? Should I avoid waiting until I feel the urge to go? Is there a relationship between stress and these episodes? Besides using ointments, are there other proactive treatment options? Based on my situation, would this be classified as external hemorrhoids or internal hemorrhoids? Are there other conditions that might not be detected during a colonoscopy? Just seeing blood in the toilet really affects my mood...

Mr. Zhang, 20~29 year old female. Ask Date: 2016/02/27

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr.
Chang: The diagnosis should be correct, so there is no need to worry.
You can visit the gastroenterology outpatient clinic to obtain laxatives to maintain regular bowel movements, in order to prevent hard stools from causing anal fissures or bleeding from internal hemorrhoids.
Additionally, try to reduce stress from work and daily life.
Changhua Hospital cares about your health.
Sincerely, Chen Shidian.

Reply Date: 2016/02/27

More Info

Rectal bleeding can be a concerning symptom, and understanding its causes, treatments, and lifestyle changes is crucial for managing this condition effectively. Based on your description, it seems that you have been experiencing rectal bleeding intermittently for several years, primarily associated with bowel movements. The bleeding appears to be linked to hard stools and possibly anal fissures or hemorrhoids, which are common causes of rectal bleeding.

Causes of Rectal Bleeding
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain and bleeding during bowel movements.

2. Hemorrhoids: Swollen blood vessels in the rectal area can cause bleeding, especially during bowel movements. They can be classified as internal (inside the rectum) or external (under the skin around the anus).

3. Constipation: A longer interval between bowel movements can lead to harder stools, which can exacerbate fissures and hemorrhoids.

4. Other Conditions: While your colonoscopy results were normal, other conditions such as diverticulosis, inflammatory bowel disease (IBD), or colorectal polyps can also cause rectal bleeding, although these are less likely given your recent evaluations.

Treatments
1. Topical Treatments: You mentioned using ointments for hemorrhoids, which can help reduce inflammation and discomfort. Continue using these as directed by your healthcare provider.

2. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and promote regular bowel movements. Staying well-hydrated is equally important.

3. Stool Softeners: Over-the-counter stool softeners can be beneficial in preventing hard stools and reducing the risk of fissures and hemorrhoids.

4. Warm Baths: Soaking in warm water can help relieve discomfort associated with hemorrhoids and fissures.

5. Sitz Baths: These are particularly effective for soothing the anal area and promoting healing.

Lifestyle Changes
1. Regular Bowel Habits: Establishing a routine for bowel movements can help. Try to go to the bathroom at the same time each day, even if you don’t feel the urge. This can help train your body to have more regular bowel movements.

2. Avoid Straining: Straining during bowel movements can worsen fissures and hemorrhoids. If you find yourself straining, consider adjusting your diet or using stool softeners.

3. Manage Stress: Stress can impact gut health and bowel habits. Techniques such as mindfulness, yoga, or regular exercise can help manage stress levels.

4. Physical Activity: Regular exercise can promote bowel regularity and overall digestive health.

When to Seek Further Help
If your symptoms persist or worsen, or if you experience significant changes in your bowel habits, it’s essential to consult with your healthcare provider. They may recommend further evaluations, such as imaging studies or additional colonoscopy, to rule out any underlying conditions that may not have been detected previously.

Conclusion
In summary, rectal bleeding can stem from various causes, with anal fissures and hemorrhoids being the most common in your case. By adopting dietary changes, maintaining regular bowel habits, and managing stress, you can potentially reduce the frequency of your symptoms. However, ongoing monitoring and communication with your healthcare provider are essential to ensure that any underlying issues are addressed promptly. Remember, while occasional rectal bleeding can be benign, persistent or severe symptoms warrant further investigation.

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