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Painless rectal bleeding. Pale stools, blood during bowel movements. What can cause this?

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My 21 yr old daughter has been experiencing painless rectal bleeding for the past week. No other symptoms of distress. No hemorhoids or fissures on exam although she was very tense and difficult to examine rectally. Today she started passing very pale, XXXXXXX coloured stools. No abdominal pain or discomfort. Continues to have large amount of XXXXXXX blood during bowel movements. Good appetite. No nausea and vomiting. Is fatigued. Bloodwork one week ago for CBC was normal.
Did have a bout of severe abdominal pain approx. 6 weeks ago but nothing since.
What can cause bleeding and pale stools?
Posted Thu, 20 Sep 2012 in Digestion and Bowels
Answered by Dr. Om Lakhani 1 hour later

Thanks for writing in.

The commonest cause for painless rectal bleeding is hemorrhoids, however you said they have been ruled out by a rectal examination. Sometimes XXXXXXX hemorrhoids can be missed on Per rectal examination and simple proctoscopy may help in seeing them. Loss of blood can cause fatigue. However at her age a bleeding from rectum can also be due to inflammatory bowel disease like ulcerative colitis. I would suggest you this:

1. Get doctor to do a simple proctoscopy and rule out XXXXXXX hemorrhoids. This can be done under sedation if she is very tense. This can be done by a take a GI consult to get a sigmoidoscopy/colonoscopy done. This too can be done under sedation.

Since she also had abdominal pain 6 weeks back I would advise an aggressive and urgent evaluation.

Hope I have answered your query. If you have any further questions I will be happy to help

Dr. Om Lakhani
Above answer was peer-reviewed by
Follow-up: Painless rectal bleeding. Pale stools, blood during bowel movements. What can cause this? 1 hour later
Thanks for the quick response.

She does have a referral for a GI consult but my fear is that this will take weeks to happen.

Should the new symptom of very pale, XXXXXXX coloured stools be of concern?

Answered by Dr. Om Lakhani 23 minutes later

Yes. Blood mixed with pale stools is a concern. Does she have any itching all over ? Has she lost weight ? Does she have jaundice ?

In any case as I advised you may check with a primary care doc for a proctoscopy. Did your doctor find anything unusual in the physical examination ? Also you may ask your doctor about an ultrasound of the abdomen which I am sure a family doc as well as an internist can order. Also you need to report to ER next time she bleeds profusely.

In brief , to answer your question the stools you have described is a cause for concern.

Hope this helps .

Dr. Om Lakhani
Above answer was peer-reviewed by
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