What could be causing me to pass blood clots and blood mucus from my anus, accompanied by intermittent lower right abdominal and lower back pain, and nausea?

Urgent Medical Evaluation Required for Suspected Lower Gastrointestinal Bleeding

You need immediate emergency department evaluation—passing blood clots and bloody mucus from the anus for a week, combined with right lower abdominal pain, lower back pain, and nausea, requires urgent assessment to rule out serious conditions including inflammatory bowel disease, diverticular bleeding, anorectal abscess, or colorectal malignancy. 1

Immediate Actions You Should Take

Seek emergency care today if you experience:

• Worsening abdominal pain, especially if it becomes constant 1
• Fever or chills (suggesting infection/abscess) 1
• Increasing volume of blood or large clots 1
• Dizziness, lightheadedness, or weakness (signs of significant blood loss) 1
• Inability to pass stool or severe constipation 2

What the Emergency Department Will Do

Clinical Assessment

The medical team will perform a focused history and complete physical examination including digital rectal examination to identify the bleeding source and rule out serious causes. 1 This examination is mandatory for anyone presenting with blood from the rectum. 1

Key vital signs and laboratory tests will include: 1

• Blood pressure and heart rate to assess hemodynamic stability
• Complete blood count (hemoglobin and hematocrit) to determine severity of bleeding
• Coagulation studies to assess clotting function
• Serum electrolytes, BUN, and creatinine
• Blood type and cross-match if bleeding is severe

Imaging and Endoscopy

CT scan of the abdomen and pelvis is indicated given your right lower abdominal pain and systemic symptoms to evaluate for abscess, inflammatory bowel disease, or neoplasm. 1 The combination of rectal bleeding with localized abdominal pain raises concern for conditions beyond simple hemorrhoids.

Anoscopy or flexible sigmoidoscopy will likely be performed as the first-line diagnostic tool to visualize the bleeding source. 1 If high-risk features are present or bleeding is ongoing, urgent colonoscopy within 24 hours may be necessary. 1, 3

Why Your Symptoms Are Concerning

Not Typical Hemorrhoid Presentation

While hemorrhoids are the most common cause of rectal bleeding, anal pain is generally NOT associated with uncomplicated hemorrhoids unless thrombosis has occurred—your description of lower abdominal and back pain suggests other pathology requiring closer investigation. 1, 4

Red Flags in Your Presentation

• Blood clots and mucus for one week: This duration and character of bleeding requires evaluation beyond simple hemorrhoids 1
• Right lower abdominal pain: This location raises concern for appendiceal issues, inflammatory bowel disease (particularly Crohn's disease), diverticulitis, or abscess formation 1
• Lower back pain with nausea: These systemic symptoms suggest a more significant process 1

Differential Diagnoses to Consider

The emergency team will evaluate for: 1, 5

• Anorectal abscess: Can present with bleeding, pain, and systemic symptoms requiring urgent surgical drainage
• Inflammatory bowel disease: Crohn's disease or ulcerative colitis can cause bloody mucus, abdominal pain, and systemic symptoms
• Diverticular bleeding: Particularly from right-sided (ascending colon) diverticulosis, which can cause significant hematochezia 3
• Colorectal malignancy: Must be excluded, especially with persistent symptoms 1
• Complicated hemorrhoids: Including thrombosed or strangulated hemorrhoids, though less likely given your pain pattern 1
• Anal fissure with secondary infection: Though typically causes pain with bowel movements 4, 6

Common Pitfalls to Avoid

Do not assume this is "just hemorrhoids" without proper evaluation—up to 20% of patients with hemorrhoids have concomitant pathology such as anal fissures, and serious conditions can present similarly. 1, 4

Do not delay seeking care hoping symptoms will resolve—you've already had symptoms for a week, and the combination of bleeding with abdominal pain and systemic symptoms (nausea) warrants urgent evaluation. 1

Do not attempt self-treatment with over-the-counter hemorrhoid preparations until a proper diagnosis is established, as this may mask serious underlying conditions. 1

What Happens After Initial Evaluation

If imaging reveals an abscess, you will need urgent surgical drainage with broad-spectrum antibiotics. 1, 5 If inflammatory bowel disease is suspected, colonoscopy with biopsies will be necessary. 1 If diverticular bleeding is identified, approximately 75% of episodes stop spontaneously, but you may require colonoscopy for definitive diagnosis and potential intervention. 3

The key message: Your symptom complex—particularly the combination of rectal bleeding with right lower abdominal pain, back pain, and nausea lasting one week—requires urgent medical evaluation to exclude serious pathology. 1