Blood in Stool

Blood in the stools or faecal blood can be an important symptom of an underlying condition and needs to be investigated thoroughly. The cause of blood in stools can range from a local condition such as piles or anal tear to serious conditions such as gut ulcers and even gut cancers. It is only when there is a substantial amount of blood loss, that can you see the blood in your toilet pot otherwise it may go unnoticed. If you have noticed blood in stools it is also important to note the colour of blood (whether it is bright red or blackish red). This will help your doctor to understand the source of bleeding. Physical examination can be very useful in identifying the cause; hence visiting your doctor for examination will be helpful. You may initially feel hesitant or embarrassed to seek medical help. However, the condition should not be ignored and you should seek prompt medical advice to rule out any serious illness. As such, medical consultation in such situations is always helpful.

What is blood in stools?

Blood in stools is a condition in which a person notices a bright red colour in the toilet pot or in the wiping tissue after passing stools. Blood can also be mixed with stools and noticed as blackish red stools.

Blood in stools is broadly divided into two categories depending upon the colour of blood:

• Hematochezia
  It refers to the bright red colour blood seen either on toilet paper or in the toilet pot after the evacuation of bowel or blood mixed with stools. It indicates bleeding from the lower part of the gastrointestinal tract which includes the large intestine, colon, rectum, and anus.
• Melena
  It refers to blackish red or black coloured stools resulting from the oxidation of haemoglobin in the gut. It is caused by bleeding from the upper gastrointestinal tract which includes the mouth, oesophagus, stomach, and small intestine.

Blood in stools is itself a symptom of an underlying disease or condition. Other symptoms which can help in the diagnosis of conditions are as follows:

• Abdominal pain
  Pain or cramping may be related to gut ulcers or intestinal ulcers, inflammation in gut or cancers. (Read more - Stomach pain treatment)
• Fainting
  Due to blood loss, you may feel dizzy or light-headedness.
• Weakness
  You may feel weak and tired because of blood loss.
• Coffee colour vomiting
  If you noticed coffee coloured vomit it may be due to a stomach or oesophageal bleeding and you should immediately consult your doctor.
• Pain during bowel movements
  You may feel pain while passing stools along with blood in stools which is a typical symptom of piles or anal tear (fissure).

There are many causes for blood in the stools. Finding out the exact cause helps in initiating prompt treatment and in preventing complications. The causes include:

Causes

Causes can be divided into causes of upper gut bleeding and lower gut bleeding.

Most common cause of upper gut bleeding is:

• Peptic ulcer disease
  These are ulcers or soreness caused due to the production of excessive acid in the stomach or intestine. The ulcers cause pain and bleeding due to erosion and can be due to Helicobacter pylori infection or excessive use of non-steroidal anti-inflammatory drugs (NSAIDs).  

Less common causes of upper gut bleeding include:

• Fistula
  It is the abnormal tract developed between the walls of the gut which may bleed.
• Tumours 
  Tumours of the gut can also cause blood in stools.

Most common causes of lower gut bleeding are

• Haemorrhoids
  Also called as piles, these are the swelling of veins in the anus causing pain and itchy sensation and difficulty in passing stool.
• Anal fissures
  They are caused by the tear in the anal region which is painful while passing stools.

Less common causes of lower gut bleeding include :

• Diverticulosis
  Diverticulum means a pouch-like structure formed in the colon due to weakness in the muscle which can bleed if the underlying vein gets eroded due to continuous friction.
• Irritable bowel syndrome
  It is a chronic inflammatory condition of the bowel. (Read more - Irritable bowel syndrome symptoms and treatment)
• Colorectal cancer
  Colorectal cancer is cancer which involves the large intestine or the rectum.

Risk Factors

There are many risk factors related to those conditions which can cause blood in the stools. These include:

• Helicobacter pylori infection
  It is a bacterium whose infection increases the risk of stomach and intestinal ulcers. (Read more - Stomach ulcer causes and treatment)
• Use of painkillers
  Prolonged use of painkillers known as Non-steroidal anti-inflammatory drugs or NSAIDs can lead to increased risk of stomach and intestinal ulcers.
• Excessive stress
  Stressful life can also increase the chances of ulcers.
• Excessive alcohol intake
  Alcohol consumption can worsen the piles as well as gastric ulcers.
• Unhealthy diet
  Spicy and junk food can increase chances of developing piles or can worsen them.

Most of the time blood in stools is due to piles, fissure or ulcer like conditions which can be prevented by following measures:

• Avoid stress
  Managing stress effectively can help avoid ulcers and improve overall health and well being of a person. Meditation, deep breathing, Tai Chi and yoga help in managing stress better. Also, exercising 5 days a week for 30 minutes can be helpful in relieving stress.
• Avoid Alcohol
  Alcohol can aggravate many factors leading to worsening of gut ulcers. Hence, limiting or completely avoiding alcohol can help in healing the ulcer. One drink a day for women and two drinks for men are acceptable.
• Healthy diet
  Diet plays an important role in a healthy bowel movement. A diet containing fibre such as fresh fruits, green leafy vegetables can ease the bowel evacuation and help relieve pain. Avoiding spicy food and preferring bland diet can also help to minimize recurrence of ulcers. Plenty of fluids in the form of smoothies, juices, and shakes can also be helpful.
• Drinking sufficient water
  Optimal water intake is essential for proper functioning of the gut and to avoid constipation. Drink at least 3-4 litres of water daily. Carrying a water bottle with you can help you drink more water.

The doctor establishes a diagnosis through:

• History and physical examination
  Your doctor may ask your history of bleeding in detail and will also examine you for any signs of anemia due to blood loss. Past history of similar episodes of bleeding and your personal history like diet, habits, occupation can also be helpful.
• Rectal examination
  Your doctor needs to examine anus (the opening from which stools come out) for any signs of injury, piles or tear in the region which may cause bleeding in stools.
• Stool routine examination
  Your doctor may advise you for a sample for stool examination to check for the presence of any infection, pus cells; red blood cells which can help get some indication of blood in stools. This test is often the first test that is carried out to confirm the presence of blood in stools. Sometimes certain foods can give a reddish colour to the stools such as beetroot. Stool examination, therefore, confirms whether the reddish discoloration is due to blood or any other substance.
• Complete blood count
  A complete blood count is performed to detect loss of blood leading to low haemoglobin, low red blood cell levels and high white blood cells counts which could indicate infection.
• Rapid urease test
  It is the test performed to detect H. pylori infection which is the common cause of peptic ulcers.
• Colonoscopy
  Colonoscopy may be carried out to rule out problems in the colon that could cause blood in the stools. It is an invasive procedure and is carried out when other methods fail to identify the cause.

Treatment depends entirely on the underlying condition. It includes:

• Assurance
  Bleeding in stools can be distressing and assurance given by your doctor can help you calm down. So talk to your doctor as soon as you notice bleeding in stools.
• Proper diet
  Your doctor may advise you to take a diet rich in fibres like green leafy vegetables, fresh fruits, salads, and fruit juices. Als,o drink plenty of water and fluids which will ease the evacuation of bowel and reduce the chance of bleeding in case of piles and fissures.
• Iron supplements
  In case of blood loss, there may be a decrease in your haemoglobin concentration. It is generally because of anaemia caused by iron deficiency. Your doctor may prescribe you iron supplements.
• Drugs
  Your doctor may prescribe drugs like proton pump inhibitors to reduce acid from the stomach, steroids in inflammatory conditions and antibiotics to kill the bacteria.
• Cauterizing
  If an active bleeding source is found; cauterization (a procedure in which affected area is sealed by electrical current) can be advised by your doctor.
• Banding
  In banding, a tight rubber band is rolled around the piles so that blood supply is completely stopped.
• Sclerotherapy
  In sclerotherapy, a chemical agent is injected in the piles which cause the piles to shrink and stop the bleeding.
• Surgery
  It is the last option to stop bleeding from the active site and in cases of tumours. For piles which are not treated with nonsurgical means and which are big in size, haemorrhoidectomy can be performed to cut them off the stop bleeding.

Lifestyle management

To avoid or prevent further loss of blood in stools, the following changes can be advised by your doctor:

• Avoid straining
  Straining during a bowel movement increases the chances of bleeding if you are having piles. Straining can be avoided by drinking sufficient water, exercising daily and eating a fibre rich diet.
• Add fibre to your diet
  Increased intake of fibre in diet can help relieve symptoms of piles and fissure and provide easy bowel movement without bleeding.
• Avoid alcohol
  Heavy intake of alcohol is one of the risk factors for bleeding in stools.  So try to minimize the quantity or if possible avoid completely.
• Take plenty of fluids
  Plenty of fluids such as fruit juices, smoothies along with more water intake at least 3-4 litres can help soften the stools and ease evacuation.
• Avoid stress
  Stress can lead to peptic ulcers which are one of the common causes of bleeding in stools. Finding effective ways to manage stress can help in managing the problem better.  
• Prompt treatment of conditions causing chronic cough
  Conditions like asthma, bronchitis can cause chronic cough which can lead to blood in stools if not treated in time. So always consult your doctor in such conditions.

Prognosis

The outcome depends upon the underlying cause of blood in stools which is mostly anal fissure or piles. These causes, though not life-threatening, should never be ignored. They may lead to extreme blood loss and other complications if not treated on time. Most importantly, one should never get embarrassed or never hesitate to visit the doctor if he notices blood in stools.

Complications

If not treated on time it may lead to serious complications like:

• Recurrent bleeding
  Unless the cause is found and treated, bleeding will continue to occur; hence it is advisable never to ignore bleeding in stools.
• Anemia
  Due to loss of blood, you may develop anemia mostly the one caused by iron deficiency.
• Perforation
  In case of peptic ulcers, if not treated it will lead to perforation or hole in your stomach or intestine which can be life-threatening.
• Obstruction
  It can also lead to an obstruction which will affect the passage of food and can cause distension of abdomen.