Few things are more frightening than seeing blood when you look in the toilet. It’s not only worrisome…it also can be embarrassing to talk about. But put any embarrassment aside—your doctor has heard this from many people before you, says gastroenterologist Suneeta Krishnareddy, MD.
Typically, when you see bright red blood in stool, on toilet paper or in the toilet bowl, it’s coming from the rectum or anus. Blood that travels from higher up, such as the small intestine, is likely to be maroon or black. Regardless of color, get examined the first time you notice blood in stool. It could be as benign as a hemorrhoid or as serious as cancer, but that’s the only way to find the cause and treat it properly. To get the right diagnosis, you also may need blood tests and a flexible sigmoidoscopy or a colonoscopy (especially if you’re close to age 45, the age at which this test is recommended as a screening tool).
Here are some common causes of blood in stool—and what to do about each…
Hemorrhoids or anal fissures
Hemorrhoids are swollen or irritated blood vessels in the anus, often stemming from constipation and straining to go. They are annoying and sometimes painful but benign…and if one ruptures, it will cause bleeding. An anal fissure—a small tear or break in the lining of the anus—also can stem from straining and cause bleeding and pain. Medications and lifestyle changes to ease constipation, such as increasing fluid and fiber intake, will help. There are topicals, such as Preparation H, to reduce discomfort. Sitting in a warm bath with Epsom salts for 20 minutes a few times a day also can be soothing.
Inflammatory bowel disease (IBD)
Bloody stool often is the first sign of the chronic inflammatory bowel disease ulcerative colitis, though it also can happen with Crohn’s disease. People typically experience abdominal pain that can be sharp or dull and achy. People also experience diarrhea, often with blood mixed in, five to seven times a day. IBD usually starts younger in life. Older people can experience what’s called ischemic colitis, low blood flow to the colon that causes inflammation, abdominal pain and sometimes bloody bowel movements.
Diverticular bleed
Diverticulosis is a common condition in which one or more pouches, or diverticula, form in the colon. For many people, these pouches don’t cause symptoms, but sometimes a pouch becomes inflamed, causing diverticulitis. It also is possible to experience a diverticular bleed, when a blood vessel in a pouch bursts, and you experience a sudden and large amount of painless bright red blood in stool or simply blood passing through the rectum. Typically, the bleeding will stop on its own, sometimes within a few hours or a few days. Even so, alert your doctor, who may want to test to make sure the bleeding isn’t due to another condition. If the bleeding is extremely heavy from the start, seek immediate medical attention at an emergency room—medical intervention could be required, including a blood transfusion and, if the bleeding can’t be stopped, possibly surgery to remove the affected area of the colon.
Advanced peptic ulcer
Ulcers in the stomach or at the beginning of the small intestine, a section called the duodenum, can be another explanation for blood in stool. Though burning gut pain is the primary symptom of a peptic ulcer, these sores can bleed if not treated early, causing black and tarlike stool. Treatment depends on the cause, which often is the bacterium H. pylori or overuse of NSAIDs. You may need oral medication as well a surgical procedure to remedy an ulcer that is bleeding.
Colon polyps and colon cancer
Polyps are growths along the intestinal wall that can become cancerous—a colonoscopy examines the colon to spot them early and remove them. Some polyps can bleed whether they’re cancerous or not. Blood in stool from a polyp is more likely to be black in color. Very rarely does colon cancer cause bright red bleeding.
Diet and medications
Both iron supplements and the stomach medication Pepto Bismol can turn your stool black. The red pigment in red beets can make your stool maroon. If your stool stays maroon or black even after eliminating beets from your diet and halting iron supplements and Pepto Bismol, get checked out by your health-care provider.
