Rectal bleeding

Hi
45y/o Fe nonsmoker, nondrinker with a family history of colon CA (mother, aunt, and uncle) and a personal history of breast CA 9 years ago.
In Dec I suddenly started having some trouble with intermittent constipation, and noticed some blood on the toilet tissue.  Just a little.  Started some Colace, stools softened, no more bleeding.  Increased my fiber and water intake, started a walking program.  
Now, I can't seem to go at all without the Colace.  I went for 4 days recently, w/o a bm.  Bloated up, very uncomfortable.  Finally resorted to taking some Dulocolax before I could go.  Recently, even with the Colace, I am only going every 2 to 3 days.  And my stools are starting to be hard again, and yesterday I noticed a bit of blood again.  I will go to my doc this week, but do you simply think my body is sort of addicted to the Colace at this point?  I eat tons of raw veggies, and drink plenty of water.  
I have never had this problem before.  I have regular colonoscopies, nary a polyp to be found.  No rectal stinging or burning or fissures that I can tell.  Just the constipation and a tiny bit of blood on the tissue.

Thanks!

[Kevin Pho, MD]

Hello - thanks for asking your question.

Colace is a medication that is not meant to be used long term.  It has been shown that prolonged use has led to dependence and then it ceases to be effective.  

If the history and physical examination do not reveal the cause of chronic constipation, an imaging study (i.e. endoscopy) of the colon and rectum should then be performed to exclude mass lesions, strictures, megacolon, and megarectum.

A normal imaging study should lead to a search for problems causing abnormal transit and pelvic floor dysfunction. Colonic marker studies are useful for this purpose; a normal study should prompt a therapeutic trial, while an abnormal test should lead to defecography or manometry to test the pelvic floor.

These tests should be performed in discussion with your personal gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.