Brief Answer:
Please follow up with further necessary details

Detailed Answer:
Hello,
Thank you for trusting HealthcareMagic,

I would like to know where the exact location of pain is, whether the pain is over the breast or deeper?

I would also like to know about your menstrual history. Whether you have been having regular menstrual cycles? Is this the first time that you noticed such spotting?

Sometimes bleeding per vagina can be confused as blood in the stool. So please confirm whether you noticed blood mixed with stool or likely menstrual/spotting blood.

Please get back with necessary details so that I can give you a focused answer.

Awaiting...

Regards
Dr.Lekshmi

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Brief Answer:
Follow up answer

Detailed Answer:
Hello again,

Thank you for following up.

Spotting in between menstrual cycles could either be due to hormonal imbalance or anatomical problems like uterine fibroids,endometrial poyps,hyperplasia etc.
Imbalance in hormone levels are common as women approaches menopause, which manifest as menstrual irregularities.However, it is also important to rule out any pathology in the genital tract.
Blood in stools can be due to several factors like hemarrhoids,anal fissures,colonic polyps, tumors,inflammatory bowel disease etc.
A condition called endometriosis can cause blood in stools along with menstrual bleeding.But this condition will be associated with severe menstrual pain and unlikely to show up after age of 40.

Since you are complaining of bleeding per rectum.and vagina, possibility of bleeding disorder, coagulation disorder and medication like aspirin causing the excess bleeding also need to be ruled out.

Regarding the pain under the rib cage, two likely possibility include muscle pain and pancreatic pain. Conditions affecting the pancreas like pancreatitis can cause a dull pain in the region.
Pancreatitis pain will be more constant and will have frequent association with food intake, flatulance,bloating, and greasy stools.

You will need a detailed physical examination,pelvic examination, rectal examination and proctoscopy.
Blood investigations including complete blood count,bleeding time (to rule out bleeding disorder),
stool analysis, S.amylase and lipase(to rule out pancreatitis), pelvic ultrasound(to rule out any uterine, ovarian, cervical pathology), serum LH,FSH,estrogen levels ,Thyroid function tests are so warranted at this point.
Cervical PAP smear is also recommended if not done within past 5 years.

Please be advised to follow up with your primary care provider for further evaluation and management.

Hope this answers your question
Please address further questions here
Regards
Dr.Lekshmi

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