Blood in Stool: Is It Just Hemorrhoids or Something More?

Abdominal pain followed by blood in the stool?

Hello Doctor: When I was 20 years old, I experienced rectal bleeding once.
I went to a large hospital, and the doctor diagnosed it as hemorrhoids.
After taking the prescribed medication, I returned to normal.
Now at 30 years old, I haven't had a bowel movement from March 1 to March 3.
Starting from March 4 to March 8, I have been experiencing rectal bleeding during bowel movements, with the toilet bowl filled with bright red blood (it feels like a jet-like bleeding).
Sometimes my stools are thin, sometimes they are normal, and I often feel like I haven't completely emptied my bowels.
Each time I have a bowel movement, the toilet is filled with bright red blood.
Since childhood, my gastrointestinal system has often been problematic; I sometimes experience constipation, and at other times, I have abdominal cramps followed by diarrhea (the stool has a very foul odor).
Occasionally, I notice small white secretions on my stool.
My gastrointestinal function has been poor since I was young, with alternating episodes of constipation, bloating, and diarrhea.
I would like to ask the doctor if this condition is simply due to hemorrhoidal bleeding.
Do I have irritable bowel syndrome or is this a sign of colorectal cancer? Should I go to the hospital for an examination? Thank you for your response.

Meimei, 30~39 year old female. Ask Date: 2016/03/08

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 bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase over-the-counter hemorrhoid suppositories for use, but it is best not to take stool softeners indiscriminately.
Increasing your intake of dietary fiber and fluids should be sufficient.
If bleeding persists, it is advisable to consult a physician.
Additionally, based on your description, there may be signs of irritable bowel syndrome.
It is recommended to maintain a light diet and a good daily routine.
If symptoms continue without improvement, you can ask a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.

Reply Date: 2016/03/08

More Info

Understanding blood in stool can be a concerning issue, and it's essential to approach it with caution. Based on your description, it seems that you have experienced a recurrence of rectal bleeding, which you previously attributed to hemorrhoids. However, the presence of bright red blood in the stool, especially if it appears consistently over several days, warrants a thorough evaluation to rule out other potential causes.

Firstly, hemorrhoids are indeed a common cause of bright red blood in the stool, particularly if the bleeding occurs during bowel movements. They can cause discomfort and bleeding, especially if there is straining involved during defecation. However, given your history of gastrointestinal issues, including alternating constipation and diarrhea, it is crucial to consider other possibilities as well.

The symptoms you describe, such as the presence of fresh blood, changes in stool consistency, and the feeling of incomplete evacuation, 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 sharp pain and bleeding during bowel movements.

2. Diverticulosis: This condition involves the formation of small pouches in the colon wall, which can become inflamed or infected, leading to diverticulitis. This can cause bleeding and changes in bowel habits.

3. Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease or ulcerative colitis can cause inflammation in the gastrointestinal tract, leading to symptoms like abdominal pain, diarrhea, and rectal bleeding.

4. Colorectal Polyps or Cancer: While less common, especially in younger individuals, the presence of blood in the stool can be a sign of polyps or colorectal cancer. This risk increases with age and family history.

5. Gastrointestinal Infections: Certain infections can lead to bloody diarrhea, often accompanied by abdominal pain and cramping.

Given your history of gastrointestinal issues and the recent onset of rectal bleeding, it is highly advisable to seek medical attention. A healthcare provider, preferably a gastroenterologist, can perform a thorough evaluation, which may include:
- Physical Examination: This may involve a digital rectal exam to assess for hemorrhoids or fissures.

- Colonoscopy: This procedure allows direct visualization of the colon and rectum, enabling the doctor to identify any abnormalities, such as polyps, inflammation, or tumors.

- Stool Tests: These can help identify infections or blood in the stool.

- Imaging Studies: In some cases, imaging studies may be necessary to evaluate the gastrointestinal tract further.

In the meantime, it is essential to maintain a healthy diet rich in fiber to help manage your bowel habits and prevent constipation. Staying hydrated and avoiding straining during bowel movements can also be beneficial.

In conclusion, while hemorrhoids are a common cause of rectal bleeding, your symptoms suggest that a more comprehensive evaluation is necessary to rule out other potential causes. Do not hesitate to seek medical attention promptly, as early diagnosis and treatment can significantly improve outcomes and address any underlying issues effectively.

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