Dr. Ajeet Kumar
Medical Gastroenterology
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
Hi doctor,
I gave birth to a baby through a C-section three months back. I was constipated before three weeks and had a hard stool the next day, and I felt little blood on the tissue, but I could not confirm. However, the next day, I had blood in stool and on tissue paper, too, as I attached the picture with a lot of blood on the tissue. I went to my physician on the same day, and she checked with a digital rectal examination and told me she did not see any blood or hemorrhoids. However, she told me it might be a year and asked to use Metamucil and Colace. The next day, I did have blood in my stool again. Initially, it was fine, but when I did a second push, I had blood at the end of the poop. I had a little stabbing or pinching needle-like pain when passing it and a little on tissue, as I attached in the picture. After that, it did not repeat, and I did start taking Colace and Metamucil, and I have been taking them. However, not sure when exactly it started. Still, rectal pressure felt as if I had to defecate. Sometimes if I fart, it goes away, and sometimes there is nothing to fart or defecate. I had this feeling three times in my entire pregnancy, and my physician told me it might be because of my placenta location and baby position. I am currently breastfeeding. Before this all started, my water intake dropped to 1 L a day, and I did eat a lot of outside food. I consulted a proctologist last week. He checked with an anoscope and told me everything looked fine inside. I asked him about rectal pressure, and he suggested giving it some time, increasing water intake, and taking Metamucil and Colace. But I am so stressed if it is colon cancer or something. To add up, I have acid reflux, so I take Pepcid every night. I did have blood in my stool three years back, and the doctor told me it was a hemorrhoid. I was very constipated and had hard stools back then. But I do not remember having any rectal pressure. I am trying to go for second opinions. So please help me in pointing right direction and path. I have no such family history. My diet was very low on fiber, and my water intake was a bit low. Now I am trying to drink at least one to two liters daily. I feel burning in the anus for some time after defecation. I feel like I still have something in the back of my rectum and want to push it out. I have no history of fever. But I do have slight lightheadedness, on and off from the time of pregnancy. When coming to weight loss, I lost my pregnancy weight a bit gradually before this all started. Kindly help, doctor.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
It is not uncommon to have gut upset at the time of pregnancy, and this is because of weight gain, water retention, the pressure of the gravid uterus over the bowel loops, and decreased water and fiber intake as in your case. Since you have been recovering fully to the back of normal, the gut upset also takes some time before it settles completely. At the moment, from your history, I suppose you have an anal fissure. The sting-type pain, pain worsening while passing stools, and pressure continuously in the anal or rectum, suggest this diagnosis. But I am a little surprised that nothing abnormal came on the digital rectal examination. The anal fissures are severely painful, and patients even do not allow to have an examination since it generates excruciating pain. The second possibility is hemorrhoids or piles that bleed intermittently, and they cause a gagging type of mild intensity pain, which is not severe. But both are relatively benign conditions that mean nothing serious.
Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
I have attached the images of the stool and blood, doctor. I am worried that my physician and proctologist told me everything looks fine. Then does that mean the bleeding is internal? And I doubt I have colon cancer. I have attached today's stool also, doctor, with a reddish tinge here and there not sure if that is blood or not. Kindly help, doctor.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
From the pictures you have attached (attachments are removed to protect the patient's identity), the color of the blood, which is fresh red in one picture, suggests the cause is the lower gastrointestinal tract, meaning the left side of the colon. Before creating any more anxiety and assumptions, there is no harm in going for a complete colonoscopy to see if your bowel is causing this blood. Colonoscopy is a relatively non-painful procedure whereby an endoscopist will pass a tube from the anal opening and see the entire colon length with a camera fitted at the front of the scope. With this, we can diagnose the condition. Please remember that given your age and very short-lived symptoms of blood in stools, do not conclude that you have colon cancer. Many more benign conditions can cause a similar type of bleeding. I hope it helps.
Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, even though I wanted to get a colonoscopy, they are booked until the end of this year. And for your information, the one with blood on the tissue is the first-day occurrence.
Hello,
Welcome back to icliniq.com.
I do not think this is serious since there has been only one episode of fresh blood, and never before. You can wait till the end of the year. I suggest you avoid constipation by taking Ispaghula (Psyllium) husk once daily with a glass of water. And I also suggest you take capsule Tranexamic acid 1 mg (antifibrinolytic) to stop bleeding if it recurs. Consult your specialist doctor, discuss with them and take medicines with their consent.
Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
My primary care provider suggested a CT (computed tomography) abdomen and pelvis scan, without any preparation. I had my last meal around 8 pm and nothing other than water in the morning. Will the results be accurate, doctor? I have attached the reports. Kindly help, doctor.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
The CT (computed tomography) scan accurately finds any major problem. You have a completely normal CT scan report (attachments are removed to protect the patient's identity), which is satisfactory. But a CT scan has limitations, like it does not elaborate or explain subtle findings in the intestine, say large or small intestine. A colonoscopy is quite a good test since it can diagnose very subtle findings within the large bowel. I suggest you go for it but make sure the doctor is well experienced.
Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply.
As I mentioned earlier, I am already on the wait list for a colonoscopy. The only thing that concerns me is they are booked till year-end and only available next year. What if it is cancer and takes so long to get a colonoscopy?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Well, cancers are extremely uncommon at this age. Secondly, you no more have these symptoms of rectal bleeding. Bleeding can occur due to anal fissures, hemorrhoids, solitary rectal ulcer syndrome, hyperplastic polyps, external hemorrhoids, angiodyplasia, and a few others. For your age, none of them is cancerous. Considering cancer at your age is highly uncommon, there is a high chance that you have the former problem. Better is to avoid anxiety and wait for the time. Otherwise, you can reach out to some private hospitals; they may consider doing it earlier.
Thank you and take care.
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Medical Gastroenterology
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