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What Causes Rectal Bleeding Prior To Periods?

Posted on Wed, 12 Feb 2014

Question: Hi. I've been having rectal bleeding mainly two days prior to my period starting and not very often for the rest of the month. I had a Colonoscopy 9 months ago and a sigmoidoscopy 3 weeks ago. Both clear. I've just recently had a colposcopy and endometrial biopsy for things that have shown up on scans. Should I be concerned about PPC or cervical cancer, since both show rectal bleeding as a symptom?

Answered by Dr. Aarti Abraham (3 hours later)

Brief Answer: ENDOMETRIOSIS MORE LIKELY. Detailed Answer: Hello Thanks for writing to us with your health concern. May I enquire since how long have you been having this very typical symptom ? With a clear colonoscopy and sigmoidoscopy, you should not worry about cancer - either PPC or cervical cancer. For cervical cancer to have rectal symptoms, it has to be advanced, and would first show up on gynecological evaluation. Have you had a formal gynaecological check up - per vaginum, per speculum and a Pap smear ? Also, please let me know in detail what ' things ' have shown up on scans. That will to a great degree allow me to formulate a diagnosis or exclude PPC. I would think of the first possibility as endometriosis. If it had been any other condition, why would it bleed only coinciding with your periods ? Endometriosis is the most likely condition where the endometriotic tissue would be present on the bowel surfaces and would bleed during and around your periods. Probably that is what has shown up on the scans - hence I request you to provide me those details. I would not put either PPC or cervical cancer as a first diagnosis - those are rare conditions. All the best. Please feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (52 minutes later)

Hi. Thanks. My last pap was a year ago and was clear. I had the colposcopy because there was something on my cervix that bleeds very easily. One gyn thinks it is a cervical prolapsing fibroid and one gyn said it looked like a polyp. Still waiting the results of the colposcopy. I've had an MRI which suggested adenomyosis, ca 125 is 69, I'm having right sided pelvic pain which is unaccounted for right now. Had a couple of ultrasounds which were clear. The rectal bleeding has been going on fir about a year. The dr. Who did the colonoscopy and sigmoid couldn't find any indication of enfometriosis. Would she be able to see it on such a test? Any other tests you would suggest? Thanks

Answered by Dr. Aarti Abraham (1 hour later)

Brief Answer: DETAILED BELOW Detailed Answer: Hello again. Please do let me know the results of the colposcopy - was a colposcopy directed biopsy taken ? That would clarify things. Also, colonoscopy and sigmoidoscopy cannot always detect rectal endometriosis - often endometriosis lies beneath the mucosa ( the lining ) which may appear intact. Diagnosis is most often by MRI / CT scan or a PET scan. Sometimes, laparoscopy of laparotomy might be required to see the actual endometriosis. The unexplained pelvic pain, raised CA 125 levels and rectal menstrual bleeding strongly lead me to think of endometriosis as a diagnosis. I would suggest trans rectal ultrasound scanning, CT / PET scanning and a laparoscopy if symptoms are unresolved. Please go through this - WWW.WWWW.WW au/bowel-endometriosis Have you been to a gynecologist with this symptom, and has endometriosis been discussed anywhere ?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (2 hours later)

Hi. My understanding is that the gyn was going to do a colposcopy biopsy on the fibroid/polyp he could visualize in my cervix. Yes, my gyn suggested the sigmoid to see if anything showed up ( like endometriosis). What do you think would be the best test after the sigmoid? I have been getting a little rectal bleeding throughout the month over the past 4-6 weeks, only with a bowel movement. The area by my pelvic bone and the crease of my right leg ( as well as the area above that) has been very sore lately as well, but nothing has shown up on the ultrasound. One ultrasound showed increased blood flow to my right ovary but it didn't see any masses or lesions. It wasn't my time of ovulation. Any thoughts? What would cause Increased blood flow to an ovary? Thanks.

Answered by Dr. Aarti Abraham (1 hour later)

Brief Answer: DETAILED BELOW Detailed Answer: Hello Yes, the biopsy would give a lot of information. If the rectal bleeding is not coinciding with your menstrual cycles, then yes, the diagnosis of endometriosis is not that likely. It could be a primary rectal cause - polyps, growth - but again stumped by the negative colonoscopy and sigmoidoscopy. Increased blood flow to the ovary can be seen after ovulation, around ovulation, even before ovulation, in case of an ovarian cyst or simply pelvic congestion pre menstrually. It is of no specific importance. I guess we have to wait for the biopsy report, apart from the colonoscopy / sigmoidoscopy, all that remains to be done is a laparoscopy. Take care.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar