What causes bright red bleeding despite a normal colonoscopy?

Question

Hello doctor,

I had a colonoscopy less than a month ago, and everything came back completely normal.

However, about a day ago, I noticed a fair amount of bright red blood after passing stool. The blood was seen in the toilet water rather than mixed directly with the stool.

I suspect it might be an anal fissure or similar issue, especially since I have also been passing very hard stools recently. What to do?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

I understand your concern about the bleeding, which can definitely feel worrying. The good news is that you recently had a colonoscopy that came back normal, which is reassuring and usually rules out major colon problems.

Based on what you described, bright red blood in toilet water after passing hard stool is often linked to hemorrhoids (piles) or an anal fissure. Since you also mentioned constipation and hard stools, an anal fissure is quite possible.

Hard stools can slightly tear the sensitive skin lining of the anus, leading to droplet-like bleeding and sometimes pain during or after passing stool.

May I ask a few questions to understand better?

Do you feel pain or burning while passing stool?
Do you sometimes feel fear or discomfort going to the toilet because of pain?
How long have these symptoms been going on?

Constipation and hard stools are major triggers for fissures, so treatment mainly focuses on softening stools and allowing the area to heal. Most cases improve with conservative management, but surgery is rarely needed.

The following things can be done to manage your condition:

Eat a high-fiber diet (fruits, vegetables, whole grains) to help soften stools.
Take Duphalac syrup - 2 teaspoons, three times daily (only if your doctor confirms it is suitable).
Drink plenty of water throughout the day to help prevent constipation.
Do sitz baths (sit in warm water) for 15 minutes, twice daily, to reduce pain and support healing.
Apply Lignocaine gel mixed with 0.2 percent GTN (Glyceryl trinitrate) ointment two to three times daily to relax the muscle and reduce discomfort.
Take Naproxen sodium twice daily for pain relief only if it is safe for you to use.

Please continue these measures for at least two weeks to see improvement. Most people recover with this approach.

If symptoms continue despite treatment, procedures like lateral anal sphincterotomy or laser treatment may be considered.

I hope this helps.

Please revert in case of further queries.

Thank you.

What causes bright red bleeding despite a normal colonoscopy?

Bright red bleeding?