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HELP! Blood on toilet paper but not in stool?

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For about a week, I've noticed some bright red blood on my toilet paper after having a bowel movement. It's mostly just a spot or two or as much as a smudge and is on the toilet paper for the first wipe and then it goes away on the second. There has been no change in my bowel movements and there is no change in color or blood in my stool that I can see.

As I'm using the bathroom, I get a twinge of sharp pain around my anus that lasts through the bowel movement. After I'm done, it's a little sore there for a few hours. If water in the shower hits it or if my urine trickles to the area, it has stung a couple of times. I do tend to push when I use the bathroom, so I'm thinking it might be either a tear or a hemorrhoid.

My worry is that it has lasted over a week. Someone I spoke to said that it's probably a tear that keeps opening every time I have a bowel movement. My mom told me to take stool softeners and apply some Preparation H to the area, so I started that today. I'm avoiding going to the doctor right now because I have no health insurance and I don't want him to just look and tell me I have a tear or something. I don't want to go to the doctor unless it's absolutely necessary.

Last week, I started the Weight Watchers diet. I'm not sure if this has anything to do with my problem, but I figured a change in diet is worth mentioning. I have a tendency to freak out about every single thing that goes wrong with my body, so I'm worried about colon or colorectal cancer. My mom had a colon cancer scare a few months ago (with very different symptoms), but it turned out to be fine. The doctor told her that red blood normally isn't anything serious and that it is the black stools that you need to worry about. I don't have that, so I'm trying not to freak out.

Any advice would be greatly appreciated!

ETA: I haven't had any other strange symptoms, abdominal cramping, or anything like that. No nausea or fatigue either. This is my only symptom. Also, I'm a 21 year old female, if that matters.
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replied March 25th, 2011
Hello and thank you for posting your health query on E health Forum.

From the history provided here, presence of blood on the toilet paper could be a sign of hemorroids or fissures in ano.

Presence of a history of chronic constipation supports this diagnosis.

Hemorrhoids can present in the form of internal hemorrhoids and external hemorrhoids.
External hemorrhoids are easily detectable, while internal hemorrhoids can be occasionally missed.

Your doctor can refer you to a gastroenterologist so that a proper view of the GI tract via a sigmoidoscopy or a colonoscopy may be done to detect all possible causes of bleeding and specifically to detect any polyps, cancers etc.

Anal fissures are very painful while passing bowel movements, and are caused due to severe constipation and hard stools. These fissures can bleed and leave a coating of blood on the toilet paper.

Use of OTC medications (Preparation H ) and Sitz baths can be helpful to relieve the symptoms. In Addition, laxatives to relieve constipation may help in the short term period.

I hope this helps.

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