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What causes rectal bleeding post intercourse?

Answered by
Dr.
Dr. Neel Kudchadkar

General & Family Physician

Practicing since :2004

Answered : 531 Questions

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Posted on Tue, 7 Jun 2016 in Digestion and Bowels
Question: Hi I am a 32 year old woman with Ankylosing Spondilitis and Chrones. I also lose a lot of blood when ever I pas a stool but after having 3colonoscopies and endoscopes nothing has shown where the blood loss is coming from. I am having blood transfusions every 6-8weeks and also iron transfusions due to this. I recently had sex with my husband after a long respite and I had immediate rectal bleeding without stools and the bleeding has continued for the last three days from the rectum especially when I pass urine.
What could be the cause? Cervical cancer??
doctor
Answered by Dr. Neel Kudchadkar 2 hours later
Brief Answer:
Cervical Cancer: Unlikely. A plan on how to stop the blood loss.

Detailed Answer:
Hi!

I'm Dr. Neel Kudchadkar and I will help you now.
I have carefully examined the health question that you have sent and
will professionally advise you on solutions to your problem.

1. You mention bleeding upon passage of stools.
2. You say that you have undergone colonoscopies and endoscopies,
yet, these did not reveal the source of the bleeding.
3. You reported an incident of intercourse wherein you promptly began
to bleed from the rectum, in absence of stools.
4. You felt worried and concerned, at age 32, whether you had developed
cervical cancer. This is a valid concern.

Conclusions.

1. If you had cervical cancer, you would bleed vaginally and not rectally.
2. Endoscopy and Gastroscopy only reveal lesions inside the tract.
3. Thus, the source of blood is from rectal varices, of an external variety.
4. Given, the information, that you have supplied, I suggest that you might be
having hemmorhoids.

Treatment and Investigations.

1. Undergo a proctoscopy.
2. You need to apply a cream with a rectal applicator containing a combination
of Beclamethasone, a vasoconstrictor (varies by product), and topical anesthetic.
usually lignocaine 1%

3. I would ask you whether you consume alcohol. This causes damage to the
hepatic plexus in the liver and causes blood loss, XXXXXXX and occult.
4. Kindly get your liver function tests done.
5. I would ask you whether you have any genetically caused bleeding problem.
6. You need a blood test to determine this. Get this done, if you have a factor
deficiency in your marrow, you can correct it easily with special supplements.


To remove fear of cervical cancer and to prevent it.

1. Get a pap smear done, at regular intervals.
2. This will demonstrate CIN - Cervical Intraepithelial Neoplasia, if they are there.
3. Given your symptoms, you probably don't have cervical cancer.

4. Get a VD scan done at a path lab for HPV infection. If true, take the neccessary countermeasures.
5. If you have subclinical chlamydial infection, take the medication and eliminate it.

Cervical cancer is caused by,

1. Genetics and family history.
2. Infections of genitals of male and female sexual partners.
3. Poor hygiene of genitals, in both partners.
4. Exposure to carcinogens - smoking and drinking and recreational drugs.


If you can avoid, treat all these last 3, which is in your hands, there is really
nothing to fear, as regards cervical cancer.

I wish you to folow these suggestions.
Do write back to me for any doubts or fears or misconceptions.

Thanks,
Dr. Neel Kudchadkar
Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Neel Kudchadkar 51 minutes later
Thank you for your fast reply Dr Kudchadkar.

In regards to your answer I have just realised I may have left out some important information.in regards to your first conclusion the Endo and Colonoscopy both revealed lesions from Chrones.
It did not reveal any fissures or Polyps and I have been advised I do not have Hemmorhoids.m
The blood loss that I experience is more than a Cup 250ml at a time. Sometimes less and sometimes more. I don't think Hemmorhoids can cause this much severe blood loss. The blood loss is also a darker colour and not the bright red of fresh blood.

I do not consume alcohol but I do smoke. I weigh 59kg at 173cm.
During intercourse it did hurt slightly on the right side and has continued to hurt since.

I don't think I have a genetically caused bleeding as I think this was one of the first things I was tested for when this all started.

Before having children I did suffer from endometriosis and cysts the size of golf balls that needed to be removed but since having children this has since stopped.

Could the cause be something to do with the Fallopian tubes or something in that vicinity? This new bleeding does have me worried.
doctor
Answered by Dr. Neel Kudchadkar 1 hour later
Brief Answer:
Freedom from Crohn's - how to accomplish it practically.

Detailed Answer:
Hi!

1. Your blood loss in the quaters of a litre, brownish, is the result
of an event called as autoimmune hemolysis. (breakdown of blood)

2. Crohn's disease is a no fault illness.

3. You felt pain on the right side after sex, because the ileum of the
small intestine is the focal flash point of Crohn's. No mistake here.
This is a harmless event and need not repeat itself.

4. I would suggest, carefully that you visit a doctor, and get evaluated
for mercaptopurine like medications for Crohn's. However, you DO NOT
need to take Methotrexate. There are many safe choices available.
Just take the medication, calculated according to your body weight and
height, tailored just for you. I would have to see you face to face and
examine you to make such an exact judgement, so I am guiding you.

5. Your fallopian tubes are probably not involved. Even if you have had
fibroids and endometrosis, and they have caused bleeding in the past,
these issues are over for now. Most probably there is no chance of recurrence, and certainly would not ever cause, what you have now, bleeding through the rectum.

6. Smoking, in any amount, any brand, including low tar, low nicotine ones,
causes Crohn's to act up.

7. Freedom from the pain of crohn's (bleeding, discomfort) and smoking cannot go hand in hand. Both go away from your life together. Therefore I will recommend you stop smoking cold turkey
without any NRT, Patches, or Meds.

8. I want you to be free of Crohn's flareups forever.

I am ready 24x7 to help you out. I sincerely hope I have done justice to your questions.
Your fears and worries are valid.

I request you to follow these suggestions.
Just for today, never take another puff ever.
The Crohn's medication won't work to it's fullest otherwise.

Most sincerely,
Dr. Neel Kudchadkar
Above answer was peer-reviewed by : Dr. Prasad
doctor
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