Blood is supposed to stay in your body. Seeing blood in your bowel movement is very frightening. It is an indication that something is not working right, but it is not always a herald of colon cancer. Rectal bleeding has many causes, but only one of them is colon cancer.
When You Note Blood in the Stool - The best action you can take now, to advocate for yourself, is to pay attention to this symptom and be prepared to discuss it with your doctor. Ask yourself these questions:
- Was the blood in the stool, toilet bowl or on the toilet paper?
- Was the blood bright red or dark red?
- Approximately how much blood did you see? (Keep in mind, a drop of blood in a toilet bowl will turn all of the water red.)
- Did you have to strain to pass the bowel movement?
- How frequently do you have bowel movements?
- Do you have other symptoms?
- When was your last colon screening exam or colonoscopy?
- Do you have a history of polyps or a family history of polyps?
- Hemorrhoids
- Inflammatory Conditions
- Colon Polyps
- Constipation
- Bowel Infections
- Colon Cancer
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Rectal Bleeding: Symptoms & Signs
Blood in the stool can be bright red, maroon in color, black and tarry, or occult (not visible to the naked eye). Causes of blood in the stool range from harmless, annoying conditions of the gastrointestinal tract such as hemorrhoids and anal tears (anal fissures) from straining against hard stools with constipation to serious conditions such as cancer. Blood in the stool should be evaluated by a health care professional.
Rectal bleeding (known medically as hematochezia) refers to passage of bright red blood from the anus, often mixed with stool and/or blood clots. Most rectal bleeding comes from the colon, rectum, or anus and can be associated with diarrhea. The color of the blood during rectal bleeding often depends on the location of the bleeding in the gastrointestinal tract. Generally, the closer the bleeding site is to the anus, the blood will be a brighter red. Thus, bleeding from the anus, rectum, and the sigmoid colon tend to be bright red, whereas bleeding from the transverse colon and the right colon (transverse and right colon are several feet away from the anus) tend to be dark red or maroon colored.
In some patients, bleeding can be black and "tarry" (sticky) and foul smelling. The black, smelly, and tarry stool is called melena. Melena occurs when the blood is in the colon long enough for the bacteria in the colon to break it down into chemicals (hematin) that are black. Therefore, melena usually signifies bleeding is from the upper gastrointestinal tract (for example, bleeding from ulcers in the stomach or the duodenum or from the small intestine) because the blood usually is in the gastrointestinal tract for a longer period of time before it exits the body. Sometimes melena may occur with bleeding from the right colon. On the other hand, blood from the sigmoid colon and the rectum usually does not stay in the colon long enough for the bacteria to turn it black. Rarely, massive bleeding from the right colon, from the small intestine, or from ulcers of the stomach or duodenum can cause rapid transit of the blood through the gastrointestinal tract and result in bright red rectal bleeding. In these situations, the blood is moving through the colon so rapidly that there is not enough time for the bacteria to turn the blood black.
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Blood in Stool
Blood in the stool can be frightening, whether you discover it while wiping after a bowel movement or from a test ordered by your health care provider. While blood in stool can signal a serious problem, it doesn't always. Here's what you need to know about the possible causes of bloody stools and what you -- and your doctor -- should do if you discover a problem.
Causes of Blood in Stool - Blood in stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for hidden blood in the stool). At other times it may visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.
Possible causes of blood in stool include:
- Diverticular disease - Diverticula are small pouches that project from the colon wall. Usually diverticula don't cause problems, but sometimes they can bleed or become infected.
- Anal fissure - A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut. Fissures are often caused by passing a large, hard stool and can be painful.
- Colitis - Inflammation of the colon. Among the more common causes are infections or inflammatory bowel disease.
- Angiodysplasia - A condition in which fragile, abnormal blood vessels lead to bleeding.
- Peptic ulcers - An open sore in the lining of the stomach or duodenum, the upper end of the small intestine. Many peptic ulcers are caused by infection with a bacterium called Helicobacter pylori (H. pylori). Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.
- Polyps or cancer - Polyps are benign growths that can grow, bleed, and could become cancerous. Colorectal cancer is the fourth most common cancer in the U.S. It often causes bleeding that is not noticeable with the naked eye.
- Esophageal problems - Varicose veins of the esophagus or tears in the esophagus can lead to severe blood loss.
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Blood in the stool (rectal bleeding)
Seeing blood in the toilet, on the outside of your stool, or with wiping after a bowel movement is common. Fortunately, most of the causes of such rectal bleeding are not life-threatening; common causes include hemorrhoids and anal fissures. However, the only way to be certain of the cause is to be evaluated by a healthcare provider. This topic will review when to seek help for blood in the stool, the most common causes of blood in the stool, and tests that may be recommended. (See "Approach to minimal bright red blood per rectum in adults".)
WHEN TO SEEK HELP - Most people with minor rectal bleeding do not have colon cancer or another serious condition. However, it is not possible to know the cause of rectal bleeding without an examination. Thus, ANYONE who notices rectal bleeding should talk to their healthcare provider to determine if an examination is needed. (See 'Rectal bleeding tests' below.)
RECTAL BLEEDING CAUSES - Seeing a small amount of blood after wiping, on the outside of your stool, or in the toilet is most commonly caused by hemorrhoids or an anal fissure:
- Hemorrhoids — Hemorrhoids are swollen blood vessels in the rectum or anus that can be painful, itchy, and can sometimes bleed (figure 1). Painless rectal bleeding with a bowel movement is a common symptom of hemorrhoids. Bright red blood typically coats the stool or blood may drip into the toilet or stain toilet paper. (See "Patient education: Hemorrhoids Beyond the Basics)".
- Anal fissure — An anal fissure is a tear in the lining of the anus, the opening where feces are excreted. Anal fissures can cause bleeding and a sensation of tearing, ripping, or burning during or after a bowel movement. (See "Patient education: Anal fissure Beyond the Basics)".
- Other causes of rectal bleeding — There are many other causes of rectal bleeding, including colon cancer, colon polyps, colitis, and diverticulosis. (See "Etiology of lower gastrointestinal bleeding in adults" and "Approach to acute lower gastrointestinal bleeding in adults".)
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Hematochezia
Hematochezia is the passage of fresh blood through the anus, usually in or with stools (contrast with melena). The term is from Greek αἷμα ("blood") and χέζειν ("to defaecate"). Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed. The difference between hematochezia and rectorrhagia is that, in the latter, rectal bleeding is not associated with defecation; instead, it is associated with expulsion of fresh bright red blood without stools. The phrase bright red blood per rectum (BRBPR) is associated with hematochezia and rectorrhagia.
Signs and symptoms - Hematochezia from upper gastrointestinal, small bowel, or colonic sources can present with moderate to large volume bleeding, whereas patients with rectal or anal outlet bleeding usually present with ‘drops’ or ‘streaks’ on the stool or toilet paper
Causes:
- In adults, most common causes are hemorrhoids and diverticulosis, both of which are relatively benign; however, it can also be caused by colorectal cancer, which is potentially fatal. In a newborn infant, haematochezia may be the result of swallowed maternal blood at the time of delivery, but can also be an initial symptom of necrotizing enterocolitis, a serious condition affecting premature infants. In babies, hematochezia in conjunction with abdominal pain is associated with intussusception. In adolescents and young adults, inflammatory bowel disease, particularly ulcerative colitis, is a serious cause of hematochezia that must be considered and excluded.
- Hematochezia can be due to upper gastrointestinal bleeding. However, as the blood from such a bleed is usually chemically modified by action of acid and enzymes, it presents more commonly as black "tarry" feces known as melena. Haematochezia from an upper gastrointestinal source is an ominous sign, as it suggests a very significant bleed which is more likely to be life-threatening.
- Eating beetroot can cause harmless red-colored feces (beeturia) because of insufficient metabolism of a red pigment, and is a differential sign that may be mistaken as hematochezia.
- Consumption of dragon fruit (pitaya) or blackberries may also cause red or black discoloration of the stool and sometimes the urine (pseudohematuria). This too, is a differential sign that is sometimes mistaken for hematochezia.
- In infants, the Apt test can be used to distinguish fetal hemoglobin from maternal blood.
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Hematuria: Blood in urine
Hematuria is the presence of red blood cells in the urine. If there are enough red cells, the urine can become bright red, pink or cola colored. Often, however, the urine appears completely normal because there is not enough blood to cause a color change. In this case, the condition is called "microscopic" hematuria. There are many possible causes of hematuria, including:
- Urinary tract infection — Hematuria can be caused by an infection in any part of the urinary tract, most commonly the bladder (cystitis) or the kidney (pyelonephritis).
- Kidney stones
- Tumors in the kidney or bladder
- Exercise — Exercise hematuria is a harmless condition that produces blood in the urine after strenuous exercise. It is more common in males than females.
- Trauma — Traumatic injury to any part of the urinary tract — from the kidneys to the urethral opening (the connection between the bladder and the outside world) — can cause hematuria.
- Drugs — Hematuria can be caused by medications, such as blood thinners, including heparin, warfarin (Coumadin) or aspirin-type medications, penicillins, sulfa-containing drugs and cyclophosphamide (Cytoxan).
- Glomerulonephritis — Glomerulonephritis is a family of illnesses that are characterized by inflammation of the glomeruli, the filtering units of the kidneys. Glomerulonephritis is a rare complication of certain viral and bacterial infections (including strep throat). It can also occur in people with certain auto-immune diseases, systemic lupus erythematosus (lupus or SLE) and vasculitis. Sometimes there is no identifiable cause.
- Bleeding disorders — This includes conditions such as hemophilia and von Willebrand's disease.
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