Unpredictable Bleeding from Hemorrhoids: Causes and Solutions

Mole bleeding intermittently and unexpectedly?

Hello Dr.
Ke, thank you for taking the time to address my concerns about my hemorrhoids.
Here’s my story: I have been experiencing rectal bleeding intermittently for about six months.
The blood in the toilet appears dark red, while the blood on the toilet paper is both bright red and dark red.
During a visit for a self-paid flu vaccine, I described my symptoms to my family physician, who prescribed a seven-day course of suppositories and ordered a stool occult blood test.
After finishing the suppositories, the bleeding continued sporadically, so I consulted a colorectal surgeon.
The examination revealed stage II internal and external hemorrhoids.
Reflecting on my lifestyle habits, I suspect that reading on the toilet and staying up late (due to caring for a young child) may have contributed to my condition (overwork leading to illness).
The doctor initially prescribed suppositories for two weeks, followed by a month of ointment (I also purchased an additional box of suppositories for combined use).
I did not experience any bleeding during bowel movements for two weeks, but two days before my follow-up appointment, I had unexpected bleeding again (painless, dark red blood in the toilet and on the toilet paper).
That evening, I immediately used the medication (I had previously stopped using it), and the next day, my condition improved (less blood).
On the day of my follow-up appointment (no blood), the doctor informed me that hemorrhoids behave this way (without discussing the results of the occult blood test, which I submitted seven days prior to the appointment).
He mentioned that surgical intervention is the only way to achieve a complete cure and recommended a barium enema for further examination, which I am scheduled to have in mid-March (the physician has many patients and did not ask if I had any other concerns).
My questions are: Is it possible for internal hemorrhoids to bleed due to pressure from stool (intermittently and unexpectedly)? If I want a complete cure, is surgery the only option, and is self-healing not possible? Thank you, Dr.
Ke, for taking the time to clarify my doubts amidst your busy schedule.
Thank you.

Jack, 40~49 year old female. Ask Date: 2016/03/01

Dr. Ke Fangxu reply Surgery

This situation is likely indicative of 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 bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase hemorrhoid suppositories over the counter for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and fluid intake should be sufficient.
If bleeding persists, a common treatment is rubber band ligation for internal hemorrhoids.
If there are still recurrent bleeding episodes, surgical intervention may indeed be the only definitive treatment.

Reply Date: 2016/03/01

More Info

Understanding unpredictable bleeding from hemorrhoids can be quite concerning, and it’s important to address both the causes and potential solutions. Hemorrhoids, which are swollen veins in the lower rectum and anus, can lead to bleeding during bowel movements, and this bleeding can vary in appearance and frequency.
In your case, the presence of dark red blood in the toilet and bright red blood on toilet paper suggests that the bleeding is likely coming from the lower rectum, which is typical for hemorrhoids. The fact that you have experienced this intermittently over the past six months indicates that there may be underlying factors contributing to the condition.

Causes of Bleeding from Hemorrhoids
1. Straining During Bowel Movements: One of the most common causes of hemorrhoid bleeding is straining during bowel movements, often due to constipation or hard stools. This can be exacerbated by prolonged sitting on the toilet, which you mentioned as a habit while reading.

2. Dietary Factors: A diet low in fiber can lead to constipation, making bowel movements more difficult and increasing the likelihood of straining. Ensuring adequate fiber intake can help soften stools and reduce the need to strain.

3. Lifestyle Factors: Your mention of staying up late to care for a child may contribute to fatigue and irregular bowel habits, which can also affect bowel health.
4. Physical Activity: Lack of physical activity can contribute to constipation and hemorrhoid issues. Regular exercise can promote healthy bowel function.

5. Chronic Conditions: Conditions that increase pressure in the abdomen, such as obesity or pregnancy, can also lead to the development of hemorrhoids.

Solutions and Management
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, whole grains, and adequate hydration can help prevent constipation. Consider incorporating fiber supplements if necessary.

2. Over-the-Counter Treatments: Topical treatments, such as creams or suppositories, can provide relief from symptoms and help reduce inflammation. It seems you have already been prescribed these, which is a good start.

3. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you find yourself needing to push hard, it may be a sign that you need to adjust your diet or hydration.

4. Regular Check-Ups: Since you have already consulted with a healthcare provider, it’s important to keep up with follow-up appointments. If bleeding persists or worsens, further evaluation may be necessary.

5. Surgical Options: If conservative measures fail and the bleeding continues, surgical options may be considered. Procedures such as rubber band ligation, sclerotherapy, or hemorrhoidectomy can provide more permanent solutions.

6. Monitoring Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, as well as any changes in bowel habits. This information can be valuable for your healthcare provider.

Conclusion
In summary, while hemorrhoids can cause unpredictable bleeding, there are several management strategies that can help alleviate symptoms and prevent further complications. It’s crucial to maintain open communication with your healthcare provider, especially regarding any changes in your condition. If you feel that your concerns are not being fully addressed, seeking a second opinion may provide additional insights and options for treatment. Remember, while surgery is an option for definitive treatment, many individuals find relief through lifestyle changes and conservative management.

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