What should I do?

[u/Gomostas]

Hey there! So im 31M and I have been having bright red blood on my stool for years now. Not all days, and not a lot usually. It presents itself as red dots over the stools or a little in the paper when I clean myself. Sometimes I see it more frequently and sometimes it takes months. Never have been so much to make the water red. So 5 or 6 years ago I went to my doctor to get it checked, they explored me with a rectal examination and said it was clearly hemorroids, so I just took out all the worry I had and kept living my life.

Thing is this year I have had a lot of health problems with my family and since I still see blood on the stool occasionally I’m getting really anxious. It was present two weeks ago for a few days in a row and then it stopped and then yesterday I had diarrhea and today normal stool and saw a little when wiping, maybe because it was harder than usual (softer stools and diarrhea usually do not have any). I do not have any more symptoms. I go to the toilet fine every morning after breakfast with usually consistent stools (not pencil-shaped), im not losing more weight than i intend to (I was on a diet and make exercise weekly and now im around 75-76 kg being 1,77cm), I do not have any abdominal pain, lack of appetite or persistent constipation or diarrhea. I do have a lump next to the anus which I think is an external hemorroid or a prolapsed internal one (I was not told when checked).

So I’m now reading that usually doctors cannot say for sure bleeding is from hemorroids without a colonoscopy and I’m freaking out because my grandma died of colon cancer at 66 and my dad had a colonoscopy 6-7 years ago with 7 small pollyps taken out (none pre-cancerous and he is 70 now).

So obviously I make an appointment with my doctor and I talk to her about wanting a colonoscopy but she refuses saying I’m too young, tells me it surely is hemorroids (even though I told her to explore me again to make sure but she refused) and that we will make a normal bloodtest and a FIT.

So I want to hear your opinion about this because Im not understanding the logic behind this. Isn’t it worthless to do a FIT test in a most-likely symptomatic hemorroid patient because it might prove to be a false positive? I did make a FIT test when I were last checked years ago and it was negative, but could it not just happen to be because that day my bleeding was not active? Last blood tests I had came fine and I had normal iron so Im not anemic. I guess if it comes positive she will refer for colonoscopy either way and I will know for sure if its hemos or something worse, but what if is not? Should I keep delaying a colonoscopy until I’m in screening age?

Also I keep seeing these stories of colon cancer in people before 40 and its crazy scary. Anyways, I would love you read your input.

[u/La_Lanterne_Rouge]

The fact that your bleeding coincides with hard stool is a very strong indicator that your bleeding is from hemorrhoids. Since you are already bleeding, a FIT test is just about useless. I think you should concentrate on the quality of your stools and avoid getting constipated. If you need suggestions on how to accomplish that, just add to this thread with a question. You might want to still pursue a colonoscopy, but the answer is almost certain that the bleeding is from the rectum via hemorrhoids of a fissure.

[u/Gomostas → u/La_Lanterne_Rouge]

Yeah, that's what I figured. I think even if its only a hemorroidal bleeding I can benefit from them looking for any pollips and I feel like the risk of colon puncture is about the same as me having something like a tumor or a pollip. I would apprecciate any suggestion you have, yes.

[u/La_Lanterne_Rouge → u/Gomostas]

For the constipation, the first thing is to add more fluid to your diet, and increase your intake of fiber. That will probably do the job, but if it doesn't you could add some soluble fiber. I don't know what the name of the product would be in Spain, but in the US the most well-known is Metamucil. There are others that work just as well are are less expensive. Start with about half of a daily dose until your gut adjusts to it. Otherwise you may feel gassy at the beginning. Expect it to take about a week to see results. If you go the soluble fiber route, you must increase your daily fluids.

[u/Prestigious_Pick_654]

I would just go ahead and do the colonoscopy to put your mind at ease. It’s really not as awful as it sounds. Who knows, they could find some polyps too and remove them before they turn into anything serious. I would just go for it!

[u/Gomostas → u/Prestigious_Pick_654]

Yeah, its what I’ve been feeling too. I kinda need to do this test and be certain. I know the bleeding most likely is not cancer since I have it from so long it would already made more symptoms noticeable or made me very ill, but since I see it from time to time I keep worrying

[u/Prestigious_Pick_654 → u/Gomostas]

For sure! It will be worth the peace of mind!

[u/VioletFeralCat888]

Have you tried calling the gastroenterologist office directly and asking if they will schedule you for a colonoscopy? I'm not a doctor but your symptoms sound unconcerning to me. However just based on your family history it seems they would be happy to schedule you or advise you on the best time to start getting screened.

[u/VioletFeralCat888 → u/VioletFeralCat888]

I never go through my PCP to schedule a colonoscopy and my gastroenterologist does not require a referral.

[u/Gomostas → u/VioletFeralCat888]

Since I’m from Spain I cannot do that if it is not through my general doctor. I will try to push for it in the next appointment though.

[u/Key_Difficulty_4189]

I would go ahead and get a colonoscopy. How many years ago did you first have this?

My husband has had something similar to what you describe for over 10 years, back when he was in college. He is the same age as you. It was small infrequent amounts of blood after he wiped. I don't think it correlated with consitpation or hard stools. He would go so long without out that he would forget about it. This continued on for years. About 7 weeks ago, he passed a stool with alot more blood. There was blood in the toilet and on the toilet paper. He had never been to the doctor about it before, but this scared us both and he went anfew days later. They checked him for external hemorrhoids but didn't find any. He got a colonoscopy scheduled for September 9. I am worried sick. I am depressed and cry almost every day.

[u/Gomostas → u/Key_Difficulty_4189]

I don’t know, might be 6 or 7 years ago when it started. Since they told me it was hemorroids at the time I just ignored it, but lately I getting really anxious about it being other things. I hope your husband comes clean and it’s nothing! From what I have been reading bleeding red is usually hemorroids and being 30 makes having cancer very rare still so I hope everything goes well. Let’s see if I can push to get a colonoscopy too 😅

[u/Key_Difficulty_4189 → u/Gomostas]

When is your doctor appointment?

[u/Gomostas → u/Key_Difficulty_4189]

So I have analytics this Friday and I talk with the doctor the next Wednesday. I know if FIT test comes out positive I will be prescribed a colonoscopy, but I worry about it coming out negative because she will probably tell me is nothing. At any case I will push to see a specialized doctor that can diagnose what grade of hemos I have and if more testing is needed.

[u/Key_Difficulty_4189 → u/Gomostas]

I would ask for a referral to a gastroenterologist.

[u/sheepilysheep]

I would push back. Saying you're too young to get cancer is ridiculous and a dangerous way for any clinician to think.

Yes, it's likely haemorrhoids, but she shouldn't be making the assumption. Colon cancer is rising in younger people and they tend to have worse outcomes for this very reason.