<s>[INST] Hi doctor, I am a 32-year-old female. For almost a year, I have had rectal bleeding on and off. I started to have painful bowel movements and then I began to bleed. The blood is on my stool, in the toilet (at times) and when I wipe, I can see it on the toilet paper. Other symptoms I experience are rectal itching and discomfort after my bowel movement. I went to the ER and they did a CT scan and did not see anything out of the normal. The doctor did a rectal examination and did not see any hemorrhoids at the time. After a month or so, I went to see my primary care physician and he said during my rectal examination, he had seen grade-1 hemorrhoids. The bleeding continues. It only happens every now and then. Being that, it has been so long I am just concerned it could be something else (cancer). Should I ask for a colonoscopy? [/INST] Hi. If the doctor who did the PR examination could not find any significant hemorrhoids, it is better to get a colonoscopy done. Do not worry about cancer as the most likely possibility is a missed internal hemorrhoid. The itching can be due to perianal soiling, fungal infection, or worm infestation. Keep the area dry and clean. I suggest having a single dose of Albendazole 400 mg tablet. Consult your specialist doctor, discuss with him or her and start taking the medicine with their consent. You can take a picture of the perianal region and look for skin damage. Do review with your reports if you have any further queries. For more information consult a medical gastroenterologist online --> </s>