Blood in stool can be frightening, whether you discover it while wiping after a bowel movement or from a test ordered by your health care provider. All cases of rectal bleeding should be reported to your primary care doctor, even though many causes are not serious.
What are the Causes of Blood in Stool?
Bloody stool is a sign that there is bleeding somewhere along the digestive tract. The blood can range in color from bright red to maroon, and it can even appear tarry and black if the bleeding is occurring higher up in the digestive tract.
The color of the blood can indicate where the bleeding is coming from:
- Bright red blood usually indicates bleeding low in the colon or rectum
- Dark red or maroon blood usually indicates bleeding higher in the colon or the small bowel
- Melena usually means bleeding in the stomach, such as bleeding from ulcers
Not all rectal bleeding is visible to the eye. In some cases, rectal bleeding can only be seen by looking at a stool sample through a microscope. There is also a test, called a Hemoccult® test that can be done in a doctor’s office.
Some of the more common, less-serious causes of bloody stool include:
- Hemorrhoids – Those who suffer from hemorrhoids may notice bright red blood either in the toilet or coating the stool after a bowel movement.
- Anal Fissures – An anal fissure is a small tear in the lining of the anus, which can cause bleeding and the sensation of ripping, tearing or burning after a bowel movement.
- Peptic Ulcers – A peptic ulcer is an open sore in the lining of the stomach, upper end of the small intestine or duodenum caused by a bacterial infection.
- Food poisoning – In addition to other issues, several foodborne organisms can cause bloody stool. A stool sample can help identify which bacteria you have been exposed to and how to treat the infection.
Other more serious causes of blood in stool include:
- Crohn’s disease – Crohn’s disease causes inflammation of the digestive tract lining and can lead to severe diarrhea and abdominal pain.
- Colon Polyps – Colon polyps are benign growths, or clumps of cells, that form along the lining of the colon. Although usually harmless, colon polyps can grow, bleed and become cancerous.
- Cancer – Blood in stool can be a symptom of cancer along the digestive tract. Colon cancer and anal cancer are two types that can cause bleeding; sometimes not noticeable to the naked eye to more severe bleeding.
Blood in Stool Diagnosis
It is important to have a doctor evaluate any bleeding in the stool. Any details you can give about the bleeding will help your doctor locate the site of bleeding. For example, a black, tarry stool is likely an ulcer or other problem in the upper part of the digestive tract. Bright red blood or maroon-colored stools usually indicate a problem in the lower part of the digestive tract such as hemorrhoids or diverticulitis.
After getting a medical history and doing a physical exam, the health care provider may order tests to determine the cause of bleeding.
Treatment for Blood in Stool
Most patients only pass from a few drops to a spoonful of blood in their stool, which is referred to as mild rectal bleeding. Usually, mild rectal bleeding can be evaluated and treated in the doctor’s office and does not require urgent treatment or hospitalization.
In other cases, patients report repeatedly passing larger quantities of blood that may be accompanied by blood clots. This moderate to severe rectal bleeding can deplete blood supply, causing weakness, low blood pressure, dizziness or fainting. Moderate to severe rectal bleeding often requires evaluation and treatment in the hospital.
Forms of additional evaluation include:
Fecal Occult Blood Test
- This is a lab test to check for blood in the stool. If blood is detected, additional tests will be used to help determine the source of the bleeding.
Digital Rectal Examination (DRE)
- If you experience rectal bleeding, your physician may perform a digital rectal examination to find the source of the bleeding. To perform a DRE, your doctor will put on a latex glove and insert a lubricated finger into the rectum to feel for growths and other abnormalities.
Anoscopy or Proctoscopy
- An anoscopy or proctoscopy may be done in conjunction with a DRE to inspect the anus and lower rectum. A lubricated instrument that has a light on the end is inserted into the rectum so the physician can examine the area. A proctoscopy uses a slightly longer instrument than an anoscope, so an enema or laxative will likely be suggested before the procedure is done.
- To examine the colon and remove small growths, a sigmoidoscopy may be suggested. During this procedure, a lighted tube is inserted through the anus. Patients will need to receive an enema or laxative to empty the colon before the test is done.
- Your physician can use this to look for the source of the bleeding and may also be used to collect small tissue samples for further testing.
- If you doctor needs to examine the entire colon, a colonoscopy will likely be completed. This procedure is similar to an EGD except the scope is inserted through the rectum to view and take samples of the colon.
Your doctor will prescribe or recommend treatment based on the diagnosis.
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