A complex case - What do you guy think?

Hi Guys

May you have good health by the grace of God.

I haven't been on here for ages because I have been in remission for several years from Non Specific Colitis. I am now confused as I again have rectal bleeding and if you don't mind I was wondering if I could tell you my story and see whether you can help me?

FYI: I am a hypochondria which I find is the main trigger if I ever have a flare.

Here is a brief history:

• August 2007 I had rectal bleeding which was diagnosed as Non-Specific Colitis + Hemmorhoids

• October 2007 on a 2nd Opinion I had rectal bleeding which was diagnosed as Non-Specific Colitis; prescibed Asacol and it cleared up.

• September 2008 did a Sigmidoscopy and took me off all meds saying I only have IBS and Piles

• September 2009 when I had rectal bleeding who diagnosed Chrohn’s Disease. It cleared up with Pentasa and Chrohns diagnosis questionned.

• I have stayed in remission for 4 years using 1000mg Pentase x 2 a day and VSL 3 once a day.

Here is the crux of my issues:

1. I do not diarrhoea with my colitis
2. I have internal haemorrhoids and a fissure
3. Each incidence happens when I have a serious stressful event in my life – my hypochondria and IBS then takes over and I start bleeding after several visits to the toilet and straining.

I do not have abdominal pain, or bloody diarrhoea or any suggestions in my blood tests of inflammation - they are always normal and HB is over 17. I get bright red blood on toilet tissue and streaks on the stool. In addition the colonoscopy sometimes shows mild inflammation on the right sided cecum and in lower part of my bowel – (patchy and mild inflammation) with no urgency or diarrhoea.

What I want to investigate is whether this patchy inflammation is IBD or something different given my very mild symptons, whether the current bright red bleeding is my haemorrhoids or something else more sinister - I do not have any other symptoms apart from an sore bum.

I feel totally fine, except for the bright red blood on stool and on tissue which now comes on occasions after a disappearance of some 4 years!

Is this complex investigation something you peeps can help me with? The anxiety is driving me insane.

LondonRed
Colitis since 2007, aged 40.

The bright red blood is usually indicative of hemorrhoids. The farther up the tract, the darker the blood. Kaz's advice is straight forward. Most CD patients don't have profuse bleeding like many UC patients have.

I guess I would be questioning the diagnosis under the same circumstances too. Do you have arthritis or other extra-intestinal symptoms? A person can have a mild form of the disease, but I would think your GI is seeing something that's not explained entirely by the hemorrhoid diagnosis. Some doctors get their panties in a wad if you ask a lot of questions but it's your body and you have a right to ask how they come to their diagnosis.

Another thing I have to keep in mind with bleeding are NSAIDs. Aspirin and even other NSAIDs to a lesser degree can cause bleeding to be far worse, even with hemorrhoids. If I take one baby aspirin, I can have bleeding. Of course, NSAIDs are usually considered off limits to Crohn's patients, but I'm one of those who can take smaller doses of ibuprofen for my arthritis. For me it's a necessary evil as I consider it safer for me than having to be on steroids, but I'm doing it under my doctor's care.

I think my anxiety is brining on inflammation today in me. I was "perfect" 3 weeks ago on a proctoscope; and normal even 2 days ago - but since seeing blood I am finding I am running to the toilet to check if there is blood!

I have been to the toilet twice already today and have only been up 8 hours. First one was red specs on loose stools but no blood on tissue.

The second BM looked like left over residue from the first one as the blood had gone maroonish but was bright on the tissue wipe and the stools looked sand like - and of very small volume.

Can hemmie blood from a previous BM pool up inside our butt? The blood isn't loads though, maybe only a teaspoon.

I am at the end of my tether but my GI keeps saying wait until my appointment on Saturday and mutters something about IBS and hemmies/ fissure.

Arrghhhhh The anxiety! And I have a 9 hour flight today.

I have Anusol HC (with cortisone) suppositories and it helps with my bleeding internal hemmies. And yes, if they bleed with a bowel movement, there is often still some blood the next time I go to the bathroom.