I have a dull aching, sometimes burning pain on my lower left side and feels warm to the touch & have noticed some blood spots in my stool.

	Asked by dianab89 (Female; 57; had a complete physical in August, 2009 with blood tests All tests were normal or in normal ranges, but my doctor added potassium as it was low.; Relevant drugs:Chlorothaid 25 mg 1 tablet once daily Pot Chloride 20 mg 1 tablet once daily ) on Thu 05, Nov 2009 05:19pm
	I have a dull aching, sometimes burning pain on my lower left side and the area feels warm to the touch, now I have noticed blood spots in my stool. I am wintering in another state than where my doctor is, so I am unable to make an appointment to see him.
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	Answer by Dr Bhupinder K, MD (doctor) on Thu 05, Nov 2009 08:08pm: Hello, Welcome to the AMD forum. I can genuinely feel your concern regarding the symptoms that you are having. Two possibilities that came to my mind from your symptoms are amoebic colitis and inflammatory bowel disease. Amoebic colitis is a parasitic infection caused by the protozoon Entamoeba histolytica and is acquired by the fecal-oral route through consumption of fecally contaminated food or water. It presents with cramping abdominal pain and blood in stools which are usually loose stools. Inflammatory bowel disease which is the second possibility is the inflammation of the bowel i.e. colon and intestines. It is of two types: Crohn’s disease and ulcerative colitis. It also presents with lower abdominal pain and blood streaked stools. To evaluate both these possibilities, a comprehensive profile of investigations is needed comprising of stool examination, serum antibody test against amoebae, ultrasound or CT abdomen and colonoscopy with biopsy of the pathological lesions. Other possibilities which may present with such symptoms (although chances are less likely in your case) are hemorrhoids, polyps (small growths) and cancerous tumors (malignant growths of tissue) and overuse of some medicines like aspirin and NSAID’s. A CT scan and colonoscopy will help in ruling them out. I sincerely suggest you to consult a gastroenterologist and get evaluated for these possibilities. Treatment is diagnosis specific and so a confirmatory diagnosis has to be made first. I hope it helps. Take care and please do keep me posted in case you have any additional doubts. Kind regards.
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	Comments: Response by Dr. A. Srivastava on Fri 06, Nov 2009 12:52am: Hello Madam, Presence of blood in the stool may arise from anyplace in the digestive tract. The color of the stool is considered diagnostic in identifying the site of bleeding. A black tarry stool is found associated with bleeding in upper GI tract and marron or bright red color in stool signifies lower part of gut is troubling. As you have associated pain in the lower left side of abdomen so the most likely site may be lower GI. In such case, the possibilities that comes to my mind are parasitic infection like amoebiosis( as described by Dr. Bhupinder is a nice manner), Hemorrhoids, diverticulosis ( a pouch in the colon is abnormally formed) , abnormal collection of blood vessels (AVMs)which is bleeding, Inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease, colon polyps or cancer( though rare). I would also advice a gastroenterologist’s consultation who may conduct certain tests like stool test to check for any parasitic infection, fecal blood test, colonoscopy or endoscopy, CT scan, barium enema test( to rule out colon pouch) which are essentially required to reach to final diagnosis. Until then I would advice you to take lots of fluid, soft diet preferably vegetables and fruits which are rich in fibers to reduce possible constipation and hence bleeding, avoid alcohol and smoking. Use of any pain killers (NSAIDS) should also be avoided as they can further irritate your bowel. Also I would like to add a few words on medications that you are taking as I feel they also need some attention though they may not be the cause of your problem but may influence the condition. You are taking chlorothiazide(a potassium lowering diuretic), I suppose. It may be influencing your electrolytic balance causing lowering of potassium. It may also cause gastrointestinal irritation and unusual bleeding. Hypokalemia may also cause constipation. Therefore, I would advice you to tell the gastroenterologist about the medicines and past history of treatment you were taking which may help him to aim upon your problem from every aspect. Hope this helps. Take care and do write to us in case of further doubts.
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