Rectal Bleeding

I am a 40 yr old women who has been having rectal bleeding on and off for a few months.  There is no pain involved and it is bright red.    I brought it up to my doctor during my yearly check up/pap test, and she referred me to a GI doctor.  Since then I have had a colonoscopy, small bowel follow thru x-ray, a CT scan and blood tests.

My bleeding will happen with bowel movements, and sometimes for no reason, like I can feel it dripping when I go to the bathroom.  Sometimes its clotty, sometimes it looks like I am having a period out of my rectum.  And other times its just alittle.   It comes and goes.   I have gone for 3 weeks without bleeding, and then it will start up again.   Originally my doctor was worried about rectal cancer because I have had HPV warts around my anus area and she was worried that they spread into my rectum.  In the last 24 months I have had 3 laser procedures to remove them.  It has been 8 months since my last laser procedure and they have not come back.

So far the colonscopy showed some inflammation but she said it looked ok and small bowel follow thru have come back ok.   The nurse for my GI doctor said that the blood tests showed I have Crohns, and that they are prescribing me Asacol to take 3 tablets, 3 times a day.  Does this seem correct?   I have known people with Crohns, and the troubles they have had, but I have none of their symptoms.   I don't have cramping, and lots of diahera or bloating.   I only have painless bleeding....    I don't feel like I have Crohns.  If I have had a flair up, I have not noticed it, unless the bleeding is my flair up.  They also said I need to go back in 6 months for another CT scan.

Will this Asacol stop the bleeding?  Should I make an appt with my general doctor and see what he thinks?   And if I start taking this medicine and keep bleeding, do I just wait 6 months and not say anything until my next CT scan?   Can I really have Crohns with no other symptoms but bleeding?

[Kevin Pho, MD]

To answer your questions:
1) If the bleeding caused by Crohn's, Asacol will help with the inflammation which may stop the bleeding.

2) I would always suggest another opinion if the symptoms continue or the diagnosis is inconclusive.

3) If the bleeding continues, you can consider a bleeding scan to rule out AV malformation and other, more uncommon, causes of bleeding.

4) Crohn's disease can simply present with just bleeding in selected cases.

These questions should be discussed with your personal physician or gastroenterologist.

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.
www.kevinmd.com