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Blood in Stool – Causes, Symptoms and Treatment

Blood in stool can indicate various conditions of the digestive tract. Learn about causes, symptoms, and when to seek medical attention.

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Things worth knowing about "Blood in Stool"

Blood in stool can indicate various conditions of the digestive tract. Learn about causes, symptoms, and when to seek medical attention.

What Is Blood in Stool?

Blood in stool refers to the presence of blood in bowel movements and can be a sign of conditions ranging from minor to serious. Medically, a distinction is made between hematochezia – bright red blood in or on the stool, typically from the lower gastrointestinal tract – and melena, which refers to black, tarry stools caused by digested blood from the upper gastrointestinal tract.

Any new occurrence of blood in stool should always be evaluated by a doctor, as it may signal anything from benign hemorrhoids to colorectal cancer.

Causes

The causes of blood in stool vary depending on the location of the bleeding within the digestive tract.

Common Causes of Bright Red Blood

Hemorrhoids: Swollen blood vessels in and around the rectum and anus; the most common cause of blood on toilet paper or in the toilet bowl.
Anal fissures: Small tears in the lining of the anus, often associated with pain during bowel movements.
Diverticula: Small pouches in the colon wall that can occasionally bleed.
Colon polyps: Benign growths in the colon lining that may bleed or develop into cancer over time.
Inflammatory bowel disease (IBD): Conditions such as Crohn's disease and ulcerative colitis frequently cause blood in stool.
Colorectal cancer: A serious cause that must be ruled out, particularly in cases of persistent rectal bleeding.

Common Causes of Black, Tarry Stool (Melena)

Peptic ulcer: Bleeding from a stomach or duodenal ulcer produces dark, digested blood in the stool.
Esophageal varices: Enlarged veins in the esophagus, commonly associated with liver disease.
Gastritis: Inflammation of the stomach lining.

Symptoms and Associated Signs

Depending on the underlying cause, blood in stool may be accompanied by:

Pain or burning during bowel movements
Abdominal cramps or pain
Changes in stool consistency or frequency
Nausea and vomiting (sometimes with blood)
Unexplained weight loss
Fatigue, dizziness, or pallor (signs of anemia)

Diagnosis

The diagnostic workup for blood in stool typically includes several steps:

Medical history and physical examination: The doctor asks about the circumstances of the bleeding and examines the abdominal and anal area.
Fecal immunochemical test (FIT/iFOBT): Detects microscopic traces of blood in stool that are invisible to the naked eye; used in colorectal cancer screening.
Proctoscopy / Rectoscopy: Visual examination of the rectum to assess hemorrhoids, fissures, or polyps.
Colonoscopy: The most important examination for evaluating the entire colon; allows tissue samples (biopsies) to be taken.
Upper endoscopy (esophagogastroduodenoscopy): Used when bleeding from the upper gastrointestinal tract is suspected.
Blood tests: To detect anemia (low hemoglobin) or signs of inflammation.

Treatment

Treatment depends on the underlying condition causing the bleeding:

Hemorrhoids: Ointments, suppositories, sclerotherapy, or surgical removal depending on severity.
Anal fissures: Topical ointments, dietary changes (high-fiber diet), and in some cases minor surgery.
Colon polyps: Removed during colonoscopy (polypectomy).
Inflammatory bowel disease: Medical therapy including anti-inflammatory drugs, immunosuppressants, or biologics.
Peptic ulcers: Proton pump inhibitors and antibiotics if Helicobacter pylori infection is present.
Colorectal cancer: Surgery, chemotherapy, and/or radiation therapy depending on the stage of the disease.

When to See a Doctor

As a general rule, any newly occurring blood in stool should be medically evaluated. Seek urgent medical attention if:

There is a large amount of blood or continuous bleeding
You experience dizziness, fainting, or severe weakness
Your stool is black and tarry
You have unexplained weight loss
There is a family history of colorectal cancer or polyps

Prevention and Screening

Colorectal cancer screening plays a key role in the early detection of conditions causing blood in stool. Regular colonoscopies and stool tests (such as the FIT) are recommended screening tools starting at age 45-50 in many countries. A high-fiber diet, regular physical activity, and avoiding risk factors such as smoking and excessive alcohol consumption all contribute to good digestive health.

References

World Health Organization (WHO): Cancer – Colorectal Cancer Fact Sheet. Geneva, 2023. Available at: www.who.int
American College of Gastroenterology (ACG): Clinical Guideline – Colorectal Cancer Screening, 2021. Available at: www.gi.org
Feldman M., Friedman L.S., Brandt L.J.: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Elsevier, Philadelphia, 2021.

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