Blood in Stool

Blood in stool implies there is bleeding somewhere in the digestive tract. The colour of blood can give you an idea of the source of bleeding. For example, bright red blood can mean the bleeding is low in your colon or rectum, while dark red blood can mean that the bleeding is higher in the colon or small bowel. 

Sometimes, the amount of blood is so small that it is not visible to the naked eye and can only be detected during a faecal occult test (a lab test of a stool sample). In such instances, you may be unaware of the bleeding. Where bleeding is the only symptom, you may have no reported symptoms. On the other hand, you may experience other symptoms such as abdominal pain, vomiting, and diarrhoea, alongside bleeding.

Why do I get bloody stools?

Rectal bleeding is a symptom of a myriad of conditions, ranging from anywhere mild to those that require immediate medical attention.

Haemorrhoids

Commonly known as piles, haemorrhoids are unusually large and bulging blood vessels in and around the anus and lower rectum. There are internal haemorrhoids and external haemorrhoids. Internal haemorrhoids develop within the anus and can bleed during bowel movements, although this bleeding is normally painless. External haemorrhoids develop near the anus and only bleeds when ruptured. Bleeding from haemorrhoids is usually fresh and bright red in colour.

Anal Fissure

An anal fissure is a non-healing tear or cut in the tissue lining the anus and usually extends to the edge of the anus. This tear or cut is often caused by passing large and hard stool, and can be quite painful. Blood occurs when passing because the stools would stretch out the fissure during the passage of the motion.

Anal Tumours

Anal tumours are rare but can present with bleeding during bowel movement and are often accompanied by deep-seated pain in the anus. Other symptoms of an anal tumour includes changes in bowel movements, and the tumour may later develop large enough to protrude through the anus or invade into the skin around the anus.

Diverticular Disease

Diverticular are small pouches that develop in the colon wall. It may affect part of or the whole colon. Diverticular typically do not cause problems but it may sometimes bleed and become inflamed. Diverticular disease is a common condition that affects those above 40 years of age, only a small proportion of patients present with symptoms and even fewer will require surgery.

Peptic Ulcers

While the most common symptom of peptic ulcers is stomach pain, there are cases in which patients present with more serious symptoms such as blood in stools. In this case, the blood is usually dark red and/or the stools are tarry. 

Polyps

Polyps are tissue growths that are typically small and less than half an inch wide. Monst polyps are benign and these are commonly found in the uterus and colon. However, polyps can turn cancerous and rectal bleeding could indicate the presence of polyps in the colon.

Oesophageal Disorders

The oesophagus, or food pipe, is the pathway in which food travels from your mouth to stomach. Different conditions can affect the oesophagus. Although the prevalent oesophageal disorder is gastrointestinal reflux disease (GERD), in which excessive acid reflux occurs, varicose veins of or tears in the oesophagus can also cause bleeding. 

When should I seek help?

You should never ignore blood in your stool. Consult your healthcare provider as soon as you detect blood in your stool. Your healthcare provider should conduct a rectal examination first. After speaking to you, he may order a set of tests to determine the exact cause.

What are the investigations for bloody stools?

Your doctor will order a set of tests depending on your symptoms and medical history. These tests may include a rectal examination, faecal occult blood test, blood works, imaging studies, endoscopy, or a combination of tests.

A rectal examination or faecal occult blood test is conducted to look for abnormalities or blood in your colon. A rectal examination is a physical examination, whereas a faecal blood test is a laboratory test of your stool sample to check for infection and determine the severity of the infection.

Blood work may be performed to check for evidence of anaemia, inflammation, or infection. Anaemia causes low haemoglobin while inflammation and infection cause an elevated white blood cell count.

Imaging studies, like an abdominal CT scan, can sometimes identify the source of the bleeding.

There are different types of endoscopy, such as colonoscopy, flexible sigmoidoscopy, esophagogastroduodenoscopy, and enteroscopy, carried out to look for blockage or abnormal growth in the gut. The procedure typically involves inserting a long tube with a camera into your mouth or anus, and is often carried out as a day surgery.

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