Rectal Bleeding: What is Blood in the Stool?

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Guest: Dr. Brenda Hoffman – Gastroenterology-Hepatology

Host: Dr. Linda Austin – Psychiatry

Dr. Linda Austin: I am Dr. Linda Austin, talking with Dr. Brenda Hoffman who is Professor of Medicine at the Digestive Disease Center, Medical University of South Carolina. Dr. Hoffman, one of the earliest signs that there can be something going on in the GI tract is rectal bleeding, or blood in the stool. Sometimes that can be for not such a serious reason, such as a hemorrhoid, for example. When should a person be concerned about blood in their stool?

Dr. Brenda Hoffman: In young individuals, the most common diagnosis is going to be non-cancer. If you have a family history, though, of colon cancer then you need to be concerned no matter what your age. In younger individuals, if they have persistent bleeding, if it came and it lasted, then they need to seek assistance.

Anyone over 45 who has newly developed bleeding per rectum needs to have it evaluated. It may turn out to be something very simple, like a hemorrhoid or something called a fissure, little tears that occur when we have difficult bowel movements, but it still warrants an investigation because your risk of malignancy, of colon cancer, increases, depending on the decade of age. So, the older you are, the more significant rectal bleeding is.

Dr. Linda Austin: So, could you give some guidelines? Let’s imagine, fore example, somebody is accessing this podcast and they have had some rectal bleeding, when should that person call their doctor versus when can they just kind of watch and wait?

Dr. Brenda Hoffman: An individual in their 20s can usually watch and wait, unless they are having significant bleeding, more than just a streak on the toilet paper intermittently, as long as they do not have weight loss, diarrhea, something that goes along with that, or a positive family history. Any individual who starts to get older in age, in their 30s and 40s, if they see other than a small streak on the toilet paper, they need to tell their doctor.

Dr. Linda Austin: And maybe it is good wake-up call, anyway, to remind them that they need a colonoscopy.

Dr. Brenda Hoffman: It is. There are specific guidelines by the GI societies as to what types of tests can be performed. In individuals younger than 45, they can actually have a short outpatient test called a sigmoidoscopy or proctoscopy that will usually yield an answer and does not require sedation. So, it is something you can do on your lunch break. In individuals over 45, it is generally recommended that they have a complete look at the colon, if they have rectal bleeding.

Dr. Linda Austin: What are some of the other early warning signs of colon cancer?

Dr. Brenda Hoffman: One thing that is interesting is a change in caliber of the stools. It is funny, but most people actually do look in the toilet bowl to see if they are passing blood or having troubles. It will be a change in caliber toward more narrow. If they have that or a change in bowel habits, let’s say they used to go everyday after their breakfast but now they do not, that is a very subtle indication that there is something wrong.

Dr. Linda Austin: Dr. Hoffman, thank you so much for talking with us.

Dr. Brenda Hoffman: Thank you.

If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.

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