Blood in stool is the most common clinical symptom in anorectal diseases. The two extreme cases are patients with bleeding internal hemorrhoids asking the doctor to do a comprehensive examination, and the other case is that although they often have blood in stool, they do not seek medical attention and when the symptoms are very serious, it turns out to be advanced rectal cancer. These two extremes are very common in daily outpatient work, so how do we identify them?
There are many causes of blood in stool, and the clinical manifestations vary according to the site of bleeding. Bleeding from internal hemorrhoids is often bright red, does not mix with stool, and is dominated by dripping, or squirting blood when straining to defecate, and is often not accompanied by anal pain if there is no obvious prolapse or inflammatory edema. In case of bleeding from intestinal tumor, it is often accompanied by some systemic manifestations, such as change in stool habit, feeling constipated and unclean feeling in defecation recently, or increased frequency of defecation, mucus or dark red blood clots in stool. Of course, even if there are no such manifestations, tumors cannot be completely excluded, so how should we identify them?
Age is one of the most critical factors, tumors tend to occur mostly in middle-aged and elderly people. People who have family history of colon cancer should also be vigilant. Studies have shown that people with family history have high incidence of tumor and earlier age of onset.
For example, a 30-year-old patient with no family history of colon cancer had bright red blood stool after drinking alcohol with no other clinical symptoms, and after examination it was determined to be internal hemorrhoids. Another 60-year-old patient, who also had bright red bloody stools, even though there was no family history, the doctor recommended a colonoscopy. If no other problems of the intestine were found, then this patient did not need to have another colonoscopy for 10 years, which also prevented misdiagnosis and missed diagnoses.