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Can Hemorrhoids Cause Long, Narrow And Large Stools With Blood?

Posted on Tue, 15 May 2018

Question: I am a 49 yo female. I have had external hemorrhoids in the distant past. I pass a large (long), snakey, formed stool daily. The terminal part of the stool is sometime mushy. Occasionally the stool clogs the toilet. I have a very fibre rich diet and in fact increased my fruit consumption ++ in the past 3 months. I take a multivitamin, calcium supplement vitamin C as well as OCP. For the past 2 weeks I have had bright red blood in the toilet tissue on 4 occasions. On one occasion I observed a small amount of blood on the very end of my stool. I have had no changes in bowel habits. My stools are a normal caliber, although once in a while I see a linear "ridge" on the stool (infrequent). I do not have a family history (first degree relatives) of colon cancer. My paternal grandfather did have colon cancer in his 50's (reportedly). Given that I have had an occasional hemorrhoid, and at least one prolapsing hemorrhoid (perhaps a year ago), I hope this is just an internal hemorrhoid....

Answered by Dr. Ramesh Kumar (48 minutes later)

Brief Answer:
Hemorrhoids associated bleeding very likely.

Detailed Answer:
Hello dear atient,
Thanks for chooong HealthcareMagic for your query,
Have gone through your details and i appreciate your concerns.
As per the history given by you most likely the bleed is due timo henorrhoid only.

Two recommendations are-
As you are more then 45 madam as a part of protocol you should go for a colonoscopy once every 5 years.
So not just to rule out carcinoma considering your age it should be done once.

Secondly i would recommend you to go for a proctoscopic examination by a surgeon and if you know its internal hemorrhoid start conservative treatment chances are that it shed off in 3 months.

Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives,it would soften up your stool.In patient with hemorrhoid we prefer a soft stool more then well formed one as it may rub against mucosa layer.
-Secondly, Start using PreprationH use a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc. Its also OTC

Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate(NOT CALCIUM)-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.

Take home message-
At least one colonoscopy should be done.
Alng with food change proper conservative management should be taken for hemorrhoids.

I hope i was helpful.
Please feel free to follow up.
Regards!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (33 minutes later)

Thank you. I should clarify that although my stools are formed, they are very soft...they kind of just "slide out". At the end of my BM they are almost a "mushy pile". I do not presently have any visible/symptomatic external hemorrhoids, so am I to use the Preparation H cream internally? If so, for how long? There's not much to change about my diet. I rarely eat red meat and I eat at least 8 servings of fruits/vegetables daily, in addition to legumes. I am not overweight (5'3"/116lb) or sedentary and I never strain to stool. So I just cant figure out why I would have internal hemorrhoids. I do not smoke and I drink in moderation. I'm assuming I should start the oral calcium dobesilate after confirmation of the diagnosis with colonoscopy? I live in Canada and I suspect because I am "low risk" I will wait several months to see a gastroenterologist.

Answered by Dr. Ramesh Kumar (58 minutes later)

Brief Answer:
follow up.

Detailed Answer:
For starting calcium dobesilate just go for a proctoscopic examination by a general surgeon or family medicine doctor.
Basically colonoscopy is meant to rule out chances of colorectal cancer.
With perperation H you would get a applicator.Just follow the instructions on it.Use it for 3 months in conjugation with dobesilate.
No need to take lactulose instead add psyllium husk a natural husk and a bulk laxative(100% natural).Its a bulk laxative and have many health benefits.
Whether its a hemorrhoid or not would be confirmed by proctoscopy (2 minute test).

Regards!

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Above answer was peer-reviewed by : Dr. Prasad