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Reason for ULCER with bright red stools and low blood iron stores?

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I have had diarrhea for 8 weeks but blood in my stools 4/5 times today. I've been on ozamperole for severe heartburn for 4 weeks aswell for a possible ulcer. Stopped taking the meds 2 weeks ago & heartburn back. Very worried about passing blood though. It's quite a bright red. Had blood test 4 weeks ago which showed low iron stores. Thanks

Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.


Thank you for your query at DoctorSpring.com.

I understand your concern.

Bright red blood in stools indicate the bleeding is from either the colon or lower down like the rectum or anus. Stomach ulcer, if at all present, causes dark brown blood or tarry stools when it bleeds, not fresh bright blood.

Since you have had diarrhea from 8 weeks, there is a possibility of you having developed hemorrhoids causing the blood in stools. However, chronic infective diarrhea can itself have blood in stools. I would like some additional details for a definitive opinion.

- When you say diarrhea, can you please mention if the stools are loose watery/semi solid?

- Any mucus in stools?

- Any abdominal pain? Fever?

- Any anal pain or discomfort while passing stools?

- Is the blood mixed with the stool or splashed with it?

- What was your Hemoglobin level in the test done 2 weeks ago? If it was normal, you need not worry about low iron stores for now.

Please reply to the above in the follow up.

Thank you.

Patient replied :

Thank you for your response.The diarrhea is mainly early morning and night times. It is fairly runny and soft but not watery. It is definitely red through it, like mixed in rather than outside splashes. Had no mucus in it and no pain when passing. I have no fever and I'm not in agony but have a constant dull ache and when the urgency of needing the loo arises then the pain worsens to like a cramp.
not sure what my haemoglobin levels were but they were not mentioned so I assume they were ok. Thanks

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.


Thank you for the additional information.

From your symptoms, the blood in stools seems more likely to be due to hemorrhoids. This has to be confirmed by a per rectal examination. The good thing is it can be easily managed and with adequate measures, it will resolve. The heartburn and chronic diarrhea have to further evaluated to determine cause and for proper management.

I have the following suggestions.

-Please consult your GP/ surgeon for examination and confirmation of diagnosis.

-A routine stool test, if not already done, for evaluating chronic diarrhea.

-An upper GI endoscopy to visualize your food pipe and stomach and look for causes of heartburn.

-You can restart yourself on Omeprazole and take it for a week.

-If in case, rectal examination comes negative, a colonoscopy is required.

-If hemorrhoids are confirmed, then the management will be:

*Fiber intake of 20-30 g/day, You can start a fiber supplement like Metamucil as 10 g in 1 glass of water/juice, three times everyday. 

*Warm sitz baths 2-3 times daily.

I hope that was helpful.

Please let me know if you have any queries.

Thank you.

Dr. Deepu Sebin Sebastian
Category: Select Speciality
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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