Oh, okay, I wasn't aware that anal bleeding was such a pedestrian concern-- thanks, Doc.

November 11, 2008 8:33 PM

TMI Medical Filter: Previously, I had sometimes crippling stomach pain. That went away. Now I'm, uh, bleeding. Rectally. Um. Yeah. But my HMO doesn't seem to care all that much. MetaFilter is not my doctor, but I can't go to my doctor to ask... should I skip my HMO and go to the hospital?

Demographics note: Caucasian male, 20 years of age, only other major prior health problem--familial (?) migraine headaches.

Around August, I started having these awful, crippling bouts of mid-torso (stomach-area) pain in the morning and night, accompanied by abdominal bloating and upper-back pain. This continued for a week until I stopped being a moron and went to see a gastrointestinal doctor through my HMO, who put me on a preliminary regimen of Prilosec and ordered a round of tests.

For awhile, these bouts subsidied (with no word from my doctor RE: my tests), but then mid-September they began again for no readily apparent reason, prompting me to schedule another appointment, which I was not able to get in until October. I learned that apparently turned up negative for my H. Pylori scan (which apparently is predictive of having an ulcer?), though my HMO/doctor lost (!) all of the other related tests (I don't even recall all of them--one of them was an "occult blood" test). My doctor quibbled about perhaps performing an endoscopy, but would not commit to any further orders.

With a significantly increased dosage of Prilosec, the painful episodes had until recently subsided into occasional odd, funny, light pain in my stomach that I had been unaccustomed to feeling prior, but nothing that interfered with going along my day-to-day business. I had largely put that out of my mind until a few days ago, when I started to bleed rectally at almost every defecation. This began as a few drops or a bloodiness of the feces, but in my very subjective perception seems to have gotten steadily worse day-by-day. Accordingly, I've made an appointment with my doctor, but it won't be for another two weeks!

I've been calling for the past few days to try to catch a dropped appointment or see if any doctors at associated facilities have openings, explaining my circumstances, but have had absolutely no luck. Today, my bottom-torso even hurts some.

My own self-diagnosis was Meckel's Diverticulum, but, uh, then I noticed that this is mostly diagnosed at youth, and really, I don't understand anything. The symptoms seem to match me exactly, though (minus the, uh, life-threatening ones, as far as I know).

These are a lot of words to ask: At one point should I say "fuck you!" to my HMO and decide to seek some ER help at one of my great local hospitals? Is this potentially life-threatening in the immediate term? Should I have said "fuck you" the moment I started bleeding? I'm worried about incurring unnecessary hospital costs as my family and I are in a difficult financial situation (though I'm lucky to have healthcare at all, I suppose). If it helps at all or if anyone has any experience working with them, my HMO is Kaiser and I live in the Northern Virginian area.

posted by anonymous to health & fitness (26 comments total)

the standard even for the most denial-happy HMOs for whether they'll pay for an emergency room visit is whether a reasonable person would believe that they have a life-threatening medical condition requiring urgent attention.

And you, sir, are bleeding out of your ass. I can't think of many more things that indicate "life-threatening" even more clearly than that. Traumatic amputation, perhaps.

Go. To. The. ER. Now.
posted by deadmessenger at 8:38 PM on November 11, 2008 [8 favorites]

Sounds more like Ulcerative Colitis or Crohn's Disease to me, but IANAD.
posted by kisch mokusch at 8:42 PM on November 11, 2008

IANAD - if I had your symptoms, I would get medical care very soon, and not wait two weeks. The fact that you have described your symptoms and had no luck does not fill me with confidence in your doctors. I'd go to emergency, given that you are bleeding internally and the pain is getting worse. This doesn't sound like something that is just going to get better, or that you can wait two weeks to have resolved.
posted by Dasein at 8:43 PM on November 11, 2008 [1 favorite]

unknown bleeding from outface = a duh yeah you should go see the Doc.
posted by edgeways at 8:48 PM on November 11, 2008

Why are you still sitting reading askmefi? Get thee to the emergency room.. You're bleeding out of places you shoudn't be bleeding!
posted by defcom1 at 8:49 PM on November 11, 2008 [2 favorites]

I don't know what's wrong with you, but I do have Kaiser. How are you trying to get your appointment? I have had good luck calling the Advice Nurse hotline. They seem to be able to find appointment slots and will listen. Also, does your Kaiser have an Urgent Care facility? I'd walk in there ASAP.
posted by slowfasthazel at 8:55 PM on November 11, 2008

Sheesh, lighten up folks. This could just as easily be hemorrhoids. You don't mention if they blood is bright red or tarry and black. If the former, it could just as easily be garden variety hemorrhoids. If the latter, then maybe worry some more. Not that I think you should ignore this but I don't think you need to jump to "life-threatening" just yet. Is there an Urgent Care center you could go to tomorrow in your region. That's usually what I do if my doc can't fit me in but I don't feel like it's an ER-worthy thing.
posted by otherwordlyglow at 8:57 PM on November 11, 2008 [1 favorite]

You said it had subjectively increased, but is it still only a few drops?

Just saying this because, [extended anecdote] I had a friend who had a serious medical emergency, and fainting & bleeding internally (coming out rectally). A short time after we got to the ER, they were fainting if they were raised above a 45 degree angle, lying in bed.

Now this - this is where I screwed up. I *know* you have to holler & make a fuss if you have a serious medical emergency that isn't obvious, but I thought internal bleeding and fainting was pretty damn obvious emergency material, and I was freaked out enough that I had switched over to trying to look as calm as possible for the sake of my friend.

Really big mistake. We ended up waiting a couple of hours (shit, shit, shit, shit, shit).
When the Dr finally checked us, suddenly it was all on, surgeons being called in, the more general freakout as somewhere between a litre and two litres of blood had already been lost, blah blah blah...

Apparently the initial miscommunication had been, the nurse had not taken us seriously when we said 'lots of blood', and 'gushing'. Possibly she thought my friend was being a delicate little flower with the fainting, (o_O?!?!?) rather than suffering from blood loss.

The fact that she paid so little attention to us initially, obviously suggests that she did not think a small amount of rectal bleeding, in and of itself, was that serious, and expected us to be more panicked and alarmed than it justified.
So, take some small amount of comfort that medical professionals will probably be non-alarmed by your initial presentation of symptoms, except that will be pretty obvious to you, given your Dr's reactions to it.

That said - a small amount of blood anywhere else, usually not regarded as a problem. Bleeding that continues for longer than that, is usually regarded as Doctor/ER material - so I think you have pretty good excuse for going and sitting it out in the ER, but I'd be expecting to wait awhile. Try, try, try to get a Dr appointment, but otherwise, maybe go early in the morning to the ER, when they seem relatively non-busy, and take a book etc.
posted by Elysum at 8:57 PM on November 11, 2008

My dad was diagnosed with Meckel's at the age of 17, so it's not impossible. Go to the ER. Now.
posted by coppermoss at 8:58 PM on November 11, 2008

Typo:
Longer than that => longer than a few days.
posted by Elysum at 9:04 PM on November 11, 2008

It could be ulcerative colitis, Crohn's or IBS, especially if the blood is bright red. If it is any of those things it will get worse without treatment - I would definitely see the doctor right away. They may want to do a colonoscopy to check things out.
posted by Ostara at 9:09 PM on November 11, 2008

I spent a week in the hospital thanks to Ulcerative Colitis - not pleasant at all. While I don't know that you need to go to the ER right away, I'd definitely get to a doctor sooner rather than later.

It could be the difference between a simple course of medication (I should note that UC can be treated - it was in my case - but is chronic) and weeks of being laid up with an IV bag.
posted by aladfar at 9:32 PM on November 11, 2008

One of my mother's work colleagues was repeatedly reassured by his doctor that bleeding out of the ass was normal: "that happens to me, too...don't worry about it"

Then the doctor died of colon cancer.

(sorry, don't mean to alarm you, but it was just an apt anecdotal reminder that health professionals can be blinkered & human like the rest of us...)
posted by UbuRoivas at 9:40 PM on November 11, 2008 [9 favorites]

Do you not have a Kaiser facility near you? This is the kind of thing Kaiser is usually great for - they have doctors working all the time for quick appointments or urgent care clinics. Call the advice nurse and get seen no later than tomorrow. Rectal bleeding not caused by hemorrhoids is never something to ignore.
posted by Wolfie at 9:58 PM on November 11, 2008

If I were feeling dizzy, light-headed, exceptionally tired, pale, I would go to the ER. Otherwise I'd wait for the next available appointment.
posted by sero_venientibus_ossa at 3:14 AM on November 12, 2008

Ass bleeding is one of those 'yes, you should have a doctor look at that yesterday' situations.

Actually.. any bleeding that won't stop and isn't expected, really.
posted by dirtynumbangelboy at 4:54 AM on November 12, 2008

Turn your question marks into exclamation marks and do not wait for your HMO to loose more tests. Apparently your initial symptoms did not fully disappear and now... rectal bleeding? Could it be possible that the treatment never cured the illness, is untreated and worsening for months? Seems like something that can get as worse as you let it become.

Regarding the money issue, I would say most ambulant treatments are still cheaper than a visit to the ER followed by couple of days in EW. You can not afford to wait until next week.
posted by EuroBunny at 5:22 AM on November 12, 2008

could be some form of parasite or bacterial infection too, which wouldn't necessarily be urgent, but certainly warrants a visit. If you can't get an appointment with your physician for two weeks, you should seek treatment at an urgent care facility or the ER.
posted by agentwills at 6:33 AM on November 12, 2008

Call your doctor's office again and ask to speak to your doctor's nurse or to leave a voicemail on the dr's line. In my experience, this is the best way to get someone to actually listen to you, and the nurse can schedule an urgent appointment or send you to the ER if she feels that it's necessary. She might even be able to look up your "lost" labs while she has you on the phone.
posted by jrichards at 6:52 AM on November 12, 2008

Yeah, as otherwordlyglow points out, it matters whether the blood is bright red or is darker and incorporated into the stool. If it is bright red, it could be hemmorhoids, or a small rectal tear, which isn't a huge deal at all. My understanding it is more ominous if it is darker and/or incorporated into the stool, which implies that it is coming from deeper inside your intestines. I am no medical professional, and obviously you should speak with one.
posted by Jupiter Jones at 7:25 AM on November 12, 2008

I assume you've called the nurse line and/or the immediate medical advice line for Kaiser? (703-539-7878 for medical advice and 800-677-1112 for "If you're unsure of your condition and require immediate medical advice").

They'd probably be able to set you up for an appointment at one of the urgent care centers at Woodbridge or Falls Church depending on your location. If you want to avoid the hassle of dealing with ER reimbursement, but can't convince them to set you up to and they say they can't see you during the day without appointment and don't feel like you'll die, wait until after 4:30, just show up at Woodbridge or Falls Church urgent care locations they will see you. You might have to wait in person, however.

Your co-pay will probably (depending on your exact plan) be higher than a normal office visit, but it'd probably it if you're worried. This has worked for me in the past, so maybe give it a try.
posted by skynxnex at 7:55 AM on November 12, 2008

small rectal tear, which isn't a huge deal at all.

IANAD but I've read this can lead to peritonitis. From the article: "If untreated, generalised peritonitis is almost always fatal."

ER. NOW. Why the fuck would you take this risk?
posted by desjardins at 8:51 AM on November 12, 2008

Also from the wiki article: The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding.
posted by desjardins at 8:53 AM on November 12, 2008

Go.

I had paratyphoid fever, and I bled.

YOu don't want a perforated intestine. And since you aren't a doctor, don't guess.

Just go.
posted by St. Alia of the Bunnies at 2:54 PM on November 12, 2008

nthing ER.
posted by brevator at 5:26 PM on November 12, 2008

I suspect by "small rectal tear", the respondent may have meant an anal fissure, not a perforated bowel, to give them credit.
But yeah, that's one of the 7 signs of cancer. (Are those still around?) I just buried a friend with that.
Get it seen, preferably by someone who cares enough not to lose your lab results and/or blow off what is generally considered by the medical profession and sensible adults as something that needs to be looked at. The lab should have copies on file, and I would not shut up until the office called and got dup copies, and then make sure you get copies to take to the next guy. Let's say hypothetically that this doctor blamed the blood on a hemorrhoid he could see. There's nothing to say that might not be masking another second cause.
Occult blood is just a test where they catch a sample and test it for blood that's not readily visible, and it's a very important test. The real doctors around here would quickly point out it can be prone to false positives if you have one of the above, so please avoid panic if yours is. They will do other tests to confirm it.
But yes, hie thee to a place of healing as soon as you can. IANAD.
posted by unrepentanthippie at 12:35 PM on November 14, 2008