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16 year old with blood in stool.

Hi, I have a 16 year old daughter with blood in her stool. She had a colonoscopy showing normal. Upper GI biopsy only showing zero enzymes to break down milk (lactose intolerant). It has been 4 long months and we still do not have any answers. My hope is to possibly get this out so someone somewhere may have or had the same issue. Looking for any help in direction from here. Thanks!
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Avatar universal
Here is a comprehensive list of causes of chronic intermittent blood in stool at all ages, divided by location, then listed in order of prevalence:

UPPER GASTROINTESTINAL TRACT:

- Gastritis
- Esophagitis
- Gastric ulcer
- Duodenal ulcer
- Angiodysplasia
- Gastric cancer
- Esophageal cancer

LOWER GASTROINTESTINAL TRACT

Small bowel:

- Angiodysplasia
- Small bowel tumors
- Small bowel ulcers and erosions
- Crohn’s disease
- Small bowel diverticulosis
- Celiac sprue
- Radiation enteritis
- Meckel’s diverticulum
- Small bowel varices
- Lymphangioma
- Blue rubber bleb nevus syndrome
- Osler-Weber-Rendu syndrome
- Von Willebrand’s disease
- Small bowel polyposis syndrome
- Gardener’s syndrome
- Aortoenteric fistula
- Amyloidosis
- Hemosuccus pancreaticus hemobilia

Large bowel:

- Hemorrhoids
- Colorectal polyps
- Diverticulosis
- Colorectal cancer
- Proctitis/ulcerative colitis
- Arteriovenous malformations
- Colonic stricture
- Post-polypectomy bleeding
- Other colitis
- Anal neoplasms

In adolescents and young adults, inflammatory bowel disease, polyps, Meckel diverticulum, and bleeding diatheses are higher on the differential.
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Avatar universal
Please note that upper endoscopy covers only esophagus, stomach, and beginning of small bowel and lower endoscopy (colonoscopy) covers only large bowel and end of small bowel. To evaluate remainder of small bowel, consider capsule endoscopy, or alternatively CT or MRI enterography.
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1 Comments
Thank you Chin_c! My next move was to request the CT or camera.  I am pleased to know I seem to be on track with my requests for the doctor. I appreciate your feedback!
Avatar universal
Confused about that milk enzyme thing.  Mammals including humans don't have enzymes to break down milk once they reach weaning age.  While humans, unlike all other mammals, force lots of food into us that we aren't by nature equipped to consume, the lack of those enzymes just means you have an adult daughter.  Don't know about the cause of the blood, the above gives a pretty exhaustive list of causes for blood in stool but you have doctors who are much better equipped to answer this than anyone posting on a website.  Sometimes you just have to find the right doc who will keep looking until the cause is found, but blood in stool usually goes along with other symptoms that lead to a diagnosis.  
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4 Comments
My intention to post is with hopes that someone else may the the same issue and not looking for a diagnosis. After after 4 months of testing and thousands later these well equipped doctors still cannot find the issue.
How much blood? Every day? Does it look like fresh, red blood or older, darker blood? Pain?
Yes, it is bright red blood at every bowel movement. She does have some pain which makes her feel like she might vomit at times. The amount of blood looks as if she has a menstrual cycle at each bowel movement.
It's just a guess, but that sure sounds like a hemorrhoid, which could be internal and therefore not readily seen or diagnosed.

A good visual exam by an experienced doctor is what's called for. I don't believe a colonoscopy or any radiological exam is called for until you have a good exam.

So sorry you're having this problem. There are a couple of rules of thumb you may wish to embark on:

NEVER let yourself get constipated.

Never strain to get poop out.

Keep the anal area lubricated at all times, certainly before and after a BM.

Use very soft wipes, nothing hard or abrasive.

Good luck. You should do just fine assuming it's a hemorrhoid or two.
Avatar universal
I would highly suggest an MRI enterography over capsule! For one of also gets a good look at all internal organs but if for example there is strictures and scaring from ongoing disease (like crohn's) the capsule can actually become stuck and be cause for an emergency surgery. I know I suffered horribly by that she and it took into my early 20's for them to figure it out! Biggest words of advice: you are your own biggest advocate (or your chikds)! Trust your gut and your parental intuition! No one knows YOUR child better than you do!
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1 Comments
I asked about a CT scan or MRI last week and I was told it is not needed now. I submitted for an expert opinion through our insurance  so we hope to hear back in a few weeks.
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