Noticing blood in your stool can be alarming, but understanding its cause is the first step to addressing it.
Blood in stool, medically known as hematochezia or melena, depending on its appearance, is a symptom experienced by approximately 14% of young and middle-aged people in their lives. Its presence can signal anything from a minor, easily treatable condition to a more serious health concern that requires immediate attention.
Understanding the underlying causes, recognizing warning signs, and knowing the appropriate next steps equips you with the knowledge to navigate this symptom confidently to ensure timely and effective medical care.
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What Does Blood in Poop Indicate?
Blood in the stool is a symptom rather than a disease itself. It indicates that there is bleeding somewhere along the digestive tract, ranging from the mouth to the anus. The location of the bleeding often helps healthcare providers determine the underlying cause.
Types of Blood in Stool
Hematochezia, or rectal bleeding, refers to the passage of fresh, bright red blood through the anus. It typically indicates bleeding in the lower gastrointestinal (GI) tract, encompassing the colon, rectum, and anus. Common causes include:
- Hemorrhoids
- Diverticulitis
- Colorectal cancer
- Inflammatory bowel diseases
Melena describes black, tarry stool resulting from the digestion of blood. It usually indicates upper GI bleeding from the stomach or small intestine. Conditions that can cause melena include:
- Peptic ulcers
- Gastritis
- Esophageal varices (swollen veins in the esophagus)
Occult GI bleeding is not visible to the naked eye and requires testing to detect. Doctors can order blood and stool tests to screen for occult bleeding.
Frequency and Amount
A single episode of blood in stool may result from minor issues like hemorrhoids or a temporary anal fissure, often related to constipation or straining during bowel movements. These often self-resolve and don't require medical evaluation or intervention unless they are causing persistent and bothersome symptoms.
Recurrent episodes of blood in stool may indicate a chronic condition such as inflammatory bowel disease (IBD) or colorectal cancer, necessitating a thorough medical evaluation.
Maintaining a log of stool characteristics – including the presence, color, timing, and amount of blood – along with any accompanying GI symptoms can provide valuable information for healthcare providers in diagnosing the underlying cause of blood in stool.
Common Causes of Blood in Stool
Blood in stool can result from a variety of conditions, each with its own set of risk factors, symptoms, and treatment approaches. Understanding these common causes is the first step in diagnosing the underlying issue and initiating appropriate care.
Hemorrhoids
Hemorrhoids are swollen blood vessels in the rectum or anus that can rupture, causing bright red blood on toilet paper or in the stool. They are often associated with chronic constipation, straining during bowel movements, and pregnancy.
Anal Fissures
Anal fissures are small tears in the anus that can bleed and cause pain during bowel movements. They can be caused by:
- Chronic constipation or diarrhea
- Inflammatory bowel disease (IBD)
- Trauma to the anus, such as from vigorous wiping or anal intercourse
Diverticulitis
Diverticulitis occurs when pockets in the colon, called diverticula, become infected and inflamed. Fragile blood vessels inside the diverticula can rupture, causing a diverticular bleed.
Gastroenteritis
Gastroenteritis refers to inflammation of the GI tract secondary to a bacterial, viral, fungal, or parasitic infection.
The infection can be caused by:
- Consuming contaminated food or water
- Improper hand hygiene
- Contact with infected individuals
Depending on the cause, symptoms may last up to two weeks and commonly include:
- Diarrhea
- Abdominal pain and cramping
- Nausea
- Vomiting
- Fever
- Fatigue
Inflammatory Bowel Disease (IBD)
IBD, encompassing Crohn's disease and ulcerative colitis, causes chronic inflammation of the GI tract.
Crohn's disease can affect any part of the GI tract, while ulcerative colitis specifically affects the colon and rectum. The intestinal inflammation causes chronic (often bloody) diarrhea and abdominal pain.
Peptic Ulcer Disease (PUD)
Peptic ulcers are sores that can develop in the stomach or beginning portion of the small intestine (duodenum). The most common causes of PUD are Helicobacter pylori infection and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Colon Polyps and Colorectal Cancer
Colon polyps are growths on the inner lining of the colon. While most polyps are benign (non-cancerous), some can develop into colorectal cancer over time. Polyps may bleed intermittently, leading to blood in stool. Cancerous polyps are more likely to bleed than those that are benign.
Signs That Require Immediate Medical Attention
Now that we've reviewed some of the possible causes of blood in stool, let's explore the symptoms that require immediate attention.
Acute GI bleeding occurs suddenly and can present with the following symptoms:
- Black or tarry stool
- Dark or bright red blood mixed with stool
- Bright red blood in vomit
- Vomit that looks like coffee grounds
- Abdominal pain and cramping
- Fatigue
- Shortness of breath
If severe, GI bleeding can cause shock, which is life-threatening. If you experience any of these symptoms of shock, seek emergency medical attention:
- Confusion
- Rapid heart rate
- Weak pulse
- Rapid breathing
- Pale skin
- Cold hands and feet
- Sweating
- Decreased urine output
- Loss of consciousness
Chronic GI bleeding may present with less severe symptoms that come and go over time but still warrant medical evaluation:
- Intermittent blood in stool
- Unexplained abdominal pain
- Pain when passing bowel movements
- Unexplained weight loss
- Unexplained fatigue
If you experience any of these symptoms, consult a healthcare professional.
Diagnosing the Cause of Blood in Stool
During a medical evaluation for rectal bleeding or blood in stool, your doctor will narrow down the possible causes by asking you the following questions:
- When did the bleeding start?
- Do you have other GI symptoms, such as pain, changes in bowel movements, or bloating?
- Is the blood in your stool or on the toilet paper?
- What does the blood look like?
- Do you have constipation or diarrhea?
- Do you strain to have a bowel movement?
- What did you eat the day before and the day you noticed blood in your stool?
- What medications and supplements are you taking?
- Do you drink alcohol?
- Do you have hemorrhoids or diverticulosis?
- Do you have a personal or family history of IBD or colorectal cancer?
Your answers to these questions help guide doctors in ordering the next appropriate diagnostic tests and imaging, which can include:
- Digital Rectal Exam (DRE): A physical examination of the anus and rectum
- Anoscopy: An in-office examination with an anoscope (a small hollow tube) to visualize the anal canal and rectum
- Complete Blood Count (CBC): To check for anemia and signs of infection or inflammation
- Stool Tests: To detect occult blood, infection, or intestinal inflammation
- CT Scan: Imaging studies may be ordered in cases of acute bleeding to identify the sources of bleeding, diverticulitis, or tumors
- Upper Endoscopy: If melena is present, an upper endoscopy can be performed to examine the upper GI tract
- Colonoscopy: The gold-standard diagnostic procedure for lower GI bleeding that allows direct visualization of the large intestine and biopsy of suspicious areas
Treatment and Prevention Options
The treatment for blood in stool depends on the severity of bleeding, the underlying cause, and the location within the GI tract.
Treatment Based on Diagnosis
Medical interventions are tailored to address the root cause of GI bleeding. Examples include:
- Eating a high-fiber diet, avoiding straining with bowel movements, sitz baths, and, in some cases, medical procedures like rubber band ligation for hemorrhoids
- A short-term, clear liquid diet and antibiotics for diverticulitis
- The surgical removal of polyps (polypectomy) during colonoscopy to prevent progression to cancer
- Anti-inflammatory, immunomodulating, and biologic medications to manage inflammation related to IBD
- Antibiotics, acid-blocking medications, NSAID avoidance, and smoking cessation to treat and prevent the recurrence of PUD
Preventive Measures
Talk to your doctor about the best ways you can support gut health to prevent GI bleeding and blood in your stool. They may recommend some of the following:
- Diet: A high-fiber diet rich in fruits, vegetables, whole grains, and legumes and drinking plenty of water can prevent constipation, a risk factor for hemorrhoids and anal fissures. A 2019 meta-analysis of data from nearly 50,000 people in Asia also concluded that dietary fiber was protective against colorectal cancer.
- Medications: Reduce your use of NSAIDs, which increase the risk of GI bleeding by inhibiting cyclooxygenase enzymes and weakening the intestines' protective mucosal barrier.
- Smoking: Quit smoking. Cigarette smoking promotes inflammation, increasing the risk of GI disorders like Crohn's disease, PUD, and colorectal cancer. Research suggests that current smokers also have an increased risk of major bleeding, including that originating from the GI tract.
- Health Screenings: Regular colorectal screenings, such as with colonoscopy, are recommended for average-risk individuals beginning at age 45. Individuals at higher risk should talk to their doctors about starting screenings at an earlier age.
These are generalized recommendations. Always consult a healthcare professional before significantly changing your diet, medication, or lifestyle.
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Key Takeaways
Blood in your stool may range from minor issues like hemorrhoids to more serious health concerns, such as inflammatory bowel disease or colorectal cancer. Understanding the type and frequency of blood, recognizing accompanying symptoms, and seeking timely medical evaluation are key steps in addressing this symptom effectively.
Implementing preventive lifestyle factors and keeping up with routine health screenings can optimize gut health and prevent underlying health conditions that can cause GI bleeding.
In some cases, you might notice that blood in your stool resolves on its own. However, persistent bleeding should never be ignored. If you've noticed blood in your stool, consult your healthcare provider to ensure peace of mind and proper care.
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