Rectal Bleeding

[Hunter926]

I have written before on this subject, but have some updated information.  I have had some form of rectal bleeding three or four times over the past year.  The pattern is always consistent.  I have a BM in the morning, then exercise (two mile run), then subsequent to the run, I have anal itching.  I wipe and find a little “pinkish” blood mixed with “stool residue” on the toilet paper.  I brought this fact to the attention of my family physician several weeks ago.  He thought it was probably due to some form of irritation, but this may be a good excuse to get insurance to pay for a colonoscopy to rule out anything more serious (if he had his way, all men would get a baseline colonoscopy done by age 50).  We also did the fecal stool sample cards, and all three were negative for occult blood, and, he performed a DRE and noted no evidence of hemorrhoids.

I have never seen blood on the stool or in the bowl, and have never seen blood on the paper directly following a BM.  These occurrences have always followed exercise which have followed a BM.  I am a relatively healthy 48 year old male.  There have been no instances of intestinal problems either with myself or my family.  I do have “pruritis ani” (sp?) with notable itching in the perianal area, especially at night.

Questions are:  What is the likelihood that the blood is related to anal irritation only and not significant disease, and, should I seriously consider a colonoscopy given the negative FOBT cards. Obviously, I would rather you tell me that it is probably nothing to worry about and hold off on further investigation based upon the FOBT, but would greatly appreciate a thorough and honest opinion.  

I really appreciate your thoughts.

[Kevin Pho, MD]

Tough to give percentages.  At your age, it is more likely that the bleeding is due to anal irritation - either from wiping, constipation or hemorrhoids.  The probability of colon cancer would increase as you age.

As for endoscopy, it would not be unreasonable to have either a colonoscopy or flexible sigmoidoscopy (it is recommended in everyone age 50 anyways).  However with negative FOBT cards, it can also wait until age 50.  There is no right answer - this is an individual decision and that should 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.
Medical Weblog:
kevinmd_b

[surgeon]

It sounds most like anal irritation, possibly related to hemorrhoids (digital rectal exam really doesn't rule them out). Sigmoidoscopy is much simpler and cheaper than full colonoscopy and would see far enough to rule out anything more serious causing your particular symtoms.