Possible diagnosis

[JW184]

I have not yet seen a doctor, but I wanted to describe my problem so that I have an idea what I should expect (mostly because I'm concerned). I selected the topic area of IBS arbitrarily, though I have some symptoms of it.

I'm 20, male, normal weight. No health problems (at least that I think are relevant, I have a wrist injury). Several weeks ago, I started noticing blood in my stool. Naturally I found this hard to talk about so I haven't said anything to my parents (both in the medical field) or scheduled an appointment to get it looked at (though I will do so this week).

There isn't really pain during its passage, but after there is some discomfort for a while (somewhat itchy, irritated). It goes away after maybe an hour. In the stool itself, the blood appears in a sort of streak (a pretty clearly delineated vertical line), sort of fading as it goes. There is some elsewhere, but its hard to see. Then, at the very end there tends to be blood. It looks like, sometimes, there is some other kind of discharge in small amounts, mucus possibly (whitish).

Initially, there was blood on the toilet paper. That has not been the case the last week or so (except sometimes in very small amounts). The amount in the stool itself has probably decreased marginally but it's hard to say.

Though I only recently connected it to my problem, I did have an unusually violent bowel movement (diarrheal) roughly prior to the start of the bleeding. That could be related I imagine, but I didn't take special note of it so I can't guarantee the closeness of the timing; I do know the BM happened first, and I'm close to certain it was less than a week later the bleeding began (maybe as little as the next BM).

Lastly, there is no history of colon problems or bowel disease of any kind I'm aware of in my family. However, I have some Jewish ancestry and Crohn's disease is more common in that group from what I've read.

I'm going to stop putting it off and call a doctor for an appointment, but I wanted to know more before going in. Thanks in advance for your help.

[Kevin Pho, MD]

Any rectal bleeding isn't normal.  Possible causes would be hemorrhoids, infectious diarrhea, inflammatory or an anal fissure.  Being only 20 years old, things like colorectal cancer or a colon polyp would be less likely.  

In any case, this certainly should be evaluated by a physician.  An anoscopy can evaluate for distal lesions (for instance a hemorrhoid).  If there doesn't seem to be a revealing diagnosis, a flexible sigmoidoscopy can be considered to evaluate for more serious causes.

You may want to discuss this option 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.
Medical Weblog:
kevinmd_b

[Biskie2]

You probably have hemmoroids (hemorrhoids), especially after a violent BM, or if you are straining too hard. If you see bright red blood, it is at the very end of the large intestine/anal area.

[surgeon]

More likely a "fissure" which is a tear in the skin overlying the control muscle at the anus. They can sometimes be very painful; in other cases they cause the itching and irritation you describe. They may heal on their own if you keep your stools easy to pass, by using fiber, drinking plenty of fluids, sometimes taking mineral oil for  several days. At your age it's pretty unlikely to be something serious; bleeding such as you describe suggests something right at the anus, as opposed to a more significant chronic bowel disorder. If it persists, it needs to be evaluated to be sure what it is. If it's a fissure which doesn't heal on its own, there are topical medications that usually do the trick. In some cases a minor operation is required, but since you're not having severe pain, that's pretty unlikely.