Blood In The Stools
- rectal bleeding
Blood in the stools means that blood from somewhere in the body is being excreted in the stool, or bowel movement.
What is going on in the body?
Blood in the stools can occur for many reasons. It can range from a small amount of blood, as in blood-streaked stools, to large amounts of blood, with tarry black stool or bright red blood throughout the stool.
Blood in the stools may come from anywhere in the body, but the source is usually the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine (colon).
What are the causes and risks of the symptom?
Blood in the stools can be caused by many conditions. These include:
hemorrhoids, which are masses of small, dilated veins in or near the anus
peptic ulcer, which is an open sore or lesion in the lining of the stomach or small intestine
overuse or misuse of anti-inflammatory drugs, like aspirin or ibuprofen (i.e., Advil, Motrin)
lead or other heavy metal poisoning
esophageal varices, which are dilated veins that can cause pain and bleeding in the esophagus
colorectal polyps, which are tumors in the bowel that may be noncancerous or cancerous
Crohn's disease, which can cause inflammation in any part of the gastrointestinal tract
diverticulosis with hemorrhage, a condition involving pockets in the intestine at the site of small artery branches, which can rupture and bleed
anal fissure, which is a tear in the lining of the anus
anorectal fistula, which is a crack in the lining of the anus that extends to the muscle of the anus
ulcerative colitis, a disease that can cause swelling and sores in the lining of the colon
bleeding disorders, usually an inherited tendency to bleed without forming clots well
abdominal injuries, such as crush injuries from a car crash or a fall
a foreign body in the colon or rectum
dysentery or other intestinal disorders, such as Meckel's diverticulum or intussusception
ulcerative proctitis, which is an inflammation of the rectum and anus
- certain tests or procedures, such as a colonoscopy with or without polypectomy.
During a colonoscopy, the healthcare professional uses a flexible tube with a camera on the end to view the lining of the large intestines. A polypectomy is the removal of a colorectal polyp, or growth, from the intestinal lining.
What can be done to prevent the symptom?
Careful management of disorders like Crohn's disease or ulcerative colitis may prevent blood in the stools. Careful monitoring and treatment of hemorrhoids, and plenty of fiber in the diet, also may prevent blood in the stool.
Proper screening or the colon for early polyps or colon cancer can prevent bleeding. Reporting indigestion or other abdominal complaints to the healthcare professional can prevent bleeding from ulcers or other causes. Avoiding excess alcohol may decrease this risk. Some causes of blood in the stool cannot be prevented, but prompt treatment may make rectal bleeding less likely.
How is the symptom diagnosed?
A thorough medical history and physical examination is the first step in determining the cause of blood in the stools. Blood tests, such as a complete blood cell count, or CBC, can evaluate the effect of the blood loss. A stool test called the fecal occult blood test can be done. This involves smearing a small bit of stool on a card and testing it with a drop of chemical that reacts with blood.
A recent study has shown that a screening for fecal occult blood every 1 to 2 years can significantly reduce the incidence of colorectal cancer. A positive test for blood in the stools often detects precancerous lesions that can be removed before colorectal cancer develops. Scans, endoscopy, an upper GI series, and a barium enema may be used to examine the inside of the stomach and intestines. Ultrasound and rectal exams may also be done.
Long Term Effects
What are the long-term effects of the symptom?
Long-term effects of blood in the stools depend on the underlying cause. If the cause is an anal fissure or hemorrhoids, treatment may stop the bleeding. Bleeding caused by diverticulosis may improve when treated with diet, colonoscopy, or surgery. If the underlying cause of the bloody stools is colorectal cancer, permanent damage to the intestine may occur, or the cancer may be fatal.
What are the risks to others?
Blood in the stools is not contagious.
What are the treatments for the symptom?
Treatment of blood in the stools depends on the underlying cause. In an emergency situation, intravenous fluids are given to replace fluids lost from bleeding or dehydration. If significant blood has been lost, transfusion may be required. Blood pressure, heart rate, temperature, and breathing rate are watched for signs of shock.
If the bleeding is caused by a condition that can be treated with antibiotics or antifungal medications, the bleeding may stop on its own. Diet may help with some conditions, such as diverticular hemorrhage. Surgery is needed in some cases of blood in the stools. Surgery may be used to repair the problem or remove a malignant tumor. Radiation therapy and chemotherapy may also be used to treat cancer.
What are the side effects of the treatments?
All medications have possible side effects. Antibiotics can cause stomach upset and allergic reactions. Surgery can be complicated by infection, bleeding, or an allergic reaction to the anesthetic. Chemotherapy can have many side effects, such as stomach upset, hair loss, and weakness.
What happens after treatment for the symptom?
In many cases, no further measures are needed following treatment. The person is considered cured and can return to normal activities. In other cases, the cause is not curable and needs further treatment. Some causes of bleeding, such as colorectal cancer, may result in death.
How is the symptom monitored?
Underlying diseases, such as ulcerative colitis, may require lifelong medical treatment and monitoring. Any new or worsening symptoms should be reported to the healthcare professional.
Professional Guide to Signs and Symptoms, Springhouse, 1997
Current Medical Diagnosis and Treatment, 39th ed., Tierney, 2000