When to worry about blood in stool
Discovering blood in the bathroom after using the toilet is a scary experience. Even minor streaks of blood on the toilet paper are a warning, but dripping blood in the toilet bowl during or after passing number two is a definitely alarming finding for most people. Bleeding is a symptom that should not be ignored. Blood in the stool (blood in the poop) can indicate various underlying conditions, ranging from minor issues like haemorrhoids to more severe conditions like colorectal cancer. This article aims to shed light on the common, less and more serious causes of blood in the stool and the diagnostic processes involved in finding its source. By the end of this chapter you will have a more comprehensive understanding why this symptom occurs and the necessary steps to address it.
Blood in Stool Causes: When to Worry
While some blood in stool causes are benign, there are instances where the presence of blood in the poop indicates a more severe underlying condition. Here are some causes to be aware of:
Haemorrhoids:
Haemorrhoids are swollen blood vessel cushions located in the anal canal. They can be internal or external, and their presence can be associated with itching, anal discomfort or pain. When these vascular cushions become irritated or strained, they can bleed, leading to bright red blood in the poop. This bleeding is typically noticed after a bowel movement.
Anal Fissures:
Anal fissures refer to small, painful cracks in the delicate lining of the anus. These fissures can be caused by hard or large stools passing through the anus. The pain from an anal fissure is sharp and might be accompanied by a burning sensation, especially during or after a bowel movement. The presence of anal fissures often leads to visible bleeding, typically noticed on the toilet paper.
Diverticular Disease:
Diverticular disease is a condition where small pouches, known as diverticula, form in the wall of the colon. This process is part of the aging of the colon, however it happens at younger age if the diet is unhealthy and low in dietary fibres. While these little pouches are usually harmless, their complications, bleeding or inflammation, can cause serious problems. Diverticular bleeding although rare, is a rather alarming bleeding, with large amounts of fresh red blood passed through the anus and general signs of fatigue, dizziness or even collapse. Most of the time it needs medical attention, admission to hospital and administration of infusion or blood products, but thankfully often it stops by itself and rarely needs an emergency endoscopy or surgery to save the patient. Diverticulosis – the existence of these little pouches along the bowel wall – can not be reversed, but a healthy diet high in fibre and water, and a regular bathroom routine prevents the disease from getting worse and lowers the risk of complications to happen.
Gastroenteritis:
Gastroenteritis or Entero-colitis is an inflammation of the stomach, the intestines and/or the colon, often caused by viral or bacterial infections. Symptoms can include nausea, vomiting, abdominal cramps, and diarrhoea. In some cases, the inflammation can lead to the presence of blood in the diarrhoea, indicating a more severe form of the condition. It’s essential to stay hydrated and seek medical attention if symptoms persist or are severe.
Colitis:
Colitis can be caused by infections as above, but can also be part of IBD (Inflammatory Bowel Disease), which is a partly hereditary, partly dietary, immune related disease involving inflammation of the colon and sometimes the whole or any part of the gut. Inflammatory Bowel Disease is a chronic disease necessitating lifelong medical care. At first presentation abdominal cramps, frequent loose bowel movement with mucus and often with blood are seen. If only the rectum is involved the abdominal symptoms might be missing and only the changes in the stool frequency and appearance are present with or without faecal urgency.
Polyps:
Polyps are lumpy growths that develop in the lining of the colon. Until polyps are small, they are unlikely to cause visible bleeding. If they grow larger they bleed easily. Polyps can be different types depending on what kind of cells they are made of. Adenomatous polyps are one of the frequent ones and they have the potential to turn into colorectal cancer over time. This is why polyps are better to be removed.
Currently the peak age of colorectal cancer in the general population is at the 50-70 years age group. To catch and remove polyps before they present as cancer in this age group it is suggested for everyone to have a colonoscopy when one reaches 45-50 years of age. A negative colonoscopy will protect you from colorectal cancer for around 10 years. However in case adenomatous polyps were found and removed you need to attend regular colonoscopies every 2-5 years until no more polyps are found.
It is important to know what blood in stool might mean and seek medical attention if symptoms are new or if in spite of having been tested, the symptoms change to more severe. Urgent medical attention is needed if the bleeding is severe and is accompanied by general unwellness.
Diagnostic Procedures for Blood Passed through the Bottom
Identifying the cause of blood in the stool is crucial for effective treatment. When you consult a doctor about blood in stool causes, you should expect the following diagnostic steps:
Firstly, a thorough medical history is taken to understand the severity and quality of the bleeding observed by the patient and any circumstances and underlying conditions or medications that might be contributing to the bleeding. This is followed by a physical examination, especially focusing on the tummy area and the bottom.
If the bleeding was minor and the way it presented (fresh red, only on the paper) suggests a relatively superficial cause it might be sufficient to only check the anal opening and the anal canal with an Anoscopy procedure. If examination of the anal canal does not give a satisfying answer regarding the source of bleeding, Rectoscopy (or Rigid Sigmoidoscopy) i.e. examination of the rectum and the start of the sigmoid colon can be added. Anoscopy and Rectoscopy can be done as an office procedure, during your first consultation, without any previous bowel preparation and without any need for sedation. This makes it an ideal quick and very informative diagnostic procedure for per anum/per rectum bleeding. You will get an answer to your worrisome symptom in a few minutes and can leave after first consultation with an established diagnosis and a suggested treatment for most of the minor blood on the toilet problems.
If the Anoscopy and Rectoscopy do not find the source of the bleeding, or they find polyp which needs to be removed, or inflammation, which does not end at the limit of these examinations the doctor needs to look further.
Colonoscopy is a procedure that allows viewing the inner lining of the rectum and the whole colon and also, if necessary, the end of the small intestines (terminal ileum). Colonoscopy is a more complex procedure, it needs preparation (bowel preparation with laxatives) to clearly see the lining and needs sedation for you to tolerate the discomfort it comes with navigating a long thin flexible rubber tube along your colon. Colonoscopy is a diagnostic test but also allows for some treatment: polyps can be removed, bleeding can be stopped.
Other diagnostic tools might also be used if the endoscopic diagnostic tests suggest disease processes beyond the walls of the bowels or if they fail to identify the background of a significant and persistent symptom of bleeding. These imaging tests are computer tomography (CT) scan and magnetic resonance imaging (MRI). These scans are inferior to colonoscopy in diagnosing diseases of the colonic lining (mucosal lining), they are however able to “see” beyond the wall inside the abdominal cavity.
The Importance of Early Detection
Early detection of any medical condition, especially when it comes to symptoms like blood in poop, can be a game-changer. Recognizing the signs early allows less aggressive and more effective treatments and better overall outcomes.
When conditions like colorectal cancer are detected in their initial stages, the chances of successful treatment are significantly higher. Early interventions can prevent the progression of the disease, reducing the risk of complications and improving quality of life.
In essence, being proactive about your health, understanding the signs, and seeking medical advice promptly can make all the difference in the journey towards recovery.
Lifestyle Changes to Prevent Bloody Stools
Prevention is often the best cure. Making certain lifestyle adjustments can significantly reduce the risk of conditions leading to bloody stools. Here are some recommendations:
- Dietary Adjustments: Incorporate more fibre into your diet. Foods like whole grains, fruits, and vegetables can promote healthy bowel movements and reduce the risk of conditions like hemorrhoids and fissures.
- Stay Hydrated: Drinking adequate water daily ensures soft stools, reducing strain during bowel movements.
- Regular Exercise: Physical activity can improve digestion and reduce the risk of constipation.
- Avoid Straining: When using the restroom, avoid straining as it can lead to haemorrhoids and fissures.
- Limit Alcohol and Caffeine: Excessive consumption of alcohol causes irritation and inflammation in the upper part of the digestive system and is linked to more frequent occurrences of many digestive cancers. Excessive consumption of coffee can irritate the stomach and the caffeine content causes dehydration that leads to constipation.
By adopting these lifestyle changes, you can significantly reduce the chances of encountering blood in the stool and maintain a healthy digestive system.
When to Consult a Doctor
Blood passed through the anus is by no means a normal sign and should not be tolerated without getting examined. Once it has been clarified that the cause of bleeding was something minor like haemorrhoids or fissures, one still should not ignore seeing blood especially at the below scenarios
- Persistent Bleeding: after appropriate treatment of minor anal conditions the bleeding still persists or keeps coming back.
- Associated Symptoms: abdominal pain, unexplained weight loss, fatigue, or associated changes in the bowel habits warrants an early visit to a specialist.
- Dark blood in the stool: This can indicate bleeding from higher up in the digestive tract and should be addressed immediately.
- Family History: If you have a family history of inflammatory bowel disease it is important to be proactive about any symptoms, including fresh blood in stool. If you have a family history of colorectal cancer do not wait for symptoms and do not wait for the suggested average age for screening. Consult a specialist to find out, based on your family history, when is the right age for you to have the first screening colonoscopy.
Remember, early detection and intervention can lead to better outcomes. It’s always better to be safe and get any concerns addressed promptly.
Taking Action and Prioritising Health
Blood in poop, while alarming, is a symptom that many people encounter at some point in their lives. Whether it’s due to a minor issue like haemorrhoids or a more severe condition like colorectal cancer, the key is early detection and intervention.
It’s essential to prioritise one’s health, listen to the body’s signals, and not dismiss symptoms, but rather take action and visit a coloproctologist if you have noticed blood in the stool.
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