Blood in the stool

Definition

Blood in the stool can appear in a variety of ways. There are a few technical terms associated with blood in the stool:

• Hematochezia : Bright red fresh blood coming out of the anus. Hematochezia usually occurs in diseases of the lower intestinal tract.
• Melana (tarry stool): Blackish, tarry stool with a sticky texture and strong odor occurs when blood lingers in the digestive tract for several hours. This is usually the case with upper gastrointestinal bleeding.
• Occult bleeding : Occult bleeding occurs without any obvious symptoms and stool changes.

Causes of blood in the stool

Blood in the stool can be caused by various diseases of the digestive tract. The color and appearance of the bloody stool can indicate the location of the source of the bleeding. A distinction is made between upper and lower gastrointestinal bleeding.

If there is bleeding in the upper digestive tract , the stool will appear dark red to coffee grounds. The bleeding source can be in the oropharynx, esophagus, stomach or duodenum. The dark color results from a reaction between stomach acid and the red blood pigment hemoglobin. Upper gastrointestinal bleeding occurs significantly more frequently than bleeding from the lower gastrointestinal tract.

The following bleeding sources can be considered as the cause of upper gastrointestinal bleeding:

• Gastric ulcer (Ulcus) : Triggered by stress, frequent alcohol consumption and bacterial overgrowth, a poorly healing defect in the gastric mucosa can form. Patients suffer from abdominal pain, nausea and vomiting. An ulcer is the most common cause of blood in the stool.
• Superficial small mucosal defects (erosions) : Small injuries to the gastric mucosa occur somewhat less frequently and lead to blood admixture during bowel movements.
• Esophageal varices (esophageal varices) : Dilated blood vessels in the esophagus can cause sometimes life-threatening bleeding. Blood vomiting (hematemesis) can occur as a further symptom. In most cases, the cause of this vasodilatation is advanced cirrhosis of the liver.
• Stomach cancer : A malignant tumor of the digestive tract can make itself felt through blood in the stool.

If bright red blood occurs, the cause is more likely to be in the lower gastrointestinal tract . This includes the rest of the small intestine, the large intestine and the rectum:

• Chronic inflammatory bowel diseases : Chronic inflammatory bowel diseases include Crohn’s disease and ulcerative colitis. Both diseases occur with recurrent bowel irregularities. Various immunosuppressive drugs can be used to alleviate the symptoms.
• Colorectal cancer : A malignant tumor disease is often only noticeable with a changed bowel movement. Some types of cancer run in families. This means that family members of relatives with colorectal cancer are particularly at risk of also developing colorectal cancer. The earlier colorectal cancer is detected, the better the chances of recovery.
• Diverticulosis : Many older people suffer from the condition diverticulosis, which is a condition in which small protuberances form in the intestinal wall. These can become inflamed and cause minor bleeding.
• Polyps : Benign protrusions of the mucous membrane of the intestine are called polyps. Since they carry the risk of progressing to colon cancer, they should be removed by colonoscopy.
• Angiodysplasias : vascular malformations in the intestine
• Ischemic colitis : If an intestinal vessel is blocked, the affected part of the intestine can become inflamed. Older patients are particularly affected by this.
• Gastroenteritis : Transmissible gastrointestinal infection
• Hemorrhoids : Hemorrhoids describe protrusions of the blood vessels and the surrounding mucosa in the last section of the intestine (anal canal and rectum). They are common in both men and women and cause bright red blood in the stool without pain and sometimes itching.
• Anal fissure : An anus tear can present with a stinging sensation at the sphincter muscle and a foreign body sensation. The tear occurs when the stool is too hard or when you strain too hard as part of constipation.
• Anal vein thrombosis : In this condition, a blood clot forms in the area of ​​the anus.
• Medications : Taking certain medications that thin the blood, such as acetylsalicylic acid (ASA), can also cause bleeding.

Bloody stool symptoms

In addition to the bloody stool, there may be other complaints, such as

• Abdominal pain or abdominal pain
• Vomit
• pain during bowel movements
• Reduced performance and tiredness can indicate anemia.
• Anal itching or burning after a bowel movement
• In the case of fever, weight loss or night sweats , a tumor such as colon cancer could be the cause.

Diagnosing blood in the stool

You can first contact your general practitioner with your complaints. If necessary, they can refer you to a specialist. The specialist in diseases of the gastrointestinal tract is the gastroenterologist .

In order to make the correct diagnosis, the doctor treating you will first ask you a few questions about your symptoms. In this anamnesis interview, he will ask you about the appearance, frequency and duration of the bloody bowel movements. He will also ask you about any cancers in your relatives, as some digestive system cancers can be inherited.

This will be followed by a physical examination , during which your stomach will be palpated, listened to and tapped. This also includes the so-called digital rectal examination , in which the anus is palpated with a finger. Even if this examination seems uncomfortable, it often gives conclusions about the cause of the symptoms.

A quantitative immunological stool test (also: immunological fecal occult blood test/ iFOBT or fecal immunochemical tests/FIT) is used to detect even small amounts of blood in the stool. It is used for the early detection of colon cancer.

In addition, in some cases, a colonoscopy and a gastroscopy can be performed. With these examinations, the gastrointestinal tract can be viewed from the inside and a possible source of bleeding can be identified and treated in the same session. Small tissue samples (biopsies) can also be taken in the course of this, which are then examined in the laboratory.

A blood test can provide information about the severity of the blood loss. Further examinations such as an ultrasound examination or a computed tomography can also be used.

Therapy for blood in the stool

Treatment for blood in stool depends on the underlying cause. Depending on the underlying disease, different treatment approaches are available.

In the case of acute bleeding, admission to a hospital should always take place. In the inpatient setting, the patient’s circulation and general condition can be better monitored. In the case of heavy blood loss, blood supplies can help to keep the circulation going. The source of the bleeding can often be identified and stopped during the course of the gastroscopy or colonoscopy. If this does not work, a surgical procedure can help the patient.

Tips for a healthy digestive tract

• A healthy and balanced diet rich in fiber prevents numerous diseases. Meals with lots of fruit, vegetables and whole grain products contribute to your intestinal health. Avoid high meat consumption and avoid fatty finished products.
• Drink as much as possible. Adults are recommended to drink 1.5 to 2.5 liters a day.
• Regular exercise and sport are not only good for the heart but also for the gastrointestinal tract.
• Refrain from smoking and excessive consumption of alcohol.

Blood in the stool in infants

Blood in the stool can also occur in babies. Small breast injuries that occur while breastfeeding are often the cause of the changed bowel movements. Small tears in the sensitive anal mucosa in infants can also trigger the symptoms. If you are unsure about the triggers, you should consult your pediatrician as a precaution. The pediatrician should also be consulted if there is repeated blood in the stool.

When to seek help for blood in stool

If you see blood in your stool, you should always get yourself into the hands of a doctor. Blood in the stool often has harmless causes and can be easily treated. Nevertheless, it is important to rule out malignant diseases.

If you experience the following symptoms, you should seek medical attention immediately:

• circulatory weakness and exhaustion
• severe malaise
• dizziness
• Coffee grounds like vomiting
• High fever

How can Med-Healths help?

If you have blood in your stool or any of the other symptoms mentioned above, you should definitely see a doctor. Our Med-Healths doctors offer you an adequate framework in which you can describe your symptoms in detail. If further examinations are necessary or if there is an indication for admission to a clinic, our Med-Healths doctor will be happy to issue you with a referral. It is also possible to issue a prescription or a certificate of incapacity for work via the app.