Blood??

[loganaj]

Subject:  28 year old male, 5’10, 175.  No familial history of colorectal cancer.  Otherwise in apparent good health, other than anxiety for which I am prescribed Xanax.

Main concerns:
1.  Circa 1999/2000, had a “cowpie” type diarrhea where the top seemed to have a  red blood topping on it.  One time event.  Fine the next day.
2.  The same thing happened again a year later in early 2001, after eating hot chicken wings.  One time event.  Fine the next day.
3.  Happened again a few months later after eating out.  However, the drive required me to hold the diarrhea for about 10 minutes which required extreme strain (cause?).  Then, the cowpie problem with the blood topping.  One time event.  Fine the next day.  Saw the doctor .  Felt for hemorrhoids and only felt a small one.  Administered a hemoccult which was said to be negative.  Said “probably deeper hemorrhoids.”

4.  So, I am fine and it has been nearly two years with nothing similar happening.  But last Tuesday I feel crummy all day.  Had some mild diarrhea twice.  Wednesday, still feel crummy.  Then, Wednesday night around midnight, I wake up with cramps in the beltline area of the lower abdomen.  Off to the bathroom with explosive watery diarrhea.  Then, I was up and down all night with the same problem.  No blood though.  The cramps subside after the stool passes.  Then Thursday comes.  I still feel tired, crummy.  I go to a memorial service ten minutes after going to Arbys.  Then the diarrhea cramps hit me again (beltline.)  Being a memorial, I cannot get up and go to the bathroom.  So I hold it in anguish for about an hour.  Afterward, I rush to the bathroom and explode like the previous night.  This time, the watery diarrhea is mixed with blood.

The next day, I am ok.  A little leftover loose stool like it is drying out.  Still kind of worn out.  Some drier blood kind of mixed into the chunks but obviously remnants from the previous day.  No fever.  BP 137/84. Go to the doctor.  Again he said I probably tore something or have a hemorrhoid deep in the rectum.  I asked for a colonoscopy just to be sure.  But he says that having been two years since the last episode that it is more likely a vascular of hemmorhoid problem than an “organic issue.”  However, he will still order one to rule out ulcerative colitis.

Day after that, back to normal, energy is back, feel totally fine (convinced it is something I ate maybe?)

What on earth could this be?  The only time I ever see blood it is red and only has happened these mentioned times accompanied with diarrhea.  I have never had melena, just these isolated cases of hematochezia.  I might get a soliltary case of diarrhea once every month or two usually after eating out fast or spicy food, overeating, or especially when I am stressed, but never blood.  Does not seem to be to far off from what everyone else I know goes through.  

What can this be?  What about colon cancer?

[Kevin Pho, MD]

At your age, hemorrhoids is the most common cause of rectal bleeding.  However, now that you are having some changes in bowel movements (i.e. watery diarrhea), I agree with an endoscopy.  Either a colonoscopy or a flexible sigmoidoscopy would suffice.  

Other causes would include inflammatory bowel disease or other causes of colon inflammation that can cause diarrhea and bleeding.  Very rarely, there are some endocrine tumors that can present as watery diarrhea, but I think that this should be considered if the other causes have been ruled out.  

I would also consider evaluation for malabsorption if the colonoscopy is negative - this can also present as unexplained chronic diarrhea.  

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.

Thanks,
Kevin, M.D.

[loganaj]

Sorry to bother again.  What exactly defines chronic diarrhea?  I might only experience it once every month or two, and that being some quick gassy cramps and a 2 minute trip to the bathroom like I ate something that didn't agree, with no more diarrhea after that (not like I am in and out of the bathroom all day).  And the blood problem has only occurred the mentioned times.

Thanks!

[loganaj]

Well, I went for the colonoscopy and the Dr. said he found a small pollyp, just under 1cm in my rectum.  I asked if it was a hyperplastic polyp and he seemed to think so (which is benign and does not become malignant).  However, he said this polyp was not the cause of the bleeding, and that I had a fissure that was responsible!

Well, funny thing is I have no pain in that area, so how could I have a fissure?

[diarrheaguy]

A related discussion, Diarrhea Question was started.