Same problem for me, thatfield, re knowing whether blood is from a flare or my internal hemis. I am thinking from the UC in my case because when I do have blood (haven't in more than 6 months) it occurs when my overall colon flare pain is highest and starts just after my stool builds up to a 'D' 10+ times a day- and I assume that once it is 'D' there is no strain on a hemi. But maybe I am wrong and the strain is simply from going so often and the muscles working the whole rectum just to get out more air and mucus.
Pancolitis >20 years, allergic to all 5ASAs
(To pharma: enough already with the umpteen variants of Asacol!)
Tried everything under the sun (natural and alternative), low carb SCD
Some partial success with TSO but too expensive to keep up
Remicade Humira, lots of probiotics, entocort, tapering increasing pred again,
homemade fecal infusions, maybe surgery this year soon