Hi
Thanks for your query at DoctorSpring.com
I understand your concern.
I am Dr.R.K and I am pleased to assist you.
I went through your post about bleeding per rectum.
Passing bright red blood indicates the bleeding source is lower down in the colon especially the left colon.
The two most common causes are hemorrhoids and anal fissure.
With episodes of constipation , painful bowel movements and blood streaked stools point more towards anal fissure.
Since you have mentioned about digital evacuation also, the next possibility is solitary rectal ulcer.
You can consult the specialist on Tuesday. There is no need to go to ER.
Till then, the following may be done.
1. Take high fiber diet
2. Drink enough fluids. A good urine output and a moist tongue are good indicators that you are drinking adequately.
3. Take miralax which will help in easing the bowel movements
4. Do sitz bath- sit in a tub of lukewarm water exposing the anus to it for 10 minutes twice a day.
5. Apply lignocaine jelly in the anal opening for pain relief.
I hope that answers your query.
Let me know if I can assist you further.
Regards,
Dr.R.K.
Patient replied :
hi thanks for the answer . This helped. Today I noticed for the first time a small pea sized lump coming out of my anus . I guess this is an external hemorroid ?
What should I do ? Is it still something that needs me to see a gastro specialist or should I go back to my family doctor / gp again? It is painful to walk and a little painful to sit down. I'm trying to push it back in but it's not so easy
Should I just continue with the treatments above ?
This confirms that the cause of the bleeding has always been hemorrhoids.
I will advise you to meet a general surgeon who can physically examine and based on the grade can advise further management. You can meet either a gastroenterologist or a general surgeon as both are specialists in such cases.
Regards.
Patient replied :
Just to follow - plus I have another question.
I went to see the specialist who did a digital and proctoscope examination. He said it was an acute anal fissure like you initially thought and prescribed a cream which is meant to increase blood flow ( i think ) .
This was about 1 month ago - 5 weeks ago. The bleeding stopped and the area felt quite a lot healthier and without pain ( during passing stools ) .
About 2 weeks ago i started exercising again. I do quite intense exercise ( weights, HIT and cross trainer ) - it feels like this could have aggrevated my anal region again - and i have started getting bleeding again on the last 2 days. Small amounts on the tissue ( relative to before ) - but stools are blood streaked - and my anus doesnt feel as healthy.
what should i do ? Should i stop exercising? Also one thing that is worrying me - Is there a chance this is anal cancer?
Anal fissures are prone to recurrent bleeding, if not treated properly.
Please consult a general surgeon who can advise you further management since medicines are not helping.
And, no this is not suggestive of anal cancer.
Regards.
Patient replied :
Just to follow - plus I have another question.
I went to see the specialist who did a digital and proctoscope examination. He said it was an acute anal fissure like you initially thought and prescribed a cream which is meant to increase blood flow ( i think ) .
This was about 1 month ago - 5 weeks ago. The bleeding stopped and the area felt quite a lot healthier and without pain ( during passing stools ) .
About 2 weeks ago i started exercising again. I do quite intense exercise ( weights, HIT and cross trainer ) - it feels like this could have aggrevated my anal region again - and i have started getting bleeding again on the last 2 days. Small amounts on the tissue ( relative to before ) - but stools are blood streaked - and my anus doesnt feel as healthy.
what should i do ? Should i stop exercising? Also one thing that is worrying me - Is there a chance this is anal cancer?