This type of bowel movement irritates the lining of the anal canal and the anastomosis of the pouch to the upper anal canal. More severe problems, such as a fissure, ulcer in the anal canal, and occasionally hemorrhoids may be also caused by abnormal bowel movements. Bleeding may also be caused by the underlying disease which may remain in the anal canal. The disease may be previously unrecognized Crohn's disease or pouchitis which may develop after the construction of the pouch. Bleeding from the disease is in the overall context, uncommon.
Patients are concerned about bleeding, which is quite common.
Reassurance can generally be given, in that bleeding that is noticed intermittently and not associated with any pain, is of little consequence. As indicated earlier, most of the bleeding is caused by the frequency and consistency of the bowel movement. The frequency of the bowel movement can be reduced by taking anti-diarrheal medications such as Lomotil or Imodium. The consistency is improved by taking bulking agents such as Metamucil, Konsyl, Citrucel, and eating a diet that is high in fiber. If pain is present with the bowel movements it suggests that there is some anal irritation or a fissure which may require some form of topical therapy, as well as management of the bowel function to allow the irritated anal canal to heal.