Diet and Health FAQ

Tagged As: Irritable Bowl Syndrome

Question:
Can you have irritable bowel syndrome with blood in your stool? I was given a diagnosis of IBS by my gastro and I'm a bit confused by this.

Answer:
You may well have IBS, but it isn't causing the blood in your stool. Something else is causing that. Although indirectly, I guess, the IBS could cause constipation, which could cause hemorrhoids or anal fissures. With anal fissures you usually see blood on the toilet paper but not so much on the stool itself. Hemorrhoids tend to bleed a little more than fissures and you're more likely to see some blood in the toilet. If your gastroenterologist told you the IBS itself directly causes bloody stools, I'd get a second opinion. How much blood did you see, and what did it look like? What was the gastroenterologist's opinion about the blood? I get diarrhea rather than constipation.  Without wanting to be too graphic, I pass a fair amount of mucus when this happens, and the blood is mixed in with the mucus, most noticeable on the paper.  The amount of blood is relatively minor and usually just tinges the mucus.  When I do see any blood on its own it is bright red. I saw the gastro about six months ago.  He took my history and did a sigmoidoscopy, the biopsy results of which were normal.  He actually gave me a diagnosis of 'irritable rectum syndrome' rather than IBS but all I can find out about that is that it's a subset of IBS.  Maybe he just meant that I seemed like an irritable rectum. He didn't give any opinion at all on the blood.  Your mention of hemorrhoids makes me wonder if the straining may be causing those kind of problems...The symptoms abated a couple of weeks after seeing the gastro, but now it's flared up again Bloody stools are not on anybody's list of symptoms for IBS.  People with IBS often have mucus in their stools, though.  Chances are he's diagnosed IBS because he feels confident he's ruled out ulcerative colitis and Crohn's disease with the biopsies and the sigmoidoscopy. I've observed that incidents like this are more often failures in patient education than failures in diagnosis.  In your place I might call and ask him to explain how he's ruled out these other conditions, considering the blood in your stools.  After that conversation you'll either understand his reasoning and feel reassured, or you'll feel like you need another gastro. This is a link to very specific info related to your question. http://ibscrohns.about.com/od/relatedconditions/f/mucusstool.htm BTW, some with IBS are having some luck controlling their symptoms with probiotics or yogurt.  It's worth a try -- it can't hurt you. Another strategy is to cut out starch, at least during and for several weeks after a flare. Simple sugars are okay -- just no starch. You can try both of these strategies together if you like. http://ibscrohns.about.com/library/tips/bltip-13.htm Good luck!  Let me know if I can help you find more info. It is possible to have IBS and an inflammatory bowel disease. IBS only affects the colon, while IBD can happen anywhere in the digestive tract. I was correctly dx'd with spastic colon (another name for IBS) but my very mild Crohn's was missed for years because it is in the small intestine (and it is quite mild). I'm not saying *you* have an IBD - it's possible that you have an internal hemorrhoid that is bleeding - just that it is possible to have both IBS and IBD. Yeah, that'd make sense. Everything I can find seems to indicate that IBS is a diagnosis of exclusion - and it has started up again just when my life has become rather stressful, which would certainly fit IBS. I suppose all I can do is hope it goes away again soon! I think he said the blood is red, so it's got to be coming from low in the GI tract, right? Sigmoidoscopy doesn't examine most of the colon. A cheerful thought!  Well, I did have a sigmoidoscopy so I assumed (perhaps wrongly) that they would have noted any internal hemorrhoids during that. I suppose that wouldn't rule out any IBD higher up the colon, but the blood I see is bright red.  I'd assume (again, perhaps wrongly) that any blood released higher up would have had a chance to deoxygenate and would be a darker red? I'm trying to get another appointment with my gastro to sort this out. In the meantime my new base of operations is the bathroom.  Thank heaven for laptops, that's all I'm saying! My (very mild) Crohn's is in the terminal ileum, and sometimes the blood is fairly bright - but there's quite a bit more than from a hemorrhoid. Additionally, the pain I have during these blessedly infrequent episodes is so severe I literally cannot stand at times (and this again with *mild* Crohn's). This is anecdotal, of course, but I'm pretty sure all IBDs are even more painful than spastic colon. Maybe so. But since he's only done a sigmoidoscopy, which only examines the lower third of the colon, and since he hasn't expressed an opinion on the source of the blood, the doc either hasn't educated his patient appropriately about his diagnosis or he hasn't ruled out the scarier possible etiologies for the blood. I was merely relaying an anecdote - mine; not trying to make a diagnosis. My first reply was to point out that it is possible to be correctly diagnosed with spastic colon/IBS and still have an IBD. I agree that a sigmoidoscopy is not enough to rule in or out any serious problem with the colon. As an update to this, I'm still producing quite large quantities of blood on moving my bowels.  I've got an appointment with my gastro in a couple of weeks so I'll just have to hold on until then. One thing that I have found that works: peppermint tea.  It seems to dramatically reduce the cramping and the diarrhea, at least.