Fibroids, Colonoscopy, Anemia and PBC

This is going to be somewhat of a complicated post. I was diagnosed with PBC in 2014 by biopsy. I am at stage 2 as of then. I was also diagnosed last year with a uterine fibroid that was watched by ultrasound and was supposedly getting smaller, so we did nothing else with it. So I got to my Gastroenterologist last week for my annual liver check up and he said that my MCH is low and he thinks I have Iron Deficiency anemia. He wants to do a colonoscopy because he wants to check for bleeding.

I was kind of thrown by that because I really don't have any bowel symptoms to speak of. I did have a positive fecal smear once, but I believe it was due to a anal fissure I have that was flaring at the time. I also have ovarian cysts that flare up from time to time. I have lower abdominal pain that goes into my back and my hip and upper legs. I've had these pains before, off and on, for years frankly. So I don't think its my colon.

I guess my question is, can I get anaemia from the fibroids, and the fact my liver probably isn't making up the difference, or my bleeding is worse because of the liver. I guess I am grasping at straws right now in hopes that my anaemia is not from a huge colon tumor in my bowel. Thanks for your help in advance.

7 Replies

  • Yes, you can get anemia from fibroids because one of the symptoms of uterine fibroids is heavy menstrual bleeding and bleeding between periods.

    Blood loss via heavy menstrual cycles and blood loss due to internal bleeding can both cause low MCH and anemia, so perhaps your gastroenterologist just wants to rule out internal bleeding from the colon.

  • He does. He would have just done a fecal smear and an iron test, but since I tested once, last year, with blood in my stool. (Subsequent tests were negative) and my iron levels are on the lower side of normal, he wanted to do a colonoscopy. I'm not questioning doing the test, because I know I should probably have one. I don't bleed between periods, but I do have heavy, clotting periods. They are getting shorter now, but I do have at least 4 days of very heavy blood loss. A normal person, with a normal liver, etc, probably wouldn't have as much trouble, but I think with all my other disease process, mine may be worse. I don't bleed heavy for 7 or more days, but I do have pretty heavy periods.

  • Hi NotorDJP,

    How low was your MCH? My MCH, MCHC, and MCV are always low at least one or the other or all three, usually not by much just a point. I was anemic with the low hemoglobin in late 2013 early 2014 before my uterine ablation, most of my numbers improved, even if not optimal except for the aforementioned threesome. I think it's common practice to check the bowels when the iron is low, if there's no other explanation. Thats the way my gastro looked at it anyway and my primary has ignored it all together. I have hip pain too and I went to a pain management Dr. and he believes it is the sacroilliac joint and it hurts across the lower back, but with a sharper pain in that right side. There's another autoimmune condition that attacks that joint and is often associated with inflammatory bowel disease, which can cause low iron too (I believe) and that's Ankylosing Spondylitis, but since your not having bowel symptoms then I would think it less likely. AS flares they say can come and go too. Do you still have periods, and if so, are they heavy? Anyway, it's probably just a precaution. Good luck with your test and please keep us posted.

  • My MCH is about three or 4 pts low, and has been about that for the last six years or better. Possibly getting a little lower over time, but basically staying about 2-4 pts low. My MCV is not low, and my MCHC isn't either. but my RDW is high, which is a hallmark of IDA. It is a common practice to look at the bowel, so I'm not against it, just nervous. I have my gynocological symptoms than I do bowel. I go about once a day, sometimes more, but I am dieting, so I don't eat much. I don't have the constipation/diarrhea issues, but I do have gas pretty easy. I have hiatal hernia and bad reflux too, so if I am bleeding in my gastrointestinal track I would think it would be my stomach not my bowel. But I am ok with the test. Insurance will pay for all of it because my deductible is met this year, and I have wondered about having one for a while. I wondered about something autoimmune too, because this stuff comes and goes. The cramping, hip pain etc has come and gone for years too. If any of it was cancer, I would think it wouldn't get better, just continually worse. I really think I have a growing fibroid and possibly cysts again.

  • Oops, just noticed your other comment above..duh! If he's aware of your heavy periods then I'm surprised he didn't chalk it up to that. My gastro did and he didn't even ask, nor did I tell him that my periods were heavy just that I still had them. Though like you said it probably doesn't hurt to have one done, it's usually recommended at age 50 anyway. Even though it's sounds like it's probably more of gynecological problem. Best wishes!

  • I think because I had one positive fecal smear, last year (he says even if you had it once, not to ignore) he wants to make sure. I sometimes think that specialists want to rule out everything in their speciality. He mentioned it could be my menstruation, but he doesn't want to miss anything. This is the same doctor that found a remote study about PBC being linked to Thyroid cancer and I ended up having Thyroid cancer. So I think I'm his special project now. lol

  • I am also having an upper endoscope

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