What causes painless rectal bleeding with hard stools?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I have reviewed your medical history in detail, along with the pictures you have attached (attachments removed to protect the patient’s identity).

The most common cause of painless, fresh per rectal bleeding in a small amount, as you described, is hemorrhoids, either external or internal. External hemorrhoids, also known as piles, can be felt while washing, whereas internal hemorrhoids cannot be felt as they are located along the internal anal cushions.

On reviewing the first picture you shared, the initial stool passed was quite hard, lumpy, and of a larger diameter. Another important point to note is that the color of the stool was normal, which suggests that the bleeding is coming from near the anal verge rather than from the proximal large intestine.

This condition usually resolves with time, as seen in your case. There is no history of abdominal pain, diarrhea, or other alarming symptoms such as fever, making an infection highly unlikely.

The single best precaution to prevent such bleeding in the future is to avoid constipation and hard stools. For this, I suggest you follow these instructions:

1. Drink plenty of water and consume a high-fiber diet.

2. If stools remain hard, a simple laxative in a small dose, such as Sodium picosulphate syrup 5 ml once daily or as needed, should be sufficient.

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

I will answer your questions one by one.

The picture (attachments removed to protect the patient’s identity), you are referring to, is from the time you went to pass stool again after a few hours. Mucus is a normal product of the large intestine that helps move stools. When there is little or no stool left in the colon, or when a person strains to pass stool again, some mucus may occasionally be expelled.

Another explanation is that whenever there is mucosal injury, such as hemorrhoids or erosions leading to bleeding, there is increased mucus production to help healing by forming an additional protective layer over the erosion.

Regarding the color of blood, fresh blood appears red, blood present for a few hours may appear as maroon-colored clots, and blood present for many hours, such as 10 to 12 hours, becomes black, leading to black stools. This occurs because gut bacteria act on blood proteins.

Since you experienced bleeding again, a simple digital rectal examination by a doctor or an examination using a small instrument called a proctoscope would be helpful to identify internal hemorrhoids.

Based on the clinical history we discussed, the most likely cause remains hemorrhoids, which are one of the most common causes of painless, small amounts of bleeding or streaks of blood on large, lumpy, normally colored stools.

Try to avoid constipation and large, lumpy stools for a couple of days to give time for the hemorrhoids to heal. In case of persistent symptoms, even if hemorrhoids are present, further investigations should be considered, including colonoscopy. It is advisable to treat common causes first and observe the clinical response.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.