Blood in the stool - searching for the cause
July 28, 2010 | 10,00 EUR | answered by Dr. med. Mario Werner
Hello,
I am quite desperate. About 6 weeks ago, I (female, 30 years old, 163 cm, 60 kg, normal fit and healthy) noticed blood in my stool. It started out as a slight, watery diarrhea and then I noticed mucus (like egg white) with clearly visible fresh, bright red streaks of blood. Comparable to a severe cold, where mucus is sometimes mixed with blood.
Of course, I went to see a doctor immediately (specialist in internal medicine). He suspected either Crohn's disease or diverticulitis and sent me to a gastroenterologist (in a larger practice in a hospital) on the same day, who performed a colonoscopy shortly after. The result was inconclusive. He said that my intestines are completely healthy. He definitively ruled out any chronic diseases.
He then sent me to a gynecologist (where I had been for a routine check-up shortly before) - but as expected, he had nothing to do with "the issue" as it concerns the intestines.
After the bleeding stopped, I thought everything was okay again.
Now I have been experiencing blood in my stool with slight, watery diarrhea since yesterday. No cramps or anything. I called doctor 1 this morning right away. He doesn't know what to do.
What should I do now?
What could be the cause?
Which doctor could I go to next?
Thank you for any further advice!
Dear Inquirer,
First of all, it should be noted that the cause of the unclear blood loss should be further investigated.
A good sign is that the colonoscopy did not reveal any significant pathological findings. Now the focus is on finding the cause.
A proctologist specializes in diseases of the rectum. Sometimes fresh blood loss can be caused by hemorrhoids. If you often have itching in the anus, the anus can be mechanically irritated during or after bowel movements. Further investigation will be helpful here, assuming that this was also checked during the colonoscopy.
Blood loss can also come from the upper gastrointestinal tract into the rectum, but is usually not fresh and bright red. Nevertheless, if the cause remains unclear, it is also important to look "from above", so an upper endoscopy (gastroscopy) should be performed. The colonoscopy does not reach so far up the course of the intestines.
To determine if you are losing a significant amount of blood, a hemoglobin test should be done as well as a fecal occult blood test. The former provides information about your blood levels, whether your body is losing a measurable amount of blood regularly. The fecal occult blood test detects blood in your stool and provides information about whether you are losing blood continuously but not always visibly.
Another possible cause could be a fistula that has found an outlet from a vessel in your intestines, but was not visible in the colonoscopy. For example, due to an overlying mucosal fold. A contrast agent examination should be performed by a radiologist, but first the blood values from the general practitioner (especially creatinine, TSH) are needed to know if the kidney and thyroid can "tolerate" this examination. Simply speak to your general practitioner about this, they will perform the blood test and fecal occult blood test and can refer you accordingly.
Are there any unusual stresses during sex, or strong mechanical strain? Sometimes the cause can also lie here.
I hope that these explanations have helped you and wish you that the cause will be found as soon as possible, until then all the best and get well soon.
Dr. med. M. Werner
