Blood on toilet paper: it’s a serious doctor?
Blood in the stool can be frightening, as you discover it by wiping it after a bowel movement or as a result of a test ordered by your health care provider. Blood in the stool may indicate a severe problem, but this is not always the case. Here’s what you need to know about the possible causes of bloody stool and what you and your doctor should do if you discover a problem.
Causes of blood in the stool
Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for the presence of blood hidden in the stool). At other times, it may be visible on toilet paper or in the toilet after a bowel movement in the form of bright red blood. Bleeding that occurs higher in the digestive tract may cause black, tarry stools to appear.
Possible causes of blood in the stool include:
- Diverticular disease. Diverticula are small pockets that project from the wall of the colon. Usually, diverticula do not cause problems, but sometimes they can bleed or become infected.
- Anal Fissure. A small cut or tear in the tissue doubling the anus similar to cracks that occur in chapped lips or a paper cut. Cracks are often caused by the passage of a large, hard stool and can be painful.
- Angiodysplasia. A condition in which fragile and abnormal blood vessels cause bleeding.
- Peptic ulcer. An open wound in the wall of the stomach or duodenum, the upper end of the small intestine. Many peptic ulcers are caused by infection with a bacterium called
- Helicobacter pylori (H. pylori). Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.
- Polyps or cancer. Polyps are benign growths that can grow, bleed, and become cancerous. Colorectal cancer is the fourth most common cancer in the United States. It often causes bleeding that is not noticed with the naked eye.
- Esophageal problems. Esophageal varices or tears in the esophagus can cause severe blood loss.
Rectal bleeding: should we worry?
Rectal bleeding (known medically as hematochemistry) refers to the passage of red blood from the anus, often mixed with stool and blood clots. It is called rectal bleeding because the rectum is immediately above the anus, but the red blood in the stool can come from the rectum, as we will see later, but it can also come from other parts of the rectum. Gastrointestinal tract. The severity of rectal bleeding (i.e., the amount of blood that is transmitted) varies considerably. Most episodes of rectal bleeding are mild and stop on their own.
Many patients report having observed only a few drops of fresh blood that make the toilet water pink or blood stains on the tissue paper after wiping. Others may indicate a brief passage of a spoonful or two of blood. In general, mild rectal bleeding can be assessed and treated in the doctor’s office without hospitalization or need primary diagnosis and treatment.
Bleeding can also be moderate or severe. Patients with moderate bleeding will repeatedly experience more massive amounts of bright red or dark (brown) blood often mixed with stool and blood clots. Patients with severe bleeding may have many stools or a single stool containing a large amount of blood. Moderate or severe rectal bleeding can quickly deplete a patient’s body, causing symptoms of weakness, dizziness, near-fatigue or fainting, signs of low or orthostatic hypotension (decreased blood pressure when moving from sitting or lying to standing).
Rarely, bleeding can be so severe as to cause shock due to blood loss. Moderate or severe rectal bleeding is usually assessed and treated in the hospital. Patients with signs and symptoms of decreased blood volume often require emergency hospitalization and blood transfusion.
Blood in the stool: diagnosis
It is essential for a doctor to evaluate any bleeding in the stool. Any details you can give about bleeding will help your doctor locate the bleeding site. For example, a black, tarry stool is probably an ulcer or other problem in the upper part of the digestive tract. Bright red blood or brown stools usually indicate a problem in the lower gastrointestinal tract, such as hemorrhoids or diverticulitis.
After obtaining a medical history and physical examination, the health care provider may order tests to determine the cause of the bleeding. Tests may include:
A test that can tell your doctor if the bleeding is in the upper or lower digestive tract. The procedure involves removing the contents of the stomach through a tube inserted into the stomach through the nose. If the stomach does not contain blood, bleeding may have stopped or is more likely in the lower digestive tract.
A procedure that involves inserting an endoscope, or a flexible tube with a small camera at the end, through the mouth, and along the esophagus to the stomach and duodenum. The doctor can use it to find the source of the bleeding. Endoscopy can also be used to collect small tissue samples for microscopic examination (biopsy).
A procedure similar to an EGD except that the telescope is inserted through the rectum to see the colon. As in the case of an EGD, colonoscopy can be used to collect tissue samples for biopsy.
A procedure similar to EGD and colonoscopy used to examine the small intestine. In some cases, it involves swallowing a capsule with a tiny camera inside that transmits images to a video monitor as it passes through the digestive tract.
A procedure that uses a contrast product called barium to bring up the digestive tract on a radiograph. The barium can be swallowed or inserted into the rectum.
A procedure that involves injecting small amounts of radioactive material into a vein and then using a particular camera to view images of blood flow in the digestive tract to detect where the bleeding occurs.
This procedure involves injecting a special dye into a vein that makes the blood vessels visible on an x-ray or CT scan. The system detects bleeding when the dye escapes from the blood vessels at the site of bleeding.
The surgical procedure in which the doctor opens and examines the abdomen. This may be necessary if other tests fail to find the cause of the bleeding.
Health care providers also ask for laboratory tests when there is blood in the stool. These tests can look for coagulation problems, anemia and the presence of H. pylori infection.
A person who has blood in the stool may not be aware of the bleeding and have not reported any symptoms. On the other hand, they may also have abdominal pain, vomiting, weakness, difficulty breathing, diarrhea, palpitations, fainting, and weight loss depending on the cause, location, length and the severity of the bleeding.
Blood in the stool: treatment
A doctor may use one of several techniques to stop the acute bleeding. Endoscopy is often used to inject chemicals into the bleeding site, treat the bleeding site with an electric current or laser, or apply a band or forceps to close the bleeding vessel. If the endoscopy does not control the bleeding, the doctor can use angiography to inject drugs into the blood vessels to control the bleeding.
Beyond immediate cessation of bleeding, if necessary, treatment is to tackle the cause of the bleeding to prevent it from coming back. Treatment varies by reason and may include medications such as antibiotics to treat H. pylori, medicines to suppress acid in the stomach or anti-inflammatories to treat colitis. Surgery may be necessary to remove polyps or parts of the colon damaged by cancer, diverticulitis, or inflammatory bowel disease.
However, depending on the cause, the treatment may involve simple things that you can do yourself. These include a high-fiber diet to relieve constipation that can cause and aggravate hemorrhoids and anal fissures, and sit in warm or hot baths to relieve cracks.
Your doctor will prescribe or recommend a treatment based on the diagnosis.