My wife is embarrassed to go to the doctor with the following medical problem. Recently, when she passes a stool, she also passes some blood. She says her stools are very hard and appear to be covered with mucus. She also says she feels no pain while passing the stool. I seek your advice in hopes it will encourage her to overcome her embarrassment and visit a doctor.

G.H.

It is very common for people with lower intestinal and rectal complaints to be embarrassed to seek help. Usually, reassurance and emphasis on the importance of finding the cause of the symptoms will help.

Passing a hard stool with blood is most commonly a sign of hemorrhoids or an anal fissure. However, these conditions are also usually associated with painful defecation, which your wife does not have. Mucus in the stool can be found in colitis, an inflammation of the lining of the colon. Colitis can also lead to bleeding, but it is usually associated with diarrhea or loose stools. Certainly, a polyp in the lower rectum could also intermittently bleed as stool passes by it, and this is another possibility.

A very common cause of hard stools with mucus is irritable bowel syndrome (IBS). IBS is a disorder characterized by bouts of diarrhea and/or constipation, frequently with mucus passage from the rectum and cramping abdominal pain. The cause of this disorder is unknown, and may relate to abnormal sensitivity of the colon to certain stimuli. However, IBS is not associated with bleeding.

Obviously, the most dreaded cause of your wife's symptoms would be colon cancer. Your wife's age is important here, because the older a person is, the more significant the symptom of rectal bleeding. The risk of colon or rectal cancer increases with age, and bleeding is a common manifestation of this disease.

Regardless of the likelihood of cancer, your wife should be evaluated by a gastroenterologist who will discuss these issues with you. The doctor will also likely plan an endoscopic exam to search for the cause of your wife's symptoms.