Can changes in bowel movement be due to internal hemorrhoids?

Question

Hi doctor,

I am a 23-year-old male. I saw a change in bowel movement has happened since being diagnosed with internal hemorrhoids one month ago. I want to make sure this is just hemorrhoids, nothing more serious. I use the restroom to have a bowel movement two times a day. I saw my internal medicine doctor a little over a month ago after I saw blood in the toilet after I used the bathroom. I did not have blood afterward, but my doctor performed a rectal exam and stated I had internal hemorrhoids. However, I still have issues, such as constipation, diarrhea, bloating, and abdominal pain above my belly button. My anal area also itches. My stool is a mixture of flat stools, diarrhea, constipation, and normal-looking stool. There is no more blood, only very little at times when wiping, but not in the stool itself. I have lots of stomach cramps, and I feel full faster than normal. I had an abdominal or pelvic CT scan performed, and there was no cancer detected, and my abdominal organs, colon, intestines, etc. were also cancer free. What can be the cause of my ongoing symptoms? Is it possible for me to have colon cancer or any type of cancer, if I had a clean CT scan three months ago? I do not have any family history. I am currently taking Pantoprazole 40 mg for my GERD once a day.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I am reviewing your case history in detail and the attached file (the attachment is hidden to protect the patient's identity) and will get back to you in a while. Kindly respond after getting my detailed answer.

Hope this helps.

Regards.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

I have reviewed your case history in detail and your attached image (attachments are hidden to protect the patient's identity). So, your stool color and consistency are normal. Alarming colors are bright red, blood, black, or maroon-colored stools. There are multiple causes of per rectal bleeding. The most common ones are hemorrhoids and anal fissures, your small amount of blood, followed by a local physical examination by a doctor, likely suggestive of internal hemorrhoids. Change of bowel habits, bloating, and dyspeptic symptoms are more anxiety- or stress-related considering an episode of per rectal bleeding. Hemorrhoids never cause such symptoms. Your CT (computed tomography) scan was normal, which is great, but why did you have your CT scan? I mean, you had bleeding for a little over a month, and you had a CT scan before bleeding? A normal CT scan is very reassuring, and no cancer or mass would develop within a few months. Colon cancers take a lot of time to develop. At your age, the chances of cancer are relatively very less. It is more common in patients above 40 years. For your symptoms, my suggestions are to take regular home-cooked meals and try Psyllium husk 1 to 2 tablespoons full in a glass of water every day in the morning after breakfast, and in case of abdominal cramps, you can use an antispasmodic like a tablet. Mebeverine 135 mg as per need or any suitable one available at your end. Medically and as per international research data, your chances of having cancer are very low.

Following are my suggestions:

1. For 100 percent confirmation, colonoscopy is the investigation of choice. I feel if you ever notice blood in your stools from now onwards, you can go for a colonoscopy.

2. Meanwhile, avoid taking too much stress, which is actually triggering your abdominal symptoms.

3. Add probiotics to your diet, either commercially available probiotics once daily for two to four weeks or, if you like yogurt, then daily yogurt for a month. Yogurt is a very good natural source of probiotics (healthy bacteria).

4. If colonoscopy is not possible at the moment, you can go for a few stool tests and blood colon cancer tumor markers. This would help for your further reassurance. Otherwise, colonoscopy is always the best test. The following are the suggested tests:

Stool DR (detailed report).
Fecal calprotectin levels.
Fecal occult blood.
Blood or serum CEA (carcinoembryonic antigen) levels.

I feel you have a sensitive personality. At least try to avoid stress and anxiety regarding your gut, and let us see how your symptoms would respond.

Hope this helps.

Kind regards.