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Family Physician
Family Physician, Doctor
Category: Medical
Satisfied Customers: 2592
Experience:  Emergency Medicine and Family Practice for over 26 years
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My question is, as an experienced gastroenterologist whose

Customer Question

My question is, as an experienced gastroenterologist whose specialty is in this field, do you agree with the opinions of the general practitioners I’ve consulted?
Sorry, this is really long, but what worries me is the sequence of events for my rectal bleeding and lower left abdominal pain problem:
Medical History: Age 26, Ethnicity Oriental,
Acid Reflux: Was on proton pump inhibitors for anxiety induced acid reflux for 5 months in 2013. Had muscular fistulations everywhere and an odd sensation in my lower left abdomen, near the area that is now experiencing abdominal pain. All of this went away after the PPIs a rigorous regiment of healthy lving as proscribed by the doctor.
No known family history of colon cancer, may have had a great grandmother who got it around 85 and died with it, not of it.There was a period of about 5 to 6 months when I drank a lot, but I’ve basically more or less quit after deciding it was bad for me.
Around March or April 2015
-Constipation from lack of fluids. Strained to poop for weeks and finally one day I started having bright red blood on stool, on toilet paper and dripping into bowl after bowel movement.
-Went to GP, at an urgent care facility. He gave me a diagnosis of hemorrhoids "Over 99% certain" after listening to my symptoms, feeling my abdomen, performing a rectal finger exam and asked me to take more fluids and fiber supplements.
-After about 2 weeks the bleeding went away.
Late May-Early June 2015
-Sudden onset of bad lower left abdominal pain, tenderness when clenching or bending abs, no rectal bleeding. Radiated around and caused headaches, nausea.
-Went to a different GP at a different urgent care facility due to insurance stuff. He did a thorough feel test on my abdomen and some stretch tests and concluded it was a muscular problem, said that he would be worried about diverticulitis if I was older. Told me to rest and do stretching exercises. We agreed that is was probably due to me sleeping in an extremely awkward position several days earlier.
-The pain got a lot better over time but is semi-persistent. Sometimes it will be gone for day at a time, weeks. But it always comes back.
Early to mid-July 2015
-A hectic time in my life where I let off on the fluids again. The rectal bleeding happened again. This time it was just once. The blood was a deeper red, but still fresh, and mixed with mucus after a bowel movement.
-Went to the first GP’s urgent care office again. Another doctor there looked at me (A Physician’s Assistant I think). He examined my anus with an anoscope, did not see any hemorrhoids but he said it was very red and inflamed, said I had pruritus ani and a fissure. He did not see one with the anoscope but said the inflammation would make it impossible to see. When he did the stretch test with his finger, my anus just hurt in general, no specific pain that might point to a fissure in a specific area.
-Doctor and I identified the cause of pruritus ani as the frequent use of coarse toilet paper in public bathrooms. He said that I should use baby wipes exclusively for a while. I did and the bleeding stopped
-The lower left quadrant pain persists, sporadically appearing for days or weeks at significantly lower levels than initially.
December 2015
-Rectal bleeding started again, deep red, fresh, small amount. This time after having some life circumstances that forced me to use coarse toilet paper in public restroom everyday again. Went back to the first Urgent Care office to be sure. Was the same doctor who saw me the first time.
-Asked me if I had any blood mixed into the stool. I said that there was too little for me to tell. It was present on the stool or on the paper in literally pinprick specks, and rarely. Maybe 1 or 2 specks on/in a large piece of poop and another pinprick or two on the paper when wiping.
-He said there was simply no evidence of anything serious and I didn’t have to go for any further testing.
-The sporadic lower left abdominal pain is still there, is relieved by emptying my bowels.
January 2015
-Started sleeping on my left side around late December 2015 after seeing the doctor (I usually sleep on my right). For some reason this caused the sporadic lower left abdominal pain to go away completely for about two and half weeks, but it came back after.
- Mid January 2015- Soon after that I had rectal bleeding again in the same manner as I did in December 2015, with tiny specks of blood on paper and in/on poop. Except sometimes the blood color seemed a little darker. Miniscule amounts. The LLQ abdominal pain was co-present.
-Spoke to a relative of mine who is a GP trained in one of the best medical schools in Australia, with 3 years of practical experience, over the phone. Told him this whole long story where he listened patiently and felt I had nothing to worry about with my rectal bleeding. Said I probably have hemorrhoids and perhaps mild diverticular dis
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
Sorry, character limit...continued.....mild diverticular disease.
-He told me to drink plenty of fluids and take psyllium fiber supplements. He said that I’d never really let my gut heal because of a poor diet with little fiber and insufficient fluids.
-Said that he “virtually guaranteed” if I stuck to a strict regimen of fiber supplements, healthy food and lots of water for 3 months and let my gut heal it would go away completely. Like my GP over at the urgent care center he said there was no evidence supporting any sort of scope, given my age, symptoms and our family history, but if I was so worried about it I could always schedule an “elective scope” with a local gastroenterologist.
-Today, January 29th, 2015. I’ve been following my relative’s advice, but yesterday I let up on the fluids a little due to being extremely busy and this morning the speckley pinprick rectal bleeding occurred again. The LLQ abdominal pain is present but waxes and wanes during the day, feeling better if my bowels are empty, I feel some kind of movement in my abdomen when my bowel is full that makes it feel worse.
Other info:
-The LLQ abdominal pain is persistent sporadically. However, not once since the onset has it gotten as bad as it was in that initial period in May-June 2015. I rated it as a “6/10” at that time. Since that initial bout, it has never been any worse than maybe a 2.5/10. There was once or twice where there was a lot of gut churning and I felt nauseated or tired for a day, slept it off and was fine the next day.
-My stool has always been normal in shape and color except for the rectal bleeding.
-Frequency of stool is normal, although I would hold it in for a day sometimes during the first rectal bleeding episode because I didn’t want it to bleed again. (Probably irrational)
-Am presently in a very high-stress life situation.__________________________________________________________________________________
Customer: replied 1 year ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Customer: replied 1 year ago.
The phone thing was mistake, accidentally clicked it, sorry.
Expert:  khagihara replied 1 year ago.

Since you have had the abdominal pain & blood in the stool for a long time, you should have colonoscopy. It could be Crohn's disease although usually it causes diarrhea. Diverticulitis is possible but it is rare in your age.

Customer: replied 1 year ago.
What is the probability of something life threatening?
Expert:  khagihara replied 1 year ago.

If you have Crohn's disease, you would ahem the complications such as bowel obstruction, fistulas between the intestine and another organ which could be life threatening.