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Malena secondary to Hemorrhoids.

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Hi. This is embarrassing. I have had blood in my stool for sometime now (over a week). Before that I was constipated or had difficulty with emitting the stool. After that it became easier but with discernible blood coming out each time with the stool. I do not have any other medical symptoms and generally lead a healthy lifestyle, but do suffer from stress and insomnia from time to time. What can the blood in the stool imply?
Thank you.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 19 Doctors Online

Hello,

Thank you for asking your query at DoctorSpring.

I understand your concern, and will try my best to help. I would like to know some additional information from you so that I can provide my best opinion.

1. Is the blood bright red in colour (as in fresh blood). Or maroon / dark
2. Is there any pain in the anal region while passing stools ?
3. Since you are a gay person, do you practice anal sex (as a receiver or passive partner) ? If so was there any pain / bleeding at that time ? Is there any history of use of sex toys ?

You can reply as a followup.
Thank you


Patient replied :

Hi. Thanks for getting back to me. To answer the questions you have posed, in sequential order:
1. It is bright red as in fresh blood.
2. No pain as such, but discomfort. It was more pronounced before as I have stated in my original question. Originally I felt difficulty emitting my stool so really pushed and tried several times a day. I may have overdone this, but there was no pronounced blood as such back then.
3. I do practice anal sex as passive but not regularly and there was no pronounced pain. I have not had any toys or hands or similar in mh anus.


Hello,

Thank you for the additional information.

You are having a lower GI (per rectal bleed), most possibly due to Piles or Hemorrhoids. You have the typical symptoms of Hemorrhoids. This is a pretty common condition and can be managed well.

The first and foremost reason for hemorrhoids is constipation. Constipation puts pressure on the veins to engorege and rupture and a vicious cycle will set it causing more constipation. I have the following recommendations.

1. Avoid over straining while passing stools.

2. Take a high fiber diet. This is very important. Here is the Mayo Clinic data on fiber content - http://www.mayoclinic.com/health/high-fiber-foods/NU00582. Please take efforts to see that you are taking a very high fiber diet.

3. You can use an OTC anti-piles ointment like Preparation H for 4-6 days

4. A stool softener to relieve the constipation may be used (on prescription by your Doctor.)

5. The diagnosis can be confirmed by a per rectal examination. In some cases a colonoscopy might be needed. As a first step you can visit your Family Physician / General Surgeon for the confirmation. Although hemorrhoids are the most likely reason, other caused for rectal bleed needs to be ruled out.

Hope this helps
Please feel free to ask followup questions
Thank you.


Patient replied :

Thank you. The diagnosis at least distances other possibilities which were causing me stress (e.g. colon cancer).
I have one question pertaining to my condition and specifically the requirement to eat high fiber foods. From time to time I get severe excess gas, which in turn causes more frequent visits to the toilet that may exacerbate my hemerroids. Some if not most high fiber foods cause. Laurence, as I found out these past 2 days as I increased my intake of them. So it is a vicious circle, at least as prevalent now. Would you have any suggestion in this regard?



Hello,
This could be a troubling problem, I understand. You have to go for a trial and error method here. For example avoid milk and milk products and see the response and make your own list of fiber rich and stomach friendly food. Most likely this is a temporary phenomenon and will get resolved by itself.

Hope this helps
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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