[21F] With blood in stool, constipation, and low blood pressure

Patient Description

A 21-year-old female has been experiencing blood in her stool for about two months. The blood appears as drops that are enough to stain toilet paper and make the water red. This issue has developed gradually over time. Her stool has changed in color and consistency, appearing green, yellow, or very dark. She also mentioned having hard stools followed by very soft stools. Recently, she has been feeling constipated and rarely has bowel movements. She used to have frequent diarrhea but is now fully constipated. She has lost about 10 pounds over the past two months and has a decreased appetite, which has been ongoing for about a month and a half. She also experiences cold sweats regularly throughout the day. She feels lightheaded and experiences brain fog, which has been moderate in severity and has been affecting her daily life for about a month. Sleep seems to help alleviate these symptoms. The inside of one of her nostrils is inflamed and bright red, but she does not experience nosebleeds. She has been feeling fatigued and always tired. She has experienced abdominal pain that is mostly dull but can sometimes be sharp and tender to touch. She has had nausea but no vomiting. She has experienced black, tarry stools. She has taken Tylenol/Advil for two days but not regularly over the past two months. She does not have a family history of gastrointestinal conditions, and she drinks alcohol occasionally. She drinks sink water from Whitewater, Wisconsin. Her periods were never regular before getting an IUD about four years ago. She is not currently taking any medications or supplements.

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Arora's Assessment

What might be happening

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

  1. Gastrointestinal Bleeding: The presence of blood in your stool, especially if it is dark or tarry, suggests that there may be bleeding somewhere in your gastrointestinal tract. This could be due to several conditions, including:

    • Peptic Ulcers: These are sores that develop on the lining of your stomach, small intestine, or esophagus. They can cause bleeding, leading to blood in the stool.
    • Gastrointestinal Infections: Certain infections can cause inflammation and bleeding in the digestive tract.
    • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic inflammation and bleeding in the intestines.
    • Colorectal Cancer: Although less common in younger individuals, it is still a possibility that should be ruled out, especially with persistent symptoms.
  2. Constipation and Bowel Habit Changes: Your recent constipation, along with changes in stool color and consistency, could be related to:

    • Dietary Factors: Lack of fiber, dehydration, or changes in diet can lead to constipation.
    • Irritable Bowel Syndrome (IBS): This condition can cause alternating periods of diarrhea and constipation, along with abdominal pain.
    • Medication Side Effects: Although you mentioned not taking regular medications, occasional use of NSAIDs like Advil can contribute to gastrointestinal issues.
  3. Low Blood Pressure and Fatigue: Your low blood pressure, dizziness, and fatigue could be related to:

    • Dehydration: Not drinking enough fluids can lead to low blood pressure and fatigue.
    • Nutritional Deficiencies: Lack of essential nutrients, possibly due to decreased appetite, can cause fatigue and low blood pressure.
    • Chronic Illness: Underlying conditions like anemia or thyroid disorders can cause these symptoms.
  4. Nasal Inflammation: The bright red inflammation inside your nostril could be due to:

    • Allergic Rhinitis: Allergies can cause inflammation and redness in the nasal passages.
    • Infection: A localized infection or irritation could cause redness and inflammation.

What you can do

Blood in Stool and Constipation:

  • See a doctor as soon as possible: Given the presence of blood in your stool and changes in bowel habits, it's important to consult a healthcare provider. They may recommend tests such as a colonoscopy, stool tests, or blood tests to determine the cause.
  • Stay hydrated: Drink plenty of water to help with constipation and overall health.
  • Increase fiber intake: Incorporate more fruits, vegetables, and whole grains into your diet to help with bowel movements.
  • Avoid NSAIDs: Since NSAIDs can contribute to gastrointestinal issues, try to avoid them unless prescribed by a doctor.

Low Blood Pressure and Fatigue:

  • Monitor your blood pressure: Keep track of your blood pressure readings and share them with your healthcare provider.
  • Eat small, frequent meals: This can help maintain your energy levels and prevent drops in blood pressure.
  • Stay hydrated: Drink plenty of fluids throughout the day.
  • Rest and sleep: Ensure you are getting enough rest to help alleviate fatigue.

Nasal Inflammation:

  • Avoid irritants: Try to avoid allergens or irritants that may be causing the inflammation.
  • Use a saline nasal spray: This can help soothe and moisturize your nasal passages.

General Tips:

  • Document your symptoms: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your provider.
  • Seek medical care: It's important to consult a healthcare professional for a formal diagnosis and appropriate treatment.

What you should look out for

Given the severity of your symptoms and the possibility of serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe abdominal pain: If your abdominal pain becomes severe or unbearable.
  • Persistent or worsening symptoms: If your symptoms do not improve or worsen over time.
  • Signs of severe bleeding: Such as large amounts of blood in your stool, vomiting blood, or black, tarry stools.
  • Fainting or severe dizziness: If you experience fainting or severe dizziness, especially if it is accompanied by other symptoms.

Remember, while I can provide information and suggestions, it's important to consult a healthcare professional for a formal diagnosis and treatment plan.

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8 mo ago

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People Also Ask


What could cause blood in the stool and changes in bowel habits?

Blood in the stool and changes in bowel habits can be caused by gastrointestinal bleeding, which may result from conditions like peptic ulcers, gastrointestinal infections, inflammatory bowel disease, or even colorectal cancer. It's important to consult a healthcare provider for proper diagnosis and treatment.


How can I manage constipation and improve bowel movements?

To manage constipation and improve bowel movements, increase your fiber intake by eating more fruits, vegetables, and whole grains. Stay hydrated by drinking plenty of water, and try to avoid NSAIDs like Advil, which can contribute to gastrointestinal issues. If symptoms persist, seek medical advice.


What might be causing my fatigue and low blood pressure?

Fatigue and low blood pressure can be caused by dehydration, nutritional deficiencies, or chronic illnesses such as anemia or thyroid disorders. Ensure you are drinking enough fluids, eating small, frequent meals, and getting adequate rest. Monitoring your blood pressure and consulting a healthcare provider is also recommended.


What should I do if I notice nasal inflammation without nosebleeds?

Nasal inflammation without nosebleeds could be due to allergic rhinitis or a localized infection. Avoid known allergens or irritants, and consider using a saline nasal spray to soothe and moisturize your nasal passages. If symptoms persist, consult a healthcare professional for further evaluation.


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