bright red blood: first flare in years, diverticulus, med reaction, or fissure/hemmie?

Hi y'all,

Haven't posted in forever, meaning things have been really good for quite awhile. Now I'm in early stages of menopause and life in general has gotten totally whack. Sleep has been a mess for past few weeks.

So, today there was quite a bit of bright red blood when I pooped and of course I freaked. It looked like it might indeed be mixed in, couldn't quite tell. No signs of any of this earlier than today. In the past, it helped to do an extra midday Rowasa so I did that. Then I went to pee and a bunch more bright red blood fell out of my butt. Honestly, I don't remember that ever happening when I flared-- blood even when peeing, not just pooping-- though I haven't flared in so long (over a decade!) that I can't totally remember.

I had a totally clean routine scope in the fall, after which my GI mentioned all he saw was one diverticula (first ever). I'm wondering: Maybe it could be that? Or a hemmie or fissure? Gosh, it would be great if it wasn't really a flare. Obviously if it keeps up I'll go get a flex sig, but was curious what others think.

The only other thing: For past two days I was trying a new heartburn med, Gaviscon Advance from the UK (sodium alginate) and on Saturday also some Prelief to help me drink some wine. (Reflux has been acting up along with everything else.) The Prelief in particular, but possibly both, did seem to mess with my digestive tract--actually slowing things down rather than speeding them up.

I do worry all the crazy hormonal stuff may cause UC probs... but also just the lack of sleep...

Any thoughts?? Thanks so much!

Passing blood when we poop could be a UC flare or a diverticula (or multiple) could have burst. Hemmorrhoids are possible bleeders, as are an anal fissure or an anorectal abscess might have developed (do you have a history of any of those? Less likely if you have no history of them).

I'd try not to panic over a 1 day episode of bleeding when pooping. I'd see if it happens consistently for 4 or so days.

If it does reoccur consistently and persist, then standard flare-protocol would apply. I'd call your gasteroenteroligist and ask for a stool test for plausible infectious causes, like c-diff. To get to the bottom of whether there is actual inflammation going on, you might want some sort of endoscopy, like a flexible-sigmoidoscopy (as you have multiple possible things that could cause this). Alternatively, ask for a Fecal Calprotectin (FCP) stool test or at least a C-reactive protein (CRP) blood test to assess inflammation-levels (less invasive and you did have a scope in the fall).

As a precaution, you can always up your oral mesalamine from 2,400mgs a day to 4,800mgs a day, and take nightly rowasa retention-enemas (if you have extras on-hand) to see if you improve after a couple weeks on your own.