Blood in Stool: When to Consider a Colonoscopy

Blood in the stool?

Hello Doctor: I have issues with constipation and diarrhea that fluctuate; sometimes my bowel movements are smooth, and other times they are difficult.
I often feel like my bowel movements are incomplete, and it frequently takes a long time to finish.
Sometimes, after a bowel movement, I feel a protrusion around the anus.
Last year, I underwent a fecal occult blood test and a blood test for colorectal cancer, both of which were normal.
Recently, I have noticed that after wiping, there is no blood, but there is a dark red sediment that looks like blood in the toilet water.
My stool tends to be dark but does not have blood on it.
This condition has persisted for over six months, occurring intermittently, especially during episodes of constipation.
Last week, I used a laxative for constipation, and the next morning, I passed a mixture of oil with a faint amount of fresh blood.
Should I undergo a colonoscopy?

Zheng, 30~39 year old female. Ask Date: 2016/03/14

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like irritable bowel syndrome combined with 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 the toilet.
Warm sitz baths may also help alleviate symptoms.
You can purchase over-the-counter hemorrhoid suppositories for use.
It is best not to take stool softeners indiscriminately; instead, a light diet and maintaining a good daily routine are advised.
If symptoms persist without improvement, you may consult a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.

Reply Date: 2016/03/14

More Info

When it comes to understanding blood in the stool and determining whether a colonoscopy is necessary, several factors must be considered. Blood in the stool can be alarming and may indicate various underlying conditions, ranging from benign issues like hemorrhoids to more serious conditions such as colorectal cancer or inflammatory bowel disease.

Given your symptoms of alternating constipation and diarrhea, along with the presence of dark red sediment in the toilet water and occasional fresh blood after bowel movements, it is crucial to take these signs seriously. The fact that you have experienced this for over six months, especially with the use of an enema leading to the passage of blood, warrants further investigation.

When to Consider a Colonoscopy
1. Persistent Symptoms: If you have ongoing gastrointestinal symptoms such as blood in the stool, significant changes in bowel habits (like alternating constipation and diarrhea), or any abdominal pain, a colonoscopy is often recommended. These symptoms can indicate conditions that require further evaluation.

2. Blood in Stool: The presence of blood, whether it is bright red or dark, should always be evaluated. Bright red blood typically indicates bleeding from the lower gastrointestinal tract, such as hemorrhoids or anal fissures, while dark red or black stools may suggest bleeding from higher up in the digestive tract.

3. Family History: If you have a family history of colorectal cancer or other gastrointestinal diseases, this increases your risk and may necessitate earlier screening.

4. Age and Risk Factors: Generally, routine screening for colorectal cancer begins at age 45 for average-risk individuals. If you are older or have risk factors, a colonoscopy may be warranted even if you do not have overt symptoms.

5. Previous Abnormal Findings: Since you mentioned having normal results from previous stool tests and blood tests for colorectal cancer, it is still important to consider that these tests can sometimes yield false negatives. If your symptoms persist or worsen, a colonoscopy can provide a direct view of the colon and rectum, allowing for the identification of any abnormalities.

Additional Considerations
- Diet and Lifestyle: Your symptoms may also be influenced by dietary factors, such as low fiber intake, which can lead to constipation and subsequent straining during bowel movements. This can exacerbate issues like hemorrhoids, which may cause bleeding.
- Inflammatory Conditions: Conditions such as ulcerative colitis or Crohn's disease can also present with blood in the stool and require a colonoscopy for diagnosis. These conditions often have additional symptoms like abdominal pain, weight loss, or fatigue.

- Follow-Up with Healthcare Provider: It is essential to communicate your ongoing symptoms to your healthcare provider. They may recommend a colonoscopy based on your history and current symptoms, especially given the duration and nature of your issues.

Conclusion
In summary, based on your symptoms of blood in the stool, changes in bowel habits, and the duration of these symptoms, it is advisable to consider a colonoscopy. This procedure can help rule out serious conditions and provide peace of mind. It is always better to err on the side of caution when it comes to gastrointestinal health. Please consult with your healthcare provider to discuss your symptoms in detail and determine the best course of action.

Similar Q&A

Should You Get a Colonoscopy for Blood in Stool and Abdominal Pain?

Hello, doctor. For the past three months, I have noticed blood in my stool about once a month. The amount is small, but it is bright red and somewhat sticky. There is no blood when I wipe after using the toilet. I usually experience abdominal pain in the morning before going to w...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: You can first consult a gastroenterologist or a colorectal specialist for an evaluation to determine if a colonoscopy is necessary. Changhua Hospital cares about your health. Dr. Tsai An-Shun.

Understanding Blood in Stool: When to Seek Colonoscopy for Peace of Mind

I often experience flatulence, and it has a strong odor. I have both internal and external hemorrhoids, and for the past few days, I've noticed bright red blood in my stool. Initially, there was a small amount of blood on the toilet paper after a bowel movement, and blood at...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: Examinations are conducted to corroborate clinical suspicions. The necessity of the examination should be assessed, especially for invasive procedures. It is advisable to trust the recommendations of your clinician; if the examination is warranted, proceed with it, and if ...

Is Colonoscopy Necessary After Blood in Stool? Understanding Your Options

Hello, doctor. Recently, I have had blood in my stool twice over the past week (I have bowel movements approximately every 2-5 days). I visited the National Taiwan University Hospital Yunlin Branch, where the doctor recommended a colonoscopy. However, since it is a bit far, I ret...

Dr. Cai Jinji reply Gastroenterology and Hepatology
Hello: Each individual's situation varies, and it is important to assess based on family history, medical history, and bowel habits. It is recommended to consult a doctor in an outpatient setting for diagnosis and treatment. Wishing you peace and happiness.

Understanding Blood in Stool: Causes, Concerns, and Colonoscopy Insights

Hello, doctor. I have been experiencing symptoms of blood in my stool for the past few years. The bleeding mostly occurs at the beginning of the stool, with the blood mixed in (I have hemorrhoids, and hemorrhoid bleeding typically occurs at the end of the stool). Occasionally, I ...

Dr. Ke Fangxu reply Surgery
At the age of 25, the likelihood of developing colorectal cancer is not zero, but generally, it is very, very low. Based on your description, it seems more like hemorrhoidal bleeding. It is recommended to maintain a light diet and good lifestyle habits, avoiding spicy, irritating...