Fresh blood in your stool can understandably set your mind racing with worry. You might see a small amount of blood on the toilet tissue or notice a red to maroon streak in your stool. Larger amounts of fresh blood typically lead to burgundy-colored stools or cause the commode water to appear bloody. Fresh blood in the stool usually indicates bleeding from the lower gastrointestinal tract, including the colon, rectum and anus. Rarely, passage of fresh blood signals heavy bleeding from the upper digestive system. There are many possible causes of fresh blood in the stool due to lower gastrointestinal bleeding, ranging in severity from hemorrhoids to inflammatory bowel disease to cancer. If you notice fresh blood in your stool, contact your doctor right away to determine next steps.
Diverticuli are small pouches that project outward from the walls of the intestines. They most commonly develop toward the end of the large intestine, or colon. The presence of multiple diverticuli in the colon, known as diverticulosis, most frequently affects older adults. Most seniors with diverticulosis experience no symptoms. Painless bleeding, however, occurs in an estimated 10 to 20 percent of people with the condition.
Diverticulosis is the leading cause of lower gastrointestinal (GI) bleeding. The bleeding is often preceded by mild abdominal cramps followed by an urgent need to empty the bowels. Most bleeding due to diverticulosis stops spontaneously, but careful monitoring in the hospital is typically necessary. Blood transfusions and other treatments may be needed for people with severe or persistent bleeding.
Hemorrhoids are enlarged blood vessels in the anal canal. This common condition most frequently affects people aged 45 to 65 but occurs in adults of all ages. Hemorrhoids are categorized by their severity and whether they occur internally, externally or both. Hemorrhoids are the second most common cause of lower GI bleeding, which usually arises from internal rather than external hemorrhoids.
The amount of bleeding due to hemorrhoids varies from a streak on the toilet tissue to blood dripping into the commode after passing stool. Minimal bleeding can often be treated with lifestyle changes, including increased fiber and fluid intake. Significant or recurring bleeding due to internal hemorrhoids is usually treated with an ablation procedure, which destroys the hemorrhoidal tissue responsible for the bleeding.
Colonic ischemia (CI) refers to colon tissue damage triggered by reduced blood flow and an associated lack of oxygen. This situation is usually temporary, and the damage is typically limited to an isolated segment of the colon lining. CI commonly causes passage of bloody stool and primarily affects people aged 50 or older. A number of medical conditions increase the risk for CI, including diabetes, atherosclerosis, heart failure and chronic obstructive pulmonary disease. Several medications can also increase the risk for CI, such as narcotic pain medicines and certain antibiotics, appetite suppressants, decongestants, diuretics and chemotherapy drugs.
Symptoms of CI vary but many people experience sudden lower abdominal cramps accompanied by a strong urge to move the bowels. Passage of bloody diarrhea or bright red to maroon blood mixed with stool typically follows within 24 hours of the initial symptoms. Colonic ischemia ranges in severity, although most people do well with early diagnosis and medical treatment in the hospital. Immediate surgery is necessary if a segment of the bowel dies, a medical emergency known as gangrenous colitis.
Angiodysplasia is a 10-dollar word that generally refers to a blood vessel abnormality. Colonic angiodysplasia describes a degenerative process in which previously healthy blood vessels in the colon weaken and thin over time. These thin-walled vessels can bleed and cause fresh blood in the stool. Colonic angiodysplasia is the second most common cause of lower GI bleeding and fresh blood in the stool in senior adults, after diverticulosis.
People with colonic angiodysplasia usually have several abnormal blood vessels in their colon. While most people with this condition experience no bleeding or other symptoms, it remains a common cause of fresh blood in the stool of older adults. Bleeding from colonic angiodysplasia is usually painless and causes no other symptoms, but it ranges from mild to severe and tends to recur. Active bleeding from colonic angiodysplasia that does not stop on its own usually involves destruction of the bleeding vessels. Medication and surgery may be recommended for some people.
Inflammatory Bowel Disease
Inflammatory bowel disease describes two conditions -- Crohn disease and ulcerative colitis -- characterized by chronic inflammation of the digestive tract. With Crohn disease, inflammation can occur anywhere along the digestive tract. Inflammation is limited to the colon and rectum in people with ulcerative colitis. Bloody stools, usually in the form of diarrhea, are more common with ulcerative colitis but also occur with Crohn disease involving the colon or rectum. Pus and mucus might also be present in the stool. Other possible symptoms include abdominal pain, fever, weight loss and a persistent, urgent need to empty the bowels. Most people with inflammatory bowel disease experience cyclical flareups interspersed with periods of low disease activity.
Inflammatory bowel disease can occur at any age but is most often diagnosed in people younger than 30. Medications to reduce inflammation and disease-related symptoms remain the mainstay of treatment for Crohn disease and ulcerative colitis. Specific treatment recommendations depend on disease severity. Blood transfusions may be needed during periods of heavy bleeding. Surgery is sometimes recommended for people with severe disease or complications that cannot be managed with medical therapy.
Colorectal Polyps and Cancer
Colorectal polyps are growths that arise from the lining of the colon or rectum. Most colorectal polyps are not cancerous, but these growths are important because some can become cancerous. In fact, most cases of colorectal cancer arise from a polyp. Colorectal polyps and cancers vary in size, and most cause no noticeable signs or symptoms until they become large. This is why colorectal cancer screening is so important.. Large polyps and colorectal cancers can bleed and cause fresh blood in the stool. Small amounts of blood are often detectable only with laboratory testing. Visible blood, however, is also possible. Bleeding from colorectal polyps or cancer is typically painless. Other symptoms are uncommon, although large growths may cause diarrhea or constipation.
Colorectal polyps are typically removed during a colonoscopy procedure. Depending on the size and microscopic appearance of the removed polyps, doctors recommend repeat colonoscopy screening at varied time intervals. If colorectal cancer is detected, treatment may involve surgery, chemotherapy, radiotherapy or a combination of these treatments.
Many other conditions can lead to fresh blood in the stool, although they are less likely than the causes already discussed. Some examples include:
-- Anal fissures are small tears of the anus, the opening through which stool passes from the body. These tears cause pain and a small amount of bleeding when passing stool. Most heal on their own but chronic or deep fissures can lead to anal ulcers, which also tend to bleed with bowel movements.
-- Infectious proctitis refers to an infection of the rectum, which can cause fresh blood in the stool. Infectious proctitis is usually a sexually transmitted infection, most commonly caused by the bacteria responsible for gonorrhea and chlamydia. Other symptoms include rectal pain and leakage of anal discharge.
-- Infectious colitis is a form of food poisoning that causes inflammation of the colon. Typical symptoms include watery diarrhea, which may be bloody, along with abdominal cramps and possibly fever. Common causes include certain strains of Salmonella, Shigella, Vibrio and E. coli bacteria.
-- Meckel diverticulum refers to a pouch near the junction of the small and large intestines. It is a remnant of the umbilical cord, which is present from the time of birth in approximately 2 to 3 percent of people. Most people with this condition never experience symptoms, but bleeding and bloody stools can occur in a small portion of those affected. Symptoms associated with Meckel diverticulum are more common in children than adults.
-- Rectal varices are enlarged, fragile blood vessels in the rectum. They most often occur in people with liver cirrhosis due to a backup of blood caused by impaired blood flow through the liver. These fragile blood vessels can rupture and cause massive, life-threatening bleeding. Emergency treatment is needed to control bleeding from rectal varices.
-- Heavy bleeding from the upper gastrointestinal tract, including the esophagus, stomach and small intestine, can sometimes cause bloody stools. Brisk bleeding causes the blood to move through the digestive system quickly, often appearing as bloody or maroon-colored diarrhea. Possible causes include peptic ulcer disease, severe inflammation of the stomach and ruptured varies in the esophagus.
Warnings and Precautions
Most gastrointestinal bleeding leading to fresh blood in your stool will eventually stop on its own. However, it's important not to ignore this symptom. Call your doctor right away if you notice blood in your stool. This enables your doctor to collect relevant information to determine the appropriate next steps and how quickly you need to be seen. In some cases, rapid and potentially life-threatening blood loss can occur from the gastrointestinal tract. Seek emergency medical care if you have bloody stools accompanied by signs or symptoms of significant blood loss, including:
-- Dizziness, lightheadedness or fainting.
-- Rapid heart rate or breathing.
-- Cold, clammy skin.
-- Low blood pressure.
-- Agitation, confusion or drowsiness.
Also seek urgent medical care if you experience bloody stools accompanied by a fever, severe or worsening abdominal pain, abdominal tenderness or swelling, or reduced urination.