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Noticing blood in stools. Have Reheumatoid Arthritis. On Sulphasalazine. caused due to over dose of Sulphasalazine?

Apr 2013
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Hi Doctor, I am a male, residing in Canada for the last 3 years.. I have been noticing blood in my stool for the last 1 months. I have been a patient of Reheumatoid Arthritis (Ankylosing Spondylitis) since my childhood (now I am 38) and have been on Sulphasalazine (3g/ day) for over the last 5 years (dosage varied).. I am not sure if the blood in stool is caused due to overdose of Sulpha or something else. No itching or pain while passing the stool. NO hard push required many times but sometimes I feel "ouch. XXXXXXX when passing.. My weight is 58kgs and I am feeling good, not a pinch except blood in stool which is worrying me. My Arthritis is also appears well under control.. All my blood tests (CBC, Lipids etc) were all fine (done last week), no abnormalities detected either). The doctor referred a stool test for colon cancer screening, but I am not sure if it is right. He tested for hemorrhoids with a physical exam and found none. I am not sure what is wrong, may be I need to see a Rheumatologist/ GI specialist etc. Please advice what is wrong with me and my next steps? No family history of cancer or such problems..
Posted Mon, 26 Aug 2013 in Men's Health
Answered by Dr. Ivan R. Rommstein 1 hour later
Hi and welcome to XXXXXXX Thanks for the query.

Most common causes of blood in stool are benign(95%) but this is something that should be investigated and more serious diagnoses must be ruled out. Most common causes are hemorhoids, fissures, pokyps and angiodysplasia.
If there is fresh blood on surface of fece or toilet paper then it may indicate hemorrhoids or anal fisure which would be seen on physical exam.
But physical exam cant reveal polyps or angiodysplasie. it can be detected only by colonoscopy.
Colon cancer is usually seen in people aged >50,but it can be found even in younger than you are so it should be ruled out even if there is no positive familly history. This is a reason why you need to do stool test.If this is positive,you must do colonocopy no matter how unpleasant it may be.This is our algorithm and colonoscopy can reveal tumors or polyps which can be removed then and sent to analysis. So you need to visit GI specialist.
There are reported cases of blood in stool caused by sulfasalazine,but this is rare and sulfasalazine actually reduce inflammation in bowels and can be used for treatment of rectal bleeding. So this is not likely to be your problem.
All in all, you dont have to be worried, just do recomended tests and go step by step. If there is negative stol tests then it could have been just mucosal damage due to spraining during defecation and you should ust eat high fibre fod,take enough fluids and take some stool softeners. If test is postiive,you should do colonoscopy ,especailly if your symptms persist.
wish you good health. Regards
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