Are hard stools with bright red bleeding serious at 25?

Question

Hello doctor,

I am a 25-year-old male. I have suffered from occasional constipation since middle school, sometimes with large, hard stools, sometimes hard to pass. I have occasionally had bright red blood on the surface of the stool and on the paper with sharp pain when passing, followed by burning. I have noticed the most recent bout is seemingly taking longer to feel better. It has been about a week, and I still get a sharp pain, but it doesn't last long. Should I be concerned?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am sorry you are dealing with this, and I understand how uncomfortable and worrying it can feel.

So, the pattern you describe, like longstanding constipation, hard, large stools, bright red blood on the surface, sharp pain during a bowel movement followed by burning, is very typical of an anal fissure, which is caused by passing hard stools, and most fissures heal with simple measures at home.

Start with softening the stool by taking a daily osmotic laxative such as Polyethylene Glycol powder, about one heaping tablespoon or 0.6 ounces mixed in water each day as needed to produce soft-formed stools. Increase dietary fiber to 0.8 to 1.2 ounces daily from whole grains, fruits, and vegetables, and consider a fiber supplement. Drink plenty of fluids, avoid straining, and take warm sitz baths for 10 to 15 minutes after bowel movements to reduce pain and promote healing. Over-the-counter topical analgesics can help with short-term pain, but persistent or severe pain can require topical creams, such as a short course of Nitroglycerin ointment or a topical calcium channel blocker.

If the bleeding is heavy or persistent, if you have black or tarry stools, fever, unexplained weight loss, a new change in bowel habits, a palpable lump, or if the fissure has not started to improve after two to three weeks, then you should visit the emergency room (ER) because chronic fissures sometimes need specialist treatments like botulinum toxin injection or surgical repair, and because other conditions such as hemorrhoids or inflammatory bowel disease can present with bleeding.

Given your age and history, this is likely benign and treatable. Therefore, use a laxative, sit in sitz baths, and follow a high-fiber diet. It will definitely help you.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.