Blood in the Stool: Should You Be Concerned?
I engage in “potty talk” on a daily basis. That is to say, I discuss bowel habits with patients routinely. One particularly distressing bowel problem is the sight of blood in the stool.
When blood is noted, it is important to clarify how it presents. These factors will be important as you communicate the problem to your doctor:
Blood Inside or Outside Stool? It is important to determine if the blood is outside the stool or laced within the stool. This will give an idea as to how high up the bleeding is coming from. Any loose blood will turn the toilet water red. (Note that it does not require much blood to turn the water significantly red. Such a sight can be quite scary, but it is difficult to quantify the blood loss based on the appearance of bloody toilet water.)
Black Tar Like Quality? Sometimes there is a black tar-like quality to the stool without the reddened color. This condition is called melena and it usually indicates that the bleeding has occurred in the stomach. Melena also has a particular smell that is notable.
Recent Digestive Trouble? Other factors are also important to note such as associated pain or recent constipation/diarrhea.
Possible Causes of Bloody Stools
Hemorrhoids: The most common cause of a bloody stool is hemorrhoids. Hemorrhoids are actually just a type of varicose veins. There are two types of hemorrhoids, internal and external. Internal hemorrhoids may or may not be painful and are located in the rectum, inside the body. External hemorrhoids can be felt around the anal opening. They are usually marble-sized but can get larger. Hemorrhoids may come out of nowhere but increased rectal/anal pressure is often the cause. Increased pressure may come from prolonged sitting (long car rides, reading on the toilet) or straining due to constipation. Hemorrhoids are also common in pregnancy due to pressure from the enlarged uterus.
Polyps (Diverticulosis): Polyps can be injured by passing stool and cause bleeding. In a similar fashion, diverticula can also bleed from injury. Diverticula are pockets that can form in the colon from the repeated propulsion of stool. At the age of 50, 50% of people will have divertiulosis and the rates go up from there. As such, diverticula are not considered abnormal. The condition of diverticulitis develops when diverticla become infected.
Anal Fissures: Cracks can develop on the skin of the anal opening called fissures. These are quite painful and the bleeding is usually minimal, perhaps only on the tissue paper.
Ulcers: An ulcer in the stomach or first part of the small intestine can cause melena. Red blood is not seen with an ulcer because the blood is digested as it makes its way through the small intestine.
Anal Warts: Lastly, anal warts, a venereal disease, can become irritated and bleed. These bumps are usually in groups and typically no bigger than a pea. Like fissures, any bleeding would likely be minimal.
When To Worry
Most times blood in the stool should be evaluated by a doctor. If you are sure you are dealing with an external hemorrhoid, anti-inflammatory cream and a stool softener will help. If the hemorrhoid is tense and painful, there may be a blood clot within that needs to be removed.
Any question as to where the blood is coming from needs to be answered. A doctor may use a short, 3 inch anoscope in the office to see if internal hemorrhoids are the cause. If no cause is found, a longer colonoscope is typically warranted. Most situations can wait for your personal doctor. However, if the bleeding is voluminous and you are weak or dizzy, go to the emergency room.