My colorectal surgeon has only done a proctoscopy and says the blood in my stool is coming from my hemorrhoids. He wants to treat with sclerotherapy, but I don't want that kind of intervention and still have a weird feeling in my descending colon. What's the medical best practice in a case like this?
posted by rhombus to Health & Fitness (16 answers total) 1 user marked this as a favorite
Am I worrying unnecessarily, or do I need to demand a colonoscopy? And if so, what's the best way to do that?
Yes, I am not a doctor, you are not a doctor, you are not my doctor, you are not a lawyer, you are not my doctor's lawyer, and you are not my mother. But I'd still like your advice.
The following goes into positively fecal detail. Reader discretion is advised.
I've been living in Germany for about three years.
I have had anemia on and off for years. The anemia, when present, has always been very mild. I had been a vegetarian for twenty years, and my doctor in Canada (who is also an instructor in family medicine at the university hospital in our area) never felt it was much reason to be concerned. My ferritin was checked a couple of times and always hovered around 95 µg/L.
Last fall, I decided to start giving blood. I wanted to challenge myself and do something good for someone else. I had tried giving blood in my late teens and had a pretty nasty syncope with seizure, so I had always thought that I was done donating blood for good. Well, I tried again in August of last year, and it worked -- I was nervous and I sweated a bit but stayed conscious through the whole thing and walked home a changed man.
I did it two more times in the next five months.
By the time February rolled around, though, I was feeling pretty atrocious. On a visit to see family, I saw my doctor back home in Canada again, and he did a complete blood work up. I had the light anemia again, and a ferritin level of 11 µg/L, which is rather low for a guy in his late thirties.
So I started on iron replacement and changed my diet, switching to a "paleo"-style diet that includes meat, and after about six weeks, I started to feel markedly better.
It is now about four months since I started the iron replacement. About halfway through I switched formulations, and am taking ferrous glycine-sulfate. This works very well. When taking it, I feel better in almost every respect except one: the wicked constipation, which is a well-documented side effect of oral iron supplementation, so I can only assume that's the cause.
Last Tuesday, I had a particularly awful bout. I had not had a bowel movement in three days, which is very unusual for me and also very uncomfortable -- I had pain just under the rib on my left side, about where the descending colon begins. I used a lecithin-bicarbonate suppository, which had the intended effect. When I wiped, though, there was a huge streak of blood on the paper. As this has never happened to me before, I was shocked. There was a dollop of fresh-looking blood in the toilet, perhaps a teaspoon. Concomitant with this - despite my now empty bowel - was a much sharper pain around the upper part of the descending colon. I don't recall any pain in the anal area, but maybe I was too stunned by the blood to notice.
I continued to have blood on and off in the following days. It does seem to be tapering off now. The pain in the colon has also subsided and is almost totally gone now.
I saw my doctor here in Germany today. I explained what was happening and that I was worried. He said that I needn't be; that in someone my age this was almost invariably just a hemorrhoid. He asked me about malignancies in my family history, and I said I didn't know of any (my mother later told me that her grandmother had died of colon cancer). He did a digital rectal exam but couldn't feel anything. He referred me to a colorectal surgeon just to be safe.
I saw the colorectal surgeon right afterward. After hearing my story, he said "that is certainly consistent with hemorrhoids". He stuck a proctoscope in me, told me I had two grade I hemorrhoids, and offered to treat them with sclerotherapy (polidocanol) right on the spot. Now, if there's one thing I have learned over the years, it's that it is a bad idea to make decisions about your treatment when somebody has a cold metal instrument in your ass. I demurred and said I would like to think about it before we go ahead. When I thought about it later, I thought he'd been awfully quick to suggest this kind of treatment, especially for grade I. (He also failed to mention the very high rate of recidivism with sclerotherapy.)
My question is this: is this sufficient investigation? Perhaps this blood came from the hemorrhoids, but what if it came from farther up the colon? I was struck by the fact that the blood was only ever visible at the end of the stool, plus I hadn't really had much in the way of anal pain.
The points suggestive hemorrhoids as the cause are:
- I've been on iron therapy for months, and constipation is a problem
- I have had to strain when taking a dump for some time
- When it appears, the blood is pretty fresh
- I have a tendency toward venous varicosities and have them in a couple of other spots (it runs it the family :) )
- my dad had a similar stubborn anemia, was scoped in his fifties, and came up clean.
On the other hand...
- this sensation in the descending colon is strange
- the blood has so far appeared only at the very end of the log
- my great-grandmother died of colon cancer (albeit in her 70s)
- although I've always thought I had a logical explanation for the mild anemia, this event has got me reevaluating.
Finally, the psychological factor: I lost a very good friend to colon cancer in 2010. He had visible blood in his stool for years (on and off for at least five) and his doctors explained it away as hemorrhoids the whole time. Finally the bleeding got so severe that a colonoscopy was ordered. He was 30 years old, and it turned out to be stage IV, with tumours in the liver. He died at 33.