Patient: 19 y/o female. I was having small spots of bright red blood after BM.Primary care physician gave diagnosis of internal hemmroids, but did not do hemmroids check I was prescribed Mira lax.Currently, I am off Mira lax eating lots of fiber, and drinking lots of water.Today after BM I noticed one small piece floated to the top, and was accompanied by a long string of mucus.Could this be from internal hemmroids?This may be irrelevant, but I’ve also had pain in R Lower abdomin/ hip 5/10 pain that comes and goes.
Doctor: Hi.Thanks for the query, an elucidate history and the image you have posted.Noted the history of blood in the stool for which you consulted the PCP, who did not do internal examination nut prescribed you Miralax.Currently- off Miralax, eating lots of fiber, and drinking lots of water.Today after BM you noticed one small piece floated to the top, and was accompanied by a long string of mucus. This looks to be feces only with mucus. You could have certainly send this to the Laboratory for testing.Could this be from internal hemorrhoids? > No this is not from the hemorrhoids.This may be irrelevant, but I’ve also had pain in R Lower abdomen/ hip – 5/10 pain that comes and goes.> This indicates more of colitis or appendicitis.I would advise you in such a situation the following:- Send the sample of stool for testing (if you have not flushed). Get tests of stool for 3 days.- Consult a General Surgeon for per-rectal and Proctoscopy examination to start with, have clinical evaluation, examination, order for investigations of ultrasonography to start with.- A course of Antibiotics, metronidazole, probiotics, anti-spasmodic as you have pain.- Conform the probable diagnosis whether this is just a colitis or appendicitis or such a problem.Get further tests of colonoscopy and CT scan of the abdomen- only if required.I hope every point is clear to you and helps you proper diagnosis and treatment.Please feel free to ask for any further relevant queries if you need to or if you feel that there is a gap of communication.
Comments / Follow Ups
Patient: 1. I flushed the stool. My normal BM do not normally have mucus, but I have witnessed a couple that have had a small amount of mucus. To your knowledge how much does stool testing cost.
2. Are these possible diagnosis life threatening if left un treated?
3. Do you have any natural/ dietary changes that I could make before visiting these specialist.
Please note my family is lower middle class with terrible health insurance. This is asking a lot of my parents to do this for me.
Doctor: Thanks for your feedback.
I can understand the costs involved, and your PCP is the best person who can tell you the details about the costs.
This does not looks to be life threatening.
No need to change any diet.
The simple dictum is take every food that suits you, should preferably a home-made food, boiled and cooled water to drink.
No junk foods at all.
A course of an antibiotic, Metronidazole if your PCP thinks so.
Add probiotics / curds, to your diet.
Patient: thank you for your help, I have one last question.
1. Can anxiety play a role at all into this condition? I’ve been very worried about this, could that exacerbate the symptoms?
Doctor: Certainly yes, anxiety can add on to the problems or be a reason, for example in IBS and so on / can exacerbate many problems.