Symptoms of Rectal Bleeding: Causes and Concerns

Symptoms of major bleeding?

I have experienced bleeding during bowel movements for two consecutive days.
The bleeding started yesterday, but I forgot to note the stool characteristics; today, the stool is coffee-colored, with two main longer and thicker pieces, while the rest are small (about the size of a soybean) and softer.
The toilet water has turned bright red (with more fresh blood), and it seems there are some streaks of blood in the stool, but it’s hard to see clearly due to the water color.
When wiping with toilet paper, the first sheet was almost completely soaked with blood, while the second sheet had less blood.
About five years ago, I had a similar situation.
Additionally, I had a fecal occult blood test earlier this year, which returned negative.
Can a fecal occult blood test differentiate between bleeding from hemorrhoids and bleeding from polyps? Thank you, doctor.

Shan, 20~29 year old female. Ask Date: 2016/03/13

Dr. Ke Fangxu reply Surgery

This situation is likely indicative 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 hemorrhoidal suppositories for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and hydration should be sufficient.
If bleeding persists, it is advisable to consult a physician for evaluation.
A fecal occult blood test can determine if there is blood in the stool, while the cause of the bleeding can only be identified through a colonoscopy.

Reply Date: 2016/03/13

More Info

Rectal bleeding can be a concerning symptom and may arise from various causes, ranging from benign conditions to more serious health issues. Based on your description of the symptoms, it is essential to understand the potential causes and the necessary steps to take for evaluation and treatment.

Causes of Rectal Bleeding
1. Hemorrhoids: One of the most common causes of rectal bleeding is hemorrhoids, which are swollen veins in the rectal area. They can cause bright red blood during bowel movements, often accompanied by pain or discomfort.

2. Anal Fissures: These are small tears in the lining of the anus, often resulting from passing hard stools. They can cause sharp pain and bleeding during bowel movements.

3. Diverticular Disease: Diverticula are small pouches that can form in the walls of the colon. If they become inflamed or infected (diverticulitis), they can lead to bleeding.

4. Polyps or Colorectal Cancer: Polyps are growths on the inner lining of the colon or rectum, some of which can become cancerous over time. Bleeding from polyps can vary in color and may be accompanied by changes in bowel habits.

5. Gastrointestinal Conditions: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can also lead to rectal bleeding.

Symptoms and Concerns
In your case, the presence of bright red blood in the toilet water and on the toilet paper suggests that the bleeding is likely coming from the lower gastrointestinal tract. The fact that you have experienced similar symptoms in the past raises the importance of seeking medical evaluation. The coffee-colored stool you mentioned could indicate older blood, possibly from higher up in the gastrointestinal tract, but it is essential to correlate this with your current symptoms.

Importance of Medical Evaluation
Given the recurrence of your symptoms and the significant amount of blood observed, it is crucial to consult a healthcare provider. They may recommend several diagnostic tests, including:
- Colonoscopy: This procedure allows direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as hemorrhoids, fissures, polyps, or signs of cancer.

- Flexible Sigmoidoscopy: Similar to a colonoscopy but examines only the lower part of the colon.

- Imaging Studies: In some cases, imaging studies like CT scans may be necessary to evaluate for diverticular disease or other conditions.

Stool Tests and Their Limitations
Regarding your question about fecal occult blood tests (FOBT), these tests are designed to detect hidden blood in the stool. While they can indicate the presence of bleeding, they do not specify the source. FOBT can suggest bleeding from hemorrhoids, polyps, or other gastrointestinal issues, but further investigation is typically required to determine the exact cause.

Recommendations
1. Seek Medical Attention: Given the amount of bleeding and your history, it is advisable to see a healthcare provider as soon as possible. They can perform the necessary evaluations and guide you on the appropriate treatment.

2. Monitor Symptoms: Keep track of any additional symptoms, such as changes in bowel habits, abdominal pain, or weight loss, and report these to your doctor.

3. Dietary Adjustments: While awaiting evaluation, consider increasing your fiber intake to help soften stools and reduce strain during bowel movements, which may alleviate some symptoms.

4. Avoid Straining: Straining during bowel movements can exacerbate conditions like hemorrhoids and fissures, so it is essential to maintain regular bowel habits.

In conclusion, rectal bleeding is a symptom that should not be ignored, especially with a history of similar issues. Prompt medical evaluation is essential to determine the underlying cause and initiate appropriate treatment.

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