IBD, colitis, hemorrhoids...

I am a 25yo female. Diagnosed with hemorrhoids 7 years ago, GERD 5 years ago (but had symptoms for a decade or more before diagnosis.Now taking Acifex for the last year.Diagnosed with Vulvar Vestibulitis, told to try limiting Oxalate intake 7 months ago. 6 months ago had problems with bloating after eating anything, also somewhat constipated, doctor diagnosed as IBS, scheduled a colonoscopy. Colonoscopy results showed microscopic Inflammation and colitis.

Started taking Metamucil twice a day. On the first day I had blood on the toilet paper (not in toilet) after a bowel movement that was a regular movement, there was no pain. Had another movement with blood the next day, in the same manner, and decided to stop taking the Metamucil.**A week later I had a very large amount of blood on the toilet paper, and in the toilet, and the stool was loose, 'flakey' and somewhat painful to pass. Throughout the day there was minor irritation at the anus and a feeling of swelling in my lower tract which made me feel the constant need to have another bowel movement. I've been having several small very broken up, mucusy movements a day recently, mainly in the morning. Lastly, I've also been bloating which is limiting my appetite. I am confused between hemorrhoids and colitis. If this is hemorrhoids, would the colonoscopy have mentioned hemorrhoids? Does this sound like a flare up of IBD/colitis? Or more hemorrhoids? Should I consult my doctor, even though I'm well aware I have causes for blood in my stool that everyone's aware of - is there a point?

I am confused by my doctor's suggestion to take Metamucil regularly, while articles online suggest limiting fiber intake. Are the articles talking about insoluble fiber? While Metamucil is soluble? Or should I avoid the Metamucil? I'm afraid to take it again, although I've had a bloody bowel movement (while not taking Metamucil) that was much worse than the others when I was taking the Metamucil, I'm very confused now.

Thanks!
DDP

[Ratnakar Kini, MD]

Hi,
If carefully done, hemorrhoids will be clearly seen especially while withdrawing the colonoscope.

The bleeding - whether it is due to IBD or hemorrhoids is a tricky thing.
If IBD is limited to rectum , then bleeding will resemble that of hemorrhoids and it is difficult to say by looking at the nature of bleeding alone. But one point that helps to differentiate is- in IBD  a mixture of blood and mucus is passed.Moreover there will be increased frequency and an urgency to defecate and there will be only blood and mucus and no fecal matter.

Your symptoms fit in to IBD and so we can consider it a flare up.
Consult your gastroenterolgist.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.