You might be shocked to discover blood in the toilet or when wiping after a bowel movement. Or, your doctor might find traces of blood in stools after some routine medical tests. You may also have noticed a change in the shade of colour of your stools. Blood in the stools is generally known as hematochezia. It means you may have internal bleeding somewhere inside your gastrointestinal (GI) tract.
The general location of the bleeding can affect the colour of the stools. If the blood is a bright red or maroon-like shade, it usually indicates bleeding in the rectum or colon (or somewhere else in the lower GI tract). Stools that are black and tarry, on the other hand, generally indicate bleeding in the upper GI tract.
The exact cause will only be known after you get a full medical check, as bloody stools are a common symptom of a variety of health complications. It is therefore important to get checked as soon as you discover blood in the stools. Early detection of the root cause can mean the difference between a speedy recovery or a lengthy hospital stay.
In this article, we will cover the common causes of bloody stools, and what you should know about these causes.
An anal fissure is a small cut or tears in the thin lining of the anus or anal canal, which is the opening where stools are excreted from the body. Anal fissures can happen to anyone, but the risk of it generally reduces as a person ages. Bleeding from the fissure usually leads to blood in the stools, mainly bright red in colour.
Anal fissures can occur because of difficult bowel movements, such as constipation, difficulty passing large stools, or even prolonged diarrhoea. There may also be underlying conditions that could cause anal fissures, such as infections or other diseases. Anal fissures may even affect infants and women after childbirth.
The main symptoms of anal fissures are pain and bleeding during bowel movements. There may be an initial sharp pain as you pass motion, followed by a burning sensation immediately after. Treatment of fissures will focus on softening stools, as well as easing any discomfort or bleeding that occurs. Simple home remedies, such as taking warm baths and changing your diet, are usually more than enough to cure anal fissures. Otherwise, prescribed medicated ointments or suppositories can help to treat anal fissures.
For more severe cases, surgery may be recommended to treat anal fissures.
Sometimes referred to as piles, haemorrhoids are dilated, or enlarged, blood vessels that can cause irritation, discomfort and/or, in some cases, pain. Any sort of heavy strain that might increase pressure on the belly or lower parts of the body could cause the surrounding anal and rectal veins (as well as tissue) to swell and become inflamed. As such, haemorrhoids can affect even pregnant women or persons with obesity.
There are three types of haemorrhoids: internal, external, and prolapsed. Internal haemorrhoids form within the rectum. External haemorrhoids, on the other hand, form underneath the skin around the anus. Prolapsed haemorrhoids occur when either internal or external haemorrhoids protrude outside the anus. Haemorrhoids generally cause irritation and are thankfully not life-threatening.
Blood clots on the skin may also potentially form in external haemorrhoids, causing substantial pain. This is called a thrombosed external haemorrhoid. When this happens, pain is a more prominent symptom, especially since the area around the anus is lined with many pain receptors.
Haemorrhoids can sometimes happen without any symptoms and go away after some time. Much like treating anal fissures, home remedies are good enough to treat haemorrhoids. In more serious cases, topical creams or medications (such as nonsteroidal anti-inflammatory drugs, or NSAIDs) may be prescribed to help reduce symptoms or cure them entirely. Medical procedures may instead be used if the haemorrhoids are not treated by any other means. One procedure is rubber band ligation, where a small rubber band is tied around a haemorrhoid to cut off its blood supply.
Viral gastroenteritis, or simply “stomach flu”, is an intestinal and stomach infection caused by a virus, bacteria or even a parasite. Unlike its colloquial name, gastroenteritis does not have anything to do with influenza. It affects people of any age and is caused by coming into contact with someone down with gastroenteritis (or harmful bacteria that cause it), not washing hands after using the bathroom, or consuming contaminated, or poorly prepared, food or water.
Symptoms of gastroenteritis normally include watery diarrhoea – in rare cases, with blood in stools – as well as nausea, abdominal pain or cramps, and vomiting. Diarrhoea is the most common symptom, and a person may lose a lot of water this way. Dehydration is an unintended side effect of having gastroenteritis, which could potentially weaken the body even further and cause other health complications.
Treating gastroenteritis simply requires sufficient rest and replacing lost fluids from the bouts of diarrhoea that may happen. Be sure not to stay dehydrated for too long.
Inflammatory Bowel Disease (IBD)
IBD is a term that describes a group of disorders which cause chronic inflammation in the intestines. This includes disorders such as Crohn’s disease (inflammation of the lining in the digestive tract), and ulcerative colitis (growth of ulcers in the large intestines). IBD should not be confused with irritable bowel syndrome (IBS), as the latter is a group of symptoms that affects bowel functions. IBS also does not cause severe inflammation or other damage to the intestines, unlike IBD. It is still possible to have both IBD and IBS, though.
The exact causes of IBD are still not known, though it is suspected that it could be an autoimmune disorder that causes the immune system to attack cells in the digestive tract. It may also be an inherited disease if a person’s family has a history of IBD. Whatever the cause might be, symptoms of IBD can vary depending on how severe the inflammation is. These include blood in stools, stomach pain or cramps, diarrhoea, nausea and fatigue.
IBD also can cause a variety of significant health complications, including a higher risk of developing colorectal cancer, liver disease, and other issues. Medical treatment and lifestyle changes will be needed to control inflammation and help reduce risk factors. Depending on the IBD, a person will need to take anti-inflammatory medicines, NSAIDs, or require surgery to correct major symptoms. Crohn’s disease, for example, may need a bowel resection to remove a diseased bowel segment.
Angiodysplasia refers to abnormal blood vessels in the GI tract. Some cases where blood in stools occurs without any may be due to this condition. It is also the most common vascular abnormality in the GI tract. Angiodysplasia causes blood vessels to become swollen over time, though the exact cause is not confirmed.
It is said that the occasional spasms of the GI tract might be what causes the blood vessels in the GI tract to become enlarged. This eventually causes arteriovenous malformations (AVMs) to form, where the blood vessels connecting arteries and veins are tangled up. This leads to a disruption in blood flow or even causes a blood leak as the blood vessels become weaker. Angiodysplasia tends to be associated with older people, as blood vessels also gradually weaken as a person grows older.
Symptoms of angiodysplasia may be subtle or do not present themselves at all. Symptoms may include anaemia and its associated symptoms, as well as rectal bleeding. Blood loss will depend on the severity of AVMs and if there are any leaks present. Treating it will require an angiography to block blood vessels that are bleeding, treat it with medicine; or by cauterising the site of the bleeding to prevent more blood loss.
Colonic, or colorectal, polyps are the most common type of polyp, a mass of tissue that develops on the lining of a hollow organ. In the case of colonic polyps, they grow along the lining of the colon. It is said that 15 to 40 per cent of men will have colonic polyps, more so for older men.
Polyps form for a variety of reasons, though not always fully understood. Genetics may have a connection to polyp formation, with a higher likelihood of developing polyps if someone has a hereditary condition such as Lynch syndrome or familial adenomatous polyposis. There may also be a connection to abnormal tissue growth, as well as lifestyle factors such as smoking, excessive alcohol consumption, and obesity.
People with colonic polyps tend to not have any symptoms, which is why early screenings are important to detect polyps early. If symptoms do present themselves, common symptoms include rectal bleeding, blood in stools, abdominal pain, or lengthy periods of constipation or diarrhoea. Some polyps have a higher risk of developing colorectal cancer, which can be fatal if left untreated. Removing polyps early via a colonoscopy (or laparoscopy) is the best option. This is a minimally invasive surgery with a relatively fast recovery time if all goes well.
Diverticulosis or Diverticulitis
These two terms are both related to diverticula, a kind of bulge that is formed on the lining of the colon. Diverticulosis is the presence of diverticula. If the body does not have a sufficient intake of fibre, it can lead to diverticulosis. Constipation due to this causes an increase in pressure inside the colon, forming these pockets, or bulges, in the colon. They will usually form in the weakened areas of the colon. When these diverticula become inflamed or infected, this causes diverticulitis.
Diverticulosis causes mild symptoms such as stomach pain, mild abdominal cramps, bloating and constipation. A majority of those with diverticulosis may not even exhibit any symptoms at all. If it evolves into diverticulitis, symptoms can become more severe. These may include consistent and persistent pain in the lower left side of the abdomen, nausea, vomiting, fever and blood in the stools. Thankfully, most cases of diverticulitis tend to be uncomplicated, though there is still a risk of developing abscesses (a pus-filled inflamed pocket) or having a tear in the intestinal wall.
Diverticulosis is usually treated through dietary changes, especially increasing fibre intake and frequent exercise. For diverticulitis, dietary changes usually concern a fluid-based diet and a slow increase in fibre intake as recovery progresses. Antibiotics may be prescribed to treat infections. For complicated diverticulitis, surgery may be recommended to treat it.
Ischemic colitis is a condition where blood flow to a part of the colon is interrupted. This may be due to a blockage or constriction in the blood vessels, preventing oxygen from reaching healthy cells in the digestive tract. This leads to inflammation and a weakening of tissue around the affected area. It generally affects people over the age of 60 and even those who have heart or blood vessel disorders.
Blood vessels may become blocked or constricted due to a number of reasons, including atherosclerosis (narrowed blood vessels due to fatty deposits), low blood pressure, and blood clots. Symptoms generally include blood in stools, abdominal pain, the feeling that you need to urgently pass motion, as well as diarrhoea. If left untreated, the affected area may become gangrenous (tissue death), or perforation may occur that causes persistent internal bleeding.
For treating ischemic colitis, your doctor may prescribe antibiotics to help fight infections, as well as adhere to a fluid diet given to you intravenously, so that your intestines can take a break while you recover. In more severe cases, specific medications may be administered depending on the severity of symptoms. If, for example, there might be a blood clot causing ischemic colitis, thrombolytics – medications to break up blood clots – may be prescribed to treat it.
Peptic ulcers are open sores that may develop on the inner lining of the stomach walls or the duodenum (located in the small intestine). There is a mucus layer lining the digestive tract, which protects the stomach and duodenum from the harmful effects of digestive acid. If the amount of mucus reduces, or the amount of acid increases, it can erode the protective mucus layer and cause ulcers to form. This may happen due to a h. Pylori bacterial infection, or even from regular use of NSAID medications.
Symptoms of peptic ulcers include stomach pain that comes and goes, heartburn, bloating, nausea and blood in stools. Severe symptoms can cause unexpected weight loss, vomiting, and even anaemia. The presentation of any severe symptoms should warrant an immediate check-up with a doctor. If not treated immediately, complications can include internal bleeding, perforation in the stomach wall, or even gastric cancer.
Some ulcers will eventually heal on their own, but there is a risk of recurrent peptic ulcers and the aforementioned risks that come with untreated ulcers. If the cause is due to bacterial infection, antibiotics will be prescribed. Proton pump inhibitors may also be used to control the production of stomach acid and allow the ulcers to heal. There are also cytoprotective agents that can protect the lining of the digestive tract. If the use of a specific medication may be the main cause of ulcers, you may be asked to stop taking it altogether.
Colorectal cancer is an umbrella term for colon cancer and rectal cancer. The main reason they are grouped together is that they exhibit similar features, but start in different areas of the digestive system (as per their respective names).
Cancer occurs when abnormal cell growth occurs as they continue to multiply uncontrolled. In the case of colorectal cancer, it can start from benign lumps called polyps. As mentioned earlier, most polyps tend to be benign and cause minor symptoms, but some are still at risk of developing colorectal cancer if left untreated.
Symptoms can be confused for a myriad of other digestive complications. Some of these include blood in stools, persistent abdominal discomfort, diarrhoea or constipation. There may also be bouts of fatigue, loss of appetite, and unexplained changes in diet or weight loss. It is therefore advisable to have regular screenings to find any polyps within the digestive system, and to make sure there are no signs of colorectal cancer.
Depending on the stage of colorectal cancer, treatment options may vary. Early-stage colorectal cancer can easily be treated by surgery since the polyps are small enough to be safely removed and do not cause lasting damage to the digestive tract. For late-stage cases, radiotherapy, chemotherapy and/or immunotherapy sessions may be done to kill cancer cells and even shrink polyps that may still be growing.
Take Care of Yourself
Though it does seem rather frightening, the important thing to remember is that early detection is always the first step forward to taking care of yourself. If you discover blood in stools, do not immediately jump to conclusions. Be sure to see a doctor (a gastroenterologist for any issues related to your digestive system) immediately and find out what the issue might be. Discuss what the best option is to treat the underlying issue. If need be, do not hesitate to consider a second opinion.
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