ZocdocAnswersCould this be because of a fissure?

Question

Could this be because of a fissure?

i was recently diagnosed with duodenitis and hiatal hernia. Right after mu enfoscopy I became pregnant and have been very constipated. I had a very large, hard bowel movement that tore my anus. I have had anal fissures before and they always bleed. The next day I had another hard stool and it bled again but when I wiped the material on the TP looked like coffee grounds. The actual BM did not. Could it have been old blood from the day before when I tore? I don't have any other symptoms, should I be worried its a bigger problem?

Answer

It is great that you have an awareness of your prior bleed episodes from the fissure. I recommend that you speak with your primary care doctor to be evaluated. When there is rectal bleeding, we often think of them as a upper gastrointestinal (GI) vs lower GI bleed. Lower GI bleeds are usually bright red blood from the rectum or stool that is not black like tar. The causes of lower GI bleeds are diverticulosis, malignancy, hemorrhoids, and fissures like you mentioned. Diverticulosis is an out pouching of the colon which causes painless rectal bleeding. The causes of upper GI bleeds could be from ulcers from infections (H pylori) or medications (NSAIDS such as ibuprofen) or excessive coffee consumption, malignancy, gastritis. Upper GI bleeds usually result in stool that is black. It sounds like you do have a history of constipation which led to fissures. Besides an upper GI bleed, other causes for dark stool could be iron supplementation or even blood in the colon that has been sitting there for a while. Either way, you should make an appointment with your primary care doctor to be evaluated. They can test your stool to determine if you are bleeding and they can check basic labs to make sure our blood counts are stable.

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