Blood In Stool Causes,
Investigations and Management
Passing blood in stool is common and on this page I will outline the most common causes for you.
I would always advise you to have your symptoms investigated further by your doctor as serious as well as treatable causes need to be diagnosed.
On this page, I will outline some of the causes, the investigations and management for you.
Whilst there are many harmless or benign causes including haemorrhoids, constipation in IBS or Irritable Bowel Syndrome, there are equally many causes of bloody stools that can do more harm.
These include malignant diseases such as bowel cancer and other tumours such as carcinoid tumours.
Pre-cancerous tumours or polyps in the bowel should be detected and treated appropriately and you can read more about this in the bowel cancer section.
Reasons For Blood In Stool
So what are the causes of blood in the stool? I will divide these in to sections to make this easier as a quick reference for you:
Bowel or Colon Cancer
Bowel cancer or colon cancer is a serious cause of mucus and blood in stool. Fortunately, it only accounts for about 1% of all cases of bleeding, but a condition that really needs to be picked up early. Early detection improves outcome or cancer survival and also allows the doctor to treat pre-malignant lesions or polyps before even becoming cancerous. You can read more about this in the colon cancer section.
Colon Polyps
Colon polyps are cherry-like protuberances in the large bowel. They are pre-cancerous and should be removed at colonoscopy. There are different types, but the main one that needs removing is the adenoma. These can bleed and produce mucus, particularly as the grow. Bleeding is particularly noticeable if present in the left side of your bowel.
There can be a family history of polyps and close surveillance is necessary in those families.
Haemorrhoids
Haemorrhoids or piles are the most common cause of bleeding. They don't usually cause blood in stool, but more commonly cause blood on the toilet tissue or in the toilet pan before passing stools.
They are caused by excessive straining seen with constipation and can be very painful, particularly if they thrombose or "clot off". They can also cause pruritis ani or itchiness around the anus or bottom area. Mucus is also a feature in this condition.
There are various stages with these, some prolapse through the "back passage" or anus, some are within the anal canal and some are internal to the anus. You can learn about this and the treatment options by going to the haemorrhoid symptoms page.
Anal Fissure
Anal fissure is another common cause of bleeding. They are extreamly painful and are caused by excessive straining or spasm of the anus. They can be associated with Crohn' s disease, a form of inflammatory bowel disease although most commonly they are idiopathic or unknown. Constipation can be a contributing factor and can certainly delay healing. Treatment involves local anaesthetic creams, nitrate or diltiazem ointment and addressing your constipation.
Inflammatory Bowel Disease
There are 2 main forms of inflammatory bowel disease, Ulcerative Colitis and Crohn's disease, both can cause blood in stool. They are characterised by inflammation and ulceration of the bowel and can causes symptoms of bloody diarrhea, wind and abdominal pain.
The condition can be associated with other symptoms including joint pains, rashes, eye problems and anaemia.
Diverticular Disease
Diverticular disease is characterised by pouches in the bowel as you can see in this picture. They can become inflamed and cause diverticulitis. Symptoms include mucus, bleeding and abdominal pain which is sometimes associated with a change in your bowel habit.
The disease is thought to be caused by our poor western diets, particularly diets low in fiber and high in carbohydrate.
Other Causes Of Bleeding
There are other causes of bleeding. Infections of the bowel, constipation in IBS, poor blood supply to the bowel known as ischaemic colitis, anticoagulants such as Warfarin and heparin and worm infestations can all cause bight red blood in stool.
How Is Blood In My Stool Investigated?
Your doctor should be informed as soon as you notice fresh blood in stool or on the toilet tissue. They will understand your concerns and help reassure you about this.
You will be asked a series of questions about your bleeding which will include how long you have had them for, whether the bleeding is fresh or old blood, whether you have symptoms of an itchy bottom (pruritis ani) often associated with piles or worm infestation.
You will also be asked if there is any soreness or discharge from or around the anus and if there is any family history of bowel diseases including colon cancer.
Your doctor will examine you to look for causes of bleeding and will perform a rectal or PR examination by passing a gloved finger in to your rectum or back passage.
They will be looking for lumps and evidence of blood or hemorrhoids. In a male they will also be feeling the prostate gland for enlargement or irregularity.
They may perform a proctoscopy or rigid sigmoidoscopy to look for causes of your bleeding. These are simple endoscopic tests that can normally be performed in a clinic or doctors surgery.
If they haven't got this facility available, they are likely to refer you to a surgeon or gastroenterologist to investigate your symptoms further.
Tests which are commonly performed include flexible sigmoidoscopy procedure, a colonoscopy, a CT or barium enema procedure.
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Treatment of Bleeding Causes
Primarily, the treatment of blood in stool is aimed at the underlying cause. This should be discussed with your doctor at the time of consultation or when the diagnosis has been confirmed.
It maybe a simple case of reassurance or a straight forward treatment such as a cream or suppository for your haemorrhoids. However, it may need more complex treatment including surgery if more serious issues such as cancer are found.
Most of the above conditions can be prevented or eased by having a healthy lifestyle, maintaining your 5 fruit and vegetables a day for fiber and an adequate fluid intake to keep your stools soft.
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