Flat Stools

[lodal]

Hi, 40 yr old male, recently had a physical. Dr. found blood in stool (positive feccal occult blood test). Had a sigmoiodscopy and found a small internal hemorroid, no polyps or diverticula. Started checking stool and noticed red blood on somewhat flat stool. Streaks of blood and spots of blood on almost every bowel movement. Had injecction sclerotherapy done 3 days ago. I have noticed that my stool is very flat lately. Still some blood. No constipation or diarhea. Can the flat stools be from the hemorriod, sclerotherapy or something more serious. Very worried!

[surgeon]

A hemorrhoid would not cause flat stools; it's possible the sclerotherapy could temporarily affect muscle relaxation which could affect stool shape. However, I'd say the answer is not yet clear; if the hemorrhoid were the cause of the blood, it should have stopped after treatment. And hemorrhoids don't cause blood within the stool, only on the surface. If the sigmoidoscopy was done with a flexible scope, with excellent prep of the colon, and if it went in as far as possible, and was done by a specialist with the scope, the chance of missing something is fairly low. If it was done by your GP, I'd consider seeing a gastroenterologist to review the situation.

[Kevin Pho, MD]

I agree that a referral to a gastroenterologist would be prudent.  If it were up to me, I would probably go with a colonoscopy.  As has been said, the flex sig is normally good at seeing causes that can change the shape of the stool.  

Regarding the positive fecal occult.  If this is bright red blood that is visable, then a lower cause that can be picked up by a sigmoidoscopy is more likely.  If the blood is not visable, but the occult is still positive, then the possibility of a problem higher up is possible - and would warrant a colonoscopy.  

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.

[Mazate]

If I'm not mistaken, an enlarged prostate can also caused flattened stools.

[lodal]

I am currently being seen for the hemorriod by a colorectal surgeon. He also gave me the sigmoidoscopy and the injection sclerotherapy. Should I still consult a gastroentologist. He told me that the sclerotherapy might have to be done a few times for it to work.

[eveningstar]

The sigmoidoscopy examines only the lower one third of the colon.   A colonoscopy can examine the entire colon, and any polyps or suspicious tissue can be removed during the procedure.  I have had several done, and was "out" and never knew a thing.  If I were you, I would have this done to rule out the possibility of a problem further up in the colon.   A sigmoidoscopy  cannot detect problems higher up in the colon, no matter who performs it.

[surgeon]

it's true that sigmoidoscopy can't see something above where it can see: but something that causes flat stools would be in view of a sigmoidoscope. What I said was that if you haven't seen a gastroenterologist, you probably should. It would be up to that person to recommend what tests you ought to have.