Q: Help! I saw bright red blood on the toilet paper after I wiped. What should I do!?
Short A: Come in to see us so we can check it out.
Long A: Don’t panic. We see this all the time at Student Health and it’s rarely as scary as it looks. You’re probably dealing with a hemorrhoid: a very common, and literal, pain in the butt.
Hemorrhoids are abnormally swollen veins in the rectum or anus that bleed with minor pressure, such as that which occurs from bowel movements. They can be painful or painless depending on their location, and are often associated with rectal pain and itching, a lump that you can feel and/or rectal bleeding.
Risk factors for developing hemorrhoids include
- Poor fiber intake
- Prolonged sitting or standing
- Being overweight
- Chronic constipation or diarrhea
- Engaging in anal sex
When you come to the Student Health Center, we will ask you a lot of embarrassing questions and do an embarrassing examination to rule out other more serious causes of rectal bleeding such as infections, inflammatory bowel disease, anal fissures and even (rarely) colon cancer. Since some hemorrhoids are located a few inches inside the rectal canal, we may have to use a small, lubricated, clear plastic tube called an anoscope to look on the inside.
The mainstay of hemorrhoid treatment (and prevention) is fiber, fiber, fiber. Most of us don’t get enough fiber in our diet, which leads to constipation, which leads to straining to have a bowel movement, which leads to increased pressure in the rectal veins which… you get the idea. Supplementing your diet with soluble fiber supplements (Metamucil or Benefiber) will work wonders for this problem. Other things you can do include:
- Avoid straining and prolonged sitting on the toilet
- Lose weight if necessary
- Drink 8 to 10 glasses of water per day
- Exercise regularly
- Gently clean the anal area with soft, moistened paper after each bowel movement and avoid the urge to scratch – as an old family doctor once told me: “Wipe, don’t polish!”
Again, while it can certainly be scary, rectal bleeding is rarely a sign of a life-threatening condition. But if it happens to you, be sure to see your health care provider to make sure it isn’t, especially if the bleeding is dark brown or black, is heavy, you feel weak or light-headed, or the pain gets suddenly a lot worse.
John A. Vaughn, MD
Student Health Services
The Ohio State University