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Having major bloating and alternating constipation, diarrhea. Getting blood clots in stool. IBS?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
Hi. I am a 45 year old female, 5'7" 190 lbs. I have had what I think to be IBS symptoms for several years now, which I have mostly been able to control with diet and herbs. I was having major bloating and alternating constipation and diarrhea, lots of mucus as well as spasms and general digestive uncomfortableness. Now I only have occasional days of going to the bathroom all day which is much better. What concerns me now is bright red blood clots I have been passing for the last week, mostly the size of peas. Not heavy bleeding, and not every time I go, also an uncomfortable pressure feeling at the anus and abdominal cramps. This also happened once before about a year ago but stopped. I am concerned if it may be cancer- I do not have insurance. Please tell me what it could be and if cancer is likely.
Posted Thu, 28 Mar 2013 in IBS(Irritable Bowel Syndrome)
Answered by Dr. Nsah Bernard 17 minutes later

Thanks for posting,
Let me be straight and simple in presenting my impressions from the most likely to the least likely cause of your lower bowel hemorrhage or hematochezia (bright red stool).
You might be having:
- XXXXXXX Hemorrhoid (very likely because of history of IBS especially constipation, bloating etc and the fact that it is the most common cause of hematochezia in all age groups)
- Anal fissure (same like hemorrhoid)
- Anorectal Polyp
- Anorectal cancer ( will be considered last but based on your age is a likely possibility): Here can never be so sure if you are not examined. Normally, you should have presented with weight loss, fatigue, night sweats, fever and other paraneoplasic symptoms. To me, anorectal cancer, could be investigated or suspected least (i.e after ruling out the above possible causes).

I understand that you are not able to get to see a doctor because you do not have insurance, but your situation might become worst and you might become anemic if not treated before time.
Getting you properly examined by a gastroenterologist will be the best recommendation I can give you right now.

Please feel free to ask more questions as I am here to assist.
Dr. Bernard
Above answer was peer-reviewed by
Follow-up: Having major bloating and alternating constipation, diarrhea. Getting blood clots in stool. IBS? 12 minutes later
Thank you for your reply. I have a couple more questions- is the presence of blood clots more worrisome than just liquid blood and does it make it more or less likely to be cancer? Also, if i have an episode like this not often, with a year or more between episodes is that how cancer would present? Or would cancer get progressively worse with the symptoms? Both times I have had this happen has been right after a respiratory illness that required antibiotics. It seems that that could be connected somehow? Also I have a great deal of cramping and diarrhea this week. There is no blood on the stools, but when I wipe after there is some blood and a clot or two.

And lastly- should I maybe do a special diet until this gets better to not stress the bowel? What do you recommend?

Thank you
Answered by Dr. Nsah Bernard 15 minutes later

Presence of clot simply signifies that the source of bleeding is probably slow or situated more proximal to your large intestine, hence resulting to blood clotting before it is expelled during defecation. Hemorrhoid is more of bright red blood (with no clots) and situated more distal (anally). Your update drives me to think more towards an anorectal tumor (could be benign and not necessarily malignant or cancerous). To be sincere with you, it will be very difficult to say with exactitude the cause for your bleeding without being able to physically examine you and also run a colonoscopy (reason why you need to consult a gastroenterologist or GP). A respiratory illness (with cough) could be responsible for increased peristaltic movements or bowel movements which could strain the intestines + blood vessels, and hence injury plus bleeding).
From this statement "There is no blood on the stools, but when I wipe after there is some blood and a clot or two", we would have to exclude hemorrhoid or pile (as primary cause) before we can think of tumors.
Like I said if it was cancer, there would have been some typical paraneoplasic symptoms that will be associated. Weight loss is always one of the symptoms.
Diet change is very recommended. Take a lot of high fibre diets, avoid eating foods that are too dry, eat lots of fruits, drink much fluids and avoid spicy meals (especially that contain pepper). You will also require a low dose of iron supplements ( or liquid or syrup forms) to replace the iron being loss through the bleeding.

I still say your condition requires medical attention.

Hope this was helpful
Dr. Bernard
Above answer was peer-reviewed by
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