Rectal Bleed

[birdie73]

I am seeking help /reassurance after a rather traumatic time.I take BP tablets & Water tablets + an iron supplement from health stores (Spatone) even that I can only tolerate 1/2 satchet per day, but my iron reading is very low (9) but basically has been for years. After being diagnosed with an irregular heartbeat about a year ago I have had to take Warfarin which also does not agree with my stomach. On the 18th October I had a rectal bleed so although feeling OK was taken into hospital for a night & given Vitamin K & a drip also had blood tests, & the warfarin was stopped.
On Saturday morning I had a Sigmoidoscopy the results being Multiple Diverticular & Haemorrhoids this had already been found by a full colonoscopy 2 years ago.
My GP talked to me at length of the pros & cons of Warfarin said without it I had a 40% chance of a stroke but with it of course I could have a further bleed. I have at the moment opted to take the Warfarin but it's playing havoc with my stomach.
Forgot to add I had a very slight TIA about 12 years ago.
I think what I really need is a stomach transplant !!!!!!!

[rsvp]

best wishes that all goes well for you birdie73

[slaney]

A difficult situation, birdie - balancing the risks of a rectal bleed ( presumably coming from diverticular disease) and the risk of a stroke is not easy. It would be important to keep careful control of the INR ( blood tests for warfarin) so the blood does not get too thin.
Two things - firstly you say the warfarin does not agree with your stomach. What symptoms do you have?
Secondly the low iron reading of 9 - I presume you mean this to be haemoglobin level. Iron levels/stores are measured by the serum ferritin levels.
If indeed you are proven to be iron deficient by blood tests and ferritin level, it may be worth discussing with your GP how this could be improved, asking the advice of the local haematologist if necessary. The amount of iron you are taking is about 12.5mg/day which is not a great deal. You would feel a lot better if your haemoglobin could be raised, as well as providing some kind of reserve against any future bleed.

[birdie73]

Thanks rsvp for your good wishes.
Thanks also slaney, warfarin gives me diarrhoea & permanent stomach ache & discomfort as does Iron & many other drugs.The diverticular caused the bleed & obviously I am worried it will happen again, especially as I have a disabled husband.
My GP is keeping an eye on my INR readings I started the warfarin again on Tuesday evening & have a blood test tomorrow & again on Monday.
He has also discussed the iron problem with me but finds the answer difficult but obviously will have to be addressed in the very near future. My last reading was taken after stopping the iron supplement 2 weeks prior to the sigmoidoscopy. Thanks for your help & advice, I forgot to add that I am 77 years old & sole carer for my husband so obviously lead quite a hectic life.

[slaney]

You must indeed lead a hectic life birdie, so all the more reason for you to be as well as possible.
Warfarin does not usually cause such severe side effects; you are unfortunate to be one of those so affected.
I still think it's worth while asking your GP if he/she thinks asking the advice or referral to a haematologist would be possible - they deal with both anticoagulation and anaemia.
There are alternatives to warfarin which might be considered. And the anaemia might not just be simple iron deficiency, so other treatments may help.
I hope something can be done to make life a little better for you.

[birdie73]

Thank you slaney for your advice will certainly discuss this at my next appointment with my GP, who is very helpful & understanding. I don't know when I have to see him next but imagine it will be after todays & Mondays INR test results.