Blood in Stools

Blood in stools, also known as rectal or gastrointestinal bleeding in Singapore, is a sign of bleeding somewhere in the digestive tract. The digestive or gastrointestinal tract comprises the oesophagus, stomach, small intestine, large intestine, rectum, and anus. Bleeding can occur in any of these places, and depending on where this bleeding occurs, different conditions can cause it. These conditions or causes can be serious or completely benign.

Blood in stools can look different in different people and conditions. They can appear:

• Bright red blood: this typically appears as a coating on the stool or on toilet paper after wiping. Usually indicates bleeding low in the large intestine (colon) or rectum. 
• Dark red blood: stool appears tarry or dark – melena stools. This usually indicates that bleeding is higher in the colon or small intestine or bleeding has occurred in the stomach. 

The amount of blood present in gastrointestinal bleeding varies – the bleeding may be significant where it is obvious to the naked eye or minute. This type of minute bleeding is known as occult bleeding.

Numerous conditions can cause bloody stools; these are:

• Inflammatory bowel disease (IBD): often confused with irritable bowel syndrome (IBS), IBD is an umbrella term for two diseases – Crohn’s disease and ulcerative colitis. Inflammatory bowel disease causes prolonged inflammation of the gastrointestinal tract, thus resulting in bleeding. 
• Bacterial infections: infections from bacteria such as E. coli or salmonella can cause bloody stools. However, this usually stops once the bacteria infection clears up.
• Ischaemic colitis: this condition occurs when blood flow to the large intestine or colon is disrupted or temporarily reduced, thus resulting in tissue damage and bleeding.
• Diverticular disease: a digestive condition affecting the large intestine that causes pockets or bulges to develop. Diverticular disease can eventually result in diverticulitis when these pockets or bulges become inflamed or infected, resulting in gastrointestinal bleeding.
• Anal fissure: a relatively common condition, anal fissures occur due to tears along the tissue of the anus. These tears can cause bleeding and bloody stools.
• Colonic/rectal polyps: polyps are benign growths that can develop in several areas of the gastrointestinal tract and cause bleeding. If these colonic/rectal polyps are not removed, they can grow and progress into colon cancer, which may also result in rectal bleeding. 
• Haemorrhoids: commonly known as piles, haemorrhoids are caused by straining or pushing on hard faeces. This can cause the blood vessels of the anus or rectum to swell and bleed.  
• Peptic ulcers: peptic ulcers are sores that develop due to digestive acid dissolving the inner surface of the small intestine or stomach. This can lead to gastrointestinal bleeding and blood in stools.
• Anal fistula: an anal fistula is a small passageway or tunnel that develops from within the anus to the skin outside. It usually begins in the anal glands, which can develop abscesses that may result in rectal bleeding.

The possible causes of blood in stools are numerous; hence, it is essential to identify the cause so that appropriate treatment can be administered. Book an appointment with Alpine Surgical Practice today!

This depends on the underlying cause of the bloody stools. For example, abdominal pain often accompanies bloody stools caused by IBD, haemorrhoids, anal fistulas, anal fissures, peptic ulcers, and bacterial infections. However, bloody stools caused by colonic/rectal polyps and colon cancer may not be accompanied by any pain at all.

Whether your bloody stools are accompanied by pain or not, seek medical assistance if you notice any blood in your stools as soon as possible. Early intervention is crucial to recovery.

The underlying cause of blood in stools is diagnosed in the following ways:

• Rectal examination: inform your colorectal specialist about your medical history and any activities you think may have contributed to your bloody stools. A rectal exam will also be conducted to check your rectum for any problems.
• Faecal occult blood test: a common screening tool for colon cancer, the faecal occult blood test checks for the presence of minuscule amounts of blood in stools. A sample of your stool will be obtained and sent to the laboratory for analysis. 
• Blood test: this procedure checks for the presence of any conditions such as anaemia, infections, or inflammation. 
• Imaging tests: imaging tests, such as an abdominal computed tomography scan (CT scan), can identify the source of bleeding in the gastrointestinal tract.
• Colonoscopy: a colonoscopy involves a thin and flexible tube with a light and camera attached to the end of it. This scope is gently and slowly guided through the rectum and into the colon to check for signs of growths or abnormalities.
• Gastroscopy: a gastroscopy involves a thin, flexible tube with a light and camera attached to the end. It is then gently and slowly guided down through the mouth and into the oesophagus, stomach and small intestine to check for peptic ulcers or other abnormalities.