Dr. Basuki Nath Bhagat
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have noticed some bleeding in my stool from last week. I consulted a private GP (general practitioner), and he examined the rectal area but could not find anything. He also did a stomach exam and could not find anything. He said it was reassuring that my blood count was normal. I did have a colonoscopy last year, and everything was normal. I also had a CT (computed tomography) scan of my bowel. I was instructed to perform a quantitative fecal immunochemical test (qFIT), which showed an elevation. The doctor told me he is not overly concerned but is referring me to see gastroenterology just to be sure. I do suffer from chronic constipation and do have to strain even while taking laxatives such as Laxido. I later consulted another GP, and they did a rectal exam and found a small external hemorrhoid, which might be a cause. Could the external hemorrhoid be a cause? I have no other alarming symptoms, such as weight loss. Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I have read the query, and I can understand your concern.
Yes, external hemorrhoids could be the reason for blood in the stool, and you have mentioned chronic constipation as well. Chronic constipation aggravates such a condition and even causes anal fissure.
Do you feel any mass in the perianal area?
Is the stool mixed with blood or drops of blood coming while wiping?
What treatment does your GP (general practitioner) have advised?
Is there any pain while defecating?
Please reply to the above questions to guide you precisely.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I do not have a fissure or mass in the perianal area. The stool is mixed with blood and sometimes on wiping. The GP (general practitioner) has given me treatment for the hemorrhoids, and I have also got a small anal skin tag. Sometimes it pains on defecation. The qFIT (quantitative fecal immunochemical test) test was 14 µgHb/g, while the cut-off point in my country is 10 µgHb/g. I am also going to have a sigmoidoscopy in just over a week.
Hello,
Welcome back to icliniq.com.
I have read the query, and I can understand your concern.
You have mentioned there is no external mass palpable and no anal fissure, and your qFIT point is 14 µgHb/g. The quantitative fecal immunochemical test (qFIT) is a non-invasive screening tool designed to detect occult (hidden) blood in the stool. But in your case, there is frank blood coming out, and hence, it has to be above the cut-off point. If the hemoglobin level is low and the cause of the blood loss is unclear, this test is advised. Anyways, doing a sigmoidoscopy would help you to identify if there is any growth or polyp in the sigmoid colon and the reason for the present rectal bleed other than hemorrhoid. The diagnosis of hemorrhoid is clinical, and it needs a patient visit to the doctor. In your case, it seems you have an internal hemorrhoid. Kindly follow the treatment advice by your doctor and do a sigmoidoscopy to rule out other reasons. Since one of the GPs (general practitioner) did not identify hemorrhoids and the other did, the reason is not very clear. I suggest undergoing a colonoscopy to examine the whole of the colon to find a cause for the present bleed other than hemorrhoid. You can attach a colonoscopy or sigmoidoscopy report if you need any guidance.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
Do you think there could be anything sinister, given that I have had recent investigations? My blood count was normal. I consulted a gastrologist today, and he saw an external hemorrhoid. He says it is nothing sinister and could be a result of straining as well due to chronic constipation. I did have a colonoscopy last year, and it was difficult to examine due to poor veins. I was unable to get sedation, and I found it painful. They were only able to get around half of it, and I underwent a CT (computed tomography) scan to get around all of the bowel a week later. I have had no bleeding for a few days. Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I have read the query, and I can understand your concern.
Based on your medical history, I do not think there is any serious issue. Yes, chronic constipation can cause intermittent bleeding. I would suggest the following:
Do a sitz bath three times a day for five days.
Syrup Looz (Lactulose) or any other laxative 20 ml before bedtime to make your stool soft. Avoid if there is any diarrhea episode.
Apply Anovate (Phenylephrine, Beclometasone, and Lidocaine) cream locally two times a day for five days.
Eat a high-fiber diet and maintain adequate hydration.
Consult a specialist doctor, talk to them, and then take the medication. The treatment aims to prevent constipation. Chronic constipation causes swelling of the anal canal lining and mucosal tear, which manifests as bleeding, and this repeated cycle continues with the on-and-off bleeding episodes. Do sigmoidoscopy if necessary and avoid colonoscopy based on your medical history.
I hope this will help you.
Thank you.
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