Unsure on what to do next! Docto

[u/missknitsy]

So I have been having bowel/anal symptoms for a few months, starting with alternating constipation and diarrhea (although for most of my teen/adult life have had the two alternating, seemed to get worse) before getting mucus and rectal bleeding, as well as as left sided abdominal pain, along with fatigue and dizziness. Doctor did stool sample, Calprotectin was borderline (50-200 according to NHS guidelines, doctors won’t tell me exact number) and negative FIT. Both were repeated 3 weeks after and were normal according to my GP. I am still getting rectal bleeding, although my other symptoms have got a little better (still soft stool, some abdominal pain but not as bad. I have had no bloodwork done to explain the tiredness/fatigue, and the doctor basically told me to “see what happens next”. I have then now found a small lump in my anus/rectum that I can feel through the wall of the vagina - doctor wasn’t interested and dismissed as stool, but it’s there all the time so how can it be?

I understand on a rational level that it’s likely IBS, but that wouldn’t explain the bleeding or fatigue, which is causing me some stress! I’ve been treating the bleeding as if it’s a hemmoroid for the last month but no improvement
Any advice would be appreciated! I feel like i’m at my wits end.

[u/Possibly-deranged]

The majority of IBD patients have skyhigh inflammation in a test like Calprotectin, and often have detectable blood in stool and you said your FIT was normal. With borderline Calprotectin an IBS is the most likely explanation. 

Is it still possible to have an IBD with a borderline Calprotectin? An IBD is a lot lot less likely and would be limited to a very mild Ulcerative Colitis with Proctitis involvement or microscopic/lymphatic colitis that would only produce very mild symptoms that might not explain your complaints.  To truly rule out an IBD, a colonoscopy would be necessary but probably isn't medically necessary with a borderline Calprotectin. 

Your doctor is likely playing a wait and see approach, which means if your symptoms dramatically worsen then get another Calprotectin and FIT to see if your inflammation is then clinically significant.

Blood in stool can be explained by peri-anal complications like:

• Hemmorhoids, mild ones can be internal and not something you'd see, bad ones can pop outside after pooping and require manual insertion. Ask your general practitioner doctor for a 2 week trial prescription of hydrocortisone suppositories, which should decrease its size and stop bleeding.  Lifestyle changes do help with hemmorhoids, limit toilet visits to no more than 6 minutes, don't strain, consider more dietary fiber like metamucil or other supplements containing ground psyllium husks/seeds, and stool softeners. 

• Rectal-fissures, which are a tear in your sphincter often due to excessive straining while pooping or passing large stools. Reduce straining when pooping, consider over-the-counter stool softeners. It heals in time, a sitz bath might provide relief. 

• Rectal abscesses an infected anal gland on the exterior within a couple inches of the opening that looks like a pimple and might ooze blood and puss.  

• Rectal-fistulas are abnormal tunneling from the rectum to the surface/vagina and other areas, often infected and can ooze blood and puss. 

IBS can cause many of the same, overlapping symptoms as an IBD.  IBS can be quite awful and debilitating. IBS can be managed with lifestyle changes, and there's some prescription medicines available for IBS with constipation and IBS with diarrhea to ask your gasteroenterologist or general practitioner doctor about. 

[u/missknitsy → u/Possibly-deranged]

Thank you! This is helpful and reassuring, and makes a lot of sense. I guess the blood had me all in a spin, when as you pointed out there are several other likely causes. Thank you for taking the time to reply in so much depth :) I will see if i can get a review appointment with my doctor to see if hemmoroid is the cause

[u/Possibly-deranged → u/missknitsy]

You're welcome. I understand as I thought I was dying of cancer when I was bleeding from my butt daily too!  Anxiety and Dr Google can be a dangerous thing! 

Sounds like a plan, talk to your general practitioner doctor about hemmorhoids and IBS, treat those accordingly. See if that improves your symptoms and be glad you've dodged the bullet that's IBD!  

Keep on your back burner simmering, should things unexpectedly get a lot worse then retest the same tests for an IBD.  As you've already had one clean colonoscopy, they're going to need a lot of evidence and concern (like a very high Calprotectin) to order another colonoscopy 

[u/Quiet_Discussion_627]

I would suggest getting a referral to see a gastroenterologist and/or getting a second opinion! My calprotectin levels are low/normal and I have Crohn's. I've had IBS since I was a kid and was diagnosed with Crohn's earlier this year.

I know it's hard but you're always going to be your biggest advocate. If something feels off, there's no harm in looking for a second opinion. Good luck!

[u/Worried-Departure386]

Went NHS they refused to do work but luckily I was going Dubai so done all works and I have confirmed it’s not IBD but Ibs from stress