Bright red blood in your stool, on the toilet paper, or in the toilet water can be alarming, and may well be due to hemorrhoids, but other conditions may be the cause, some potentially serious. About half the United States population has experienced problems with hemorrhoids by age 50, but because other anorectal problems have similar symptoms, it is important to see your doctor any time bleeding from the rectum occurs.
Paul E. Wise, MD, associate professor of surgery in colon and rectal surgery at Washington University, associate program director of the colon and rectal surgery residency, and director of the Washington University inherited colorectal cancer and polyposis registry, explains “The most common symptom of internal hemorrhoids is bright red blood on the outside of the stool or visible blood on the toilet paper or in the toilet bowl. Although everyone has hemorrhoids which are naturally occurring blood vessels in the anal canal, not everyone experiences symptoms.
Symptomatic hemorrhoids occur when these vessels become swollen and inflamed -- either inside the anus (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). This inflammation may be caused by straining to have a bowel movement, chronic constipation, pregnancy, aging, or diarrhea, amongst others. Thankfully, hemorrhoids are treatable.”
Sometimes, internal hemorrhoids may protrude or prolapse through the anus outside of the body, becoming irritated and painful. Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that occurs when a blood clot forms; this also is called a thrombosed external hemorrhoid.
Dr. Wise adds, “Hemorrhoids are rarely dangerous or life-threatening. However, patients should be aware that many anorectal problems – such as fissures, fistulas, or abscesses – have similar symptoms and can be confused with hemorrhoids. Even more importantly, anal or rectal cancers or other tumors may also present this way. This is why it’s important to have a proper examination by a physician or other licensed health provider any time bleeding from the rectum or blood in the stool occurs. Blood actually mixed in with the stool may be from a bleeding source higher in the intestines or rectum and also requires evaluation.”
If the physician’s exam indicates the presence of abnormal hemorrhoids, non-surgical treatments recommended to relieve the symptoms may include:
• Increase in dietary fiber (the goal is 25-30 grams of fiber per day, which may require supplements)
• Take several warm tub or “sitz” baths per day (for pain and swelling)
• Apply an over-the-counter hemorrhoidal cream
• Use over-the-counter or prescription suppositories
• Use over-the-counter or prescription stool softeners or laxatives (if constipation is an issue)
To prevent recurrence, physicians also will recommend fiber and fluids to reduce constipation and straining -- drinking six to eight glasses of fluid a day (not alcohol or caffeinated drinks) results in softer stools. This makes emptying the bowel easier and helps avoid straining.
If the non-surgical treatments do not offer relief, hemorrhoids may be treated with minimally invasive techniques in the clinic or operating room to destroy or remove the hemorrhoidal tissue. Your colon and rectal surgeon will determine which approach is best for your condition.
If you or someone you know suffers from rectal bleeding or hemorrhoids and would like to make an appointment to discuss assessment and treatment options with one of our colon and rectal surgeons, please call (314) 454-7177.
Patients are seen at two convenient locations:
Center for Advanced Medicine, GI Center, 4921 Parkview Place, 8th floor, Suite C, St. Louis, MO.
Center for Colorectal and Pelvic Floor Disorders (COPE), Medical Building One, 1040 North Mason Road, Suite 120, Creve Coeur, MO.