[20F] With bright red rectal bleeding and severe abdominal pain

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses to consider:

1. Hemorrhoids: Despite your negative test, hemorrhoids can sometimes be missed on initial examination. They can cause bright red bleeding, especially during bowel movements, and can be associated with pain and discomfort.

2. Anal Fissures: These are small tears in the lining of the anus, which can cause bright red bleeding and significant pain during bowel movements. Given your history of painful cramping and bleeding, this could be a possibility.

3. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or Ulcerative Colitis can cause chronic abdominal pain, rectal bleeding, mucus in the stool, and weight changes. Even though you mentioned no family history of IBD, it can still occur sporadically.

4. Diverticulosis/Diverticulitis: These conditions involve small pouches in the colon that can become inflamed or infected, leading to bleeding, pain (often in the lower left abdomen), and changes in bowel habits.

5. Colorectal Polyps or Cancer: While less common in younger individuals, persistent rectal bleeding warrants evaluation for polyps or colorectal cancer, especially if other symptoms like weight gain, fatigue, and changes in bowel habits are present.

What you can do

Rectal Bleeding and Abdominal Pain:

• See a Gastroenterologist: Given the duration and severity of your symptoms, it's important to consult a specialist. They may recommend a colonoscopy or other imaging studies to get a clearer picture of what's happening.
• Dietary Changes: Continue to monitor your diet. High-fiber foods can help with bowel regularity, but avoid foods that seem to trigger your symptoms.
• Hydration: Drink plenty of water to help keep your stools soft and reduce straining during bowel movements.
• Pain Management: Over-the-counter pain relievers like acetaminophen can help manage pain, but avoid NSAIDs like ibuprofen, which can exacerbate bleeding.

Fatigue and Weight Gain:

• Monitor Symptoms: Keep a journal of your symptoms, including fatigue levels, weight changes, and dietary intake. This can help your healthcare provider identify patterns and potential triggers.
• Regular Exercise: Engage in moderate physical activity, such as walking, to help manage weight and improve overall energy levels.
• Balanced Diet: Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support overall health.

Nausea and Decreased Appetite:

• Small, Frequent Meals: Eating smaller, more frequent meals can help manage nausea and ensure you're getting enough nutrients.
• Avoid Trigger Foods: Identify and avoid foods that seem to worsen your symptoms.

What you should look out for

Given the severity and persistence of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:

• Severe or worsening abdominal pain
• Dizziness or fainting
• Significant changes in bowel habits
• Unexplained weight loss
• Persistent or worsening fatigue

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.