[47F] Experiencing gastrointestinal bleeding and irregular bowel movements

Patient Description

A 47-year-old female reports recurrent episodes of gastrointestinal bleeding characterized by bright red blood mixed with stool, noticeable in the toilet water and on toilet paper. These episodes have occurred approximately four times in the last four months, each lasting 3-4 days. The patient also describes a worsening stench from stool and gas over the past year, now occurring with any food intake. She experiences lightheadedness, particularly after bowel movements, and describes it as an unsteady, dizzy feeling. The patient's bowel habits are irregular, fluctuating between constipation and diarrhea, with bowel movements 2-3 times a day or a gap of up to 4 days. The stool sometimes appears indented and is accompanied by yellowish, oily fluid. The patient has a history of a non-cancerous polyp removed during a colonoscopy last year, with no changes in symptoms post-procedure. She has a family history of colorectal cancer and IBS. Additionally, the patient has been diagnosed with Rheumatoid Arthritis and has been on Wellbutrin for approximately 11-12 years, with a dosage adjustment history from 150mg to 300mg and back to 150mg. No known drug allergies. No recent weight changes reported, but she has experienced lower abdominal pain radiating to the back and a lack of appetite. No fever or night sweats were mentioned.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Hemorrhoids: These are swollen veins in your lower rectum. Internal hemorrhoids can cause bright red blood in the stool or on toilet paper, but they are usually painless.
- Treatment typically involves over-the-counter creams or suppositories, eating a high-fiber diet, and drinking plenty of fluids. In some cases, medical procedures may be necessary.
Anal fissures: These are small tears in the thin, moist tissue that lines the anus, which can cause bright red blood in the stool or on toilet paper, along with pain during bowel movements.
- Treatment typically involves increasing your fiber intake, soaking in a warm bath, and using topical pain relievers. In some cases, surgery may be necessary.
Colorectal cancer: Given your age, family history, and symptoms, this is a possibility that should be ruled out. Colorectal cancer can cause changes in bowel habits, blood in the stool, and abdominal discomfort.
- Treatment typically involves surgery, radiation therapy, and/or chemotherapy.
Inflammatory bowel disease (IBD): This is a term that includes conditions like Crohn's disease and ulcerative colitis. These diseases can cause changes in bowel habits, blood in the stool, abdominal pain, and fatigue.
- Treatment typically involves medication to reduce inflammation and control symptoms. In some cases, surgery may be necessary.
Irritable bowel syndrome (IBS): This is a common disorder that affects the large intestine and can cause cramping, abdominal pain, bloating, gas, and changes in bowel habits.
- Treatment typically involves changes in diet, lifestyle, and stress management. Some people also benefit from medication.

Please note that these are possibilities based on your symptoms and should not be taken as a diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

Schedule an appointment with your healthcare provider as soon as possible to discuss your symptoms.
Keep a symptom diary, noting what you eat, when you have bowel movements, and any symptoms you experience. This can help your healthcare provider identify patterns and potential triggers.
Try to eat a balanced diet with plenty of fruits, vegetables, and whole grains to help regulate your bowel movements.
Stay hydrated, as dehydration can exacerbate constipation.
Try to get regular exercise, as this can help stimulate your intestines and reduce constipation.