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Passing hard stools followed by bleeding. Should I be concerned?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
I have just passed some very hard stool, which caused a reasonable amount of bleeding as visible on the toilet paper. My question is whether it is possible for these injuries to be quite XXXXXXX in the rectum and cause the bleeding to continue even if it doesn't seem to show much bleeding on the paper wipe after a few hours.
Also, how concerned should I be about infection as it seems that the stool matter contains high levels of bacteria. What should I do about the problem generally?

Posted Tue, 2 Apr 2013 in Abdominal Pain
Answered by Dr. Ketan Vagholkar 20 hours later
Thanks for writing in.
Passage of hard stools followed by bleeding without pain is usually due to hemorrhoids.If accompanied by pain then the most likely cause is fissure in ano. In hemorrhoids there is no serious injury to the deeper layers of the rectum but the bleeding may be significant enough to cause anemia. However in fissure in ano the depth may be significant to cause persistence of pain and bleeding.It can also lead to infection which aggravates the pain all the more.
Now coming to your questions.
1. These conditions do not run so XXXXXXX to cause any serious or significant complication. they are usually subcutaneous or submucous XXXXXXX
2. Yes! infection may be a cause for concern leading to a delay in healing especially in the fissure in ano and hence has to be covered by sietz bath or hot water antiseptic fomentations and antibiotics.
I would advise the following
1. plenty of water
2. stool softners
3. plenty of fiber
4. decrease the intake of red meat.
5. hot water fomentations if there is pain after passing stools.
6. do not strain at stools.
If the above measures fail to give you relief then you should consult ageneral surgeon for clinical evaluation.
I hope this answers your querry.
Above answer was peer-reviewed by
Follow-up: Passing hard stools followed by bleeding. Should I be concerned? 19 hours later
Dear Dr. Vagholkar,

Thanks for the information. I have not yet seen a doctor but I believe that the injury at this stage looks purely external, as I was cleared of hemorrhoids during a colonoscopy two years ago.
Is it possible that very hard stool can cause a cut in the external region? Is it also possible that this could lead to serious infection such as blood infection unless the hot water antiseptic and antibiotics are applied? I am only considering this as a possibility due to the very large amount of bacteria involved.

Answered by Dr. Ketan Vagholkar 8 hours later
Thanks for the feedback.
Yes hard stools can cause a abrasion in the anal region. This condition is termed as fissure in ano. This gets infected and causes severe spasm of the sphincter which prevents healing of the raw area. The usual symptoms are related to constipation accompanied by severe pain after the passage of hard stools . The stools are streaked with blood.
This condition prompts immediate diagnosis followed by prompt treatment comprising of fomentations ,antibiotics and pain killers. If the response is suboptimal then surgical intervention may be necessary.
I hope this answers your doubt.
Above answer was peer-reviewed by
Follow-up: Passing hard stools followed by bleeding. Should I be concerned? 1 hour later
Dear Dr. Vagholkar,

Thanks for the information. I feel the best course of action is an examination to determine the depth of the cut and best mode of treatment.

Best regards,
Answered by Dr. Ketan Vagholkar 12 hours later
I think that would be the best and safest option as I had already stated in my first reply.This will obviate the chance of missing out on any particular lesion.Once a proper clinical assesment is made specific treatment can be commenced.
Above answer was peer-reviewed by
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