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Ask Dr. Gott 7/19
Bloody stool has many possible causes
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    DEAR DR. GOTT: I am a 78-year-old woman in good health. Recent laboratory blood tests were normal. However, during a routine fecal occult test, blood was found in all three slides. I followed the instructions carefully, so there was no possibility of contamination. My gastroenterologist then performed a colonoscopy, endoscopy and a capsule endoscopy. All three procedures proved negative.
    Two and a half years ago, I had the same test for the same reason. All three endoscopic tests were negative. The two physicians who performed these tests could not give me any advice as to the source of the blood in the stool samples.
    This is a worrisome problem for me. Should I seek further medical advice or simply forget about it?
    DEAR READER: Rectal bleeding and positive fecal occult testing can result from numerous causes, with the two most common being hemorrhoids and anal fissures. A hemorrhoid is a swollen vein in the anal area. Straining during defecation or rubbing too hard with toilet tissue can cause a hemorrhoid to leak and bleed. Anal fissures are cracks in the skin around the anus that bleed, again resulting from straining or excessive rubbing.
    Arthritis is often treated with aspirin or nonsteroidal anti-inflammatory medications. Excessive amounts of these medications can irritate the stomach and small intestine that can ultimately cause ulcers or lesions that can bleed.
    Inflammatory bowel disease is a disorder of the digestive system without known cause. However, it is often associated with pain and bleeding, as are polyps (small growths) and cancerous tumors (malignant growths of tissue).
    Diverticulosis is a weak spot in the colon that can bleed. The difference here is that this condition will produce a significant bleed rather than appear as a few drops of blood on toilet tissue.
    I am sure your physicians considered all these possibilities when they ordered the extensive testing you had. You should be encouraged by the fact that the testing has remained normal. If you are on medication for a different medical condition, you might want to check with your physician to determine whether rectal bleeding is a side effect. If you use aspirin or anti-inflammatories in excess, attempt to reduce the dose.
    I am sure you are worried and would like resolution of what could be a serious issue. Begin with a visit to your primary care physician who can help with testing and referrals to appropriate specialists.
    You might consider a referral to a gastroenterologist. He or she could zero in on the testing done and provide the answers you require.
    To give you related information, I am sending you a copy of my Health Report "Medical Specialists." Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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