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Heavy rectal bleeding with pain, weight loss. Cause?

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I am a 33 year old, male of Indian origin. I am 166 and weight 74 kg. I have been getting intermittent rectal bleeding for 6-8 months, occurring once a month. Usually these are short lived and easily managed with an anti inflammatory cream. In the past I have also experienced bleeding after heavy exercise ( running ).

However the latest bout of bleeding has been more prolonged lasting around a week. The blood is bright red, there is a fair amount steaked on the stools, sometimes in the bowl as well and also on the toilet paper. Passing a stool had become increasingly painful. I have become constipated the last couple of days and this morning had to assist passing some of the stools. When I did this my fingers were covered in blood.

I have lost a lot of weight over last 6 months (10-12 kg) but have put this down to lifestyle changes as well ongoing treatment for an underactive thyroid. ( my dose has been increased steadily for the last six months as well ).

I have not been exercising for the last month due to a bout of bacterial bronchitis that was successfully treated with antibiotics. After that passed the rectal bleeding started.

Usually I am not constipated and pass two stools a day.
I am drinking plenty of water and eating fibre as most of the home remedies for piles suggest so this last bout of constipation is weird. Also feels like there is a blockage in my rectum making it hard to pass the stools. It is painful to pass stools ( but not excruciating ). It definitely feels like there is a problem around the anal area, rather than anywhere else in digestive tract. I have no stomach pain or indigestion and can't see or feel any lumps. I have a little tired off late , but not fatigued.

I have seen a doctor recently pwho said he could not see any external hemorroids but said the area was red and inflamed. He referred me to another specialist doctor but that appointment is not until Tuesday. Should I worry about not being able to go to pass stools? And also about the blood ? At what point does it become urgent enough to consult immediate help? Can I wait till Tuesday for my appointment with the specialist ?


Category: Gastroenterologist, Medical

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Category: Hepatologist
Dr. Ratnakar Kini is online now

Expert:  Dr. Ratnakar Kini replied 4 Days.

Hi
Thanks for your query at DoctorSpring.com
I understand your concern.
I am Dr.R.K and I am pleased to assist you.
I went through your post about bleeding per rectum.
Passing bright red blood indicates the bleeding source is lower down in the colon especially the left colon.
The two most common causes are hemorrhoids and anal fissure.
With episodes of constipation , painful bowel movements and blood streaked stools point more towards anal fissure.
Since you have mentioned about digital evacuation also, the next possibility is solitary rectal ulcer.
You can consult the specialist on Tuesday. There is no need to go to ER.
Till then, the following may be done.
1. Take high fiber diet
2. Drink enough fluids. A good urine output and a moist tongue are good indicators that you are drinking adequately.
3. Take miralax which will help in easing the bowel movements
4. Do sitz bath- sit in a tub of lukewarm water exposing the anus to it for 10 minutes twice a day.
5. Apply lignocaine jelly in the anal opening for pain relief.
I hope that answers your query.
Let me know if I can assist you further.
Regards,
Dr.R.K.


Patient replied :

hi thanks for the answer . This helped. Today I noticed for the first time a small pea sized lump coming out of my anus . I guess this is an external hemorroid ?

What should I do ? Is it still something that needs me to see a gastro specialist or should I go back to my family doctor / gp again? It is painful to walk and a little painful to sit down. I'm trying to push it back in but it's not so easy
Should I just continue with the treatments above ?


Expert:  Dr. Ratnakar Kini replied 3 Days.

This confirms that the cause of the bleeding has always been hemorrhoids.
I will advise you to meet a general surgeon who can physically examine and based on the grade can advise further management. You can meet either a gastroenterologist or a general surgeon as both are specialists in such cases.
Regards.


Patient replied :

Just to follow - plus I have another question.
I went to see the specialist who did a digital and proctoscope examination. He said it was an acute anal fissure like you initially thought and prescribed a cream which is meant to increase blood flow ( i think ) .
This was about 1 month ago - 5 weeks ago. The bleeding stopped and the area felt quite a lot healthier and without pain ( during passing stools ) .
About 2 weeks ago i started exercising again. I do quite intense exercise ( weights, HIT and cross trainer ) - it feels like this could have aggrevated my anal region again - and i have started getting bleeding again on the last 2 days. Small amounts on the tissue ( relative to before ) - but stools are blood streaked - and my anus doesnt feel as healthy.
what should i do ? Should i stop exercising? Also one thing that is worrying me - Is there a chance this is anal cancer?


Expert:  Dr. Ratnakar Kini replied 2 Days.

Anal fissures are prone to recurrent bleeding, if not treated properly.
Please consult a general surgeon who can advise you further management since medicines are not helping.
And, no this is not suggestive of anal cancer.
Regards.


Patient replied :

Just to follow - plus I have another question.
I went to see the specialist who did a digital and proctoscope examination. He said it was an acute anal fissure like you initially thought and prescribed a cream which is meant to increase blood flow ( i think ) .
This was about 1 month ago - 5 weeks ago. The bleeding stopped and the area felt quite a lot healthier and without pain ( during passing stools ) .
About 2 weeks ago i started exercising again. I do quite intense exercise ( weights, HIT and cross trainer ) - it feels like this could have aggrevated my anal region again - and i have started getting bleeding again on the last 2 days. Small amounts on the tissue ( relative to before ) - but stools are blood streaked - and my anus doesnt feel as healthy.
what should i do ? Should i stop exercising? Also one thing that is worrying me - Is there a chance this is anal cancer?



Dr. Ratnakar Kini
Category: Hepatologist
Experience: 
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
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