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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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Category: HIV- AIDS Specialist
 26 Doctors Online

Hello.



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


Hello.



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. 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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