rectal bleeding and need for further evaluation

I am a 36yo female and I want to know if I need to pursue further evaluation for rectal bleeding.  I had a colonoscopy in June 2004 to evaluate mucus stools and an endoscopy to rule out Celiac. These were normal and diagnosed as IBS.
I was diagnosed with iron defecient anemia in October 2006 after visiting my GYN due to very heavy menstrual periods. Coincidentally, the same month as this diagnosis, I experienced my current condition of occasional rectal bleeding after a bm.  My Gastro did a DRE and checked for blood in the stool with neg. results. Her opinion was that since I had a recent colonoscopy, the rectal bleeding was indicative of hemmorhoids. She said to call back if the symptoms get worse. I've never had rectal bleeding before and I was concerned because I am anemic. The Gastro said she felt sure this was due to the heavy periods. I wanted to know if this diagnosis sounds sufficient.

[Kevin Pho, MD]

I agree with the workup thus far, and the colonoscopy would have ruled out many of the major disorders (i.e. cancer, polyps etc.).  

An anoscopy or flexible sigmoidoscopy can be considered to look for specific hemorrhoids, or to ensure no growths have occurred in the meantime.  If that is negative, it is less likely that it is coming from the GI tract.  Continuing to obtain stool occult tests can be considered to ensure it is coming from the GI tract, as opposed from menstrual bleeding.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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