Q. Do anal fissure present with diarrhea and blood in stool?

Answered by
Dr. A V Hussain Shihaz
and medically reviewed by Dr. Vinodhini. J
Published on Jan 10, 2020 and last reviewed on: Jan 13, 2020

Hello doctor,

I am a 22-year-old female. I have been having some symptoms for two years. It started with noticing some blood on the toilet paper, went to my GP and he said probably hemorrhoids nothing to worry about and then, I started having diarrhea with blood on the toilet paper again. Then I had constipation with blood in stool. I went to see a specialist that said I had a fissure. Then four months ago, I started having too much diarrhea (at least once a week) and gas and borborygmi after every single meal, no matter what I ate. I went to the specialist, I did celiac test negative and my blood tests all look fine. All my doctors said that I have nothing that it is probably stress but I am too worried. How can I convince them to give me a colonoscopy?

Dr. A V Hussain Shihaz

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

I have gone through your query in detail. A few details which could be helpful are, have you lost weight? Do you have anemia or any abdominal pain? Have you had a fecal calprotectin done?

Apparently, your symptoms have been going on for close two years and specifically since you have had diarrhea with blood on toilet paper, it is unlikely to be due to anal fissures. Anal fissures usually are precipitated by constipation and quite unlikely with diarrhea. Persisting diarrhea and bloating is more in keeping with symptoms of inflammatory bowel disease (IBD) especially since the celiac markets are negative (anyways celiac disease is unlikely to cause blood with diarrhea). On these grounds, you can certainly insist on a colonoscopy.


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Thank you doctor,

I have lost weight but I do not eat much because of the stress that all this is causing me. No anemia or abdominal pain but sometimes when I wake up in the morning right before diarrhea I have some abdominal pain. When I went to the doctor right after I had diarrhea with blood and then after constipation with blood I insisted on the fact that it cannot be an anal fissure with it and the doctor said that it might be false diarrhea that comes with constipation.

I have not done the fecal test. I am really worried that it might be colon cancer especially since my blood work does not show any inflammation and all markers for IBD. I do not know if this is a symptom, but I also have been experiencing mouth sores a lot.

Dr. A V Hussain Shihaz

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

At your age (22) and the symptom duration you have mentioned of two years I would not be considering cancer anywhere on the top possibilities, but Inflammatory bowel disease as the first possibility. Usual inflammatory markers may be low or negative except for fecal calprotectin. Mouth sores would again add weightage to the probability of IBD. I think it is advisable to have a discussion with your GP regarding your concern and insist on a colonoscopy.


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Hi doctor,

Thank you so much for your help.

Dr. A V Hussain Shihaz

Medical Gastroenterology
#

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.


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