Blood in Poop - Don't Panic!

Blood in poop is something that is enough to panic most people because it is natural to assume that if you are pooping blood it means something very bad but in fact there are many things which can cause this to happen and most of them are not dangerous.

This article will concentrate on looking at the reasons why you may be pooping bright red blood and you may see fresh blood in or on your poop or on the toilet tissue or in the toilet bowl.

If you see blood in poo as us Brits would say, then you are right to take notice and get it checked out. Read on to find out why this might be happening and what action to take.

Where is Your Blood in Poop Coming From?

In this article we are talking about blood in poop or blood in stool which is fresh and red in color. This means that in most cases the site of the bleeding must be quite close to the exit or anus (butt/bum hole).

This is because when blood comes from higher up it gets changed by the digestive processes and becomes darker becoming brown and then black.

The only exception to this is when a massive hemorrhage happens that is very fast moving and can reach the exit without being changed.

If your poop is black then see the articles below.

Blood in Poop - The Causes

If you see blood in your poop then this shows that you have a break or tear in the lining of your gut. This can be triggered by various things but where you see the blood can give us a clue about what is going on.

Blood When I Wipe

Some people have told me " I see blood when I wipe ". This is the first time that many people notice any blood when they see it on the toilet paper. If this happens to you try to investigate a little further and have a look next time you go to try and work out where the blood is in relation to your poop.

Nobody really likes looking after a bowel movement but try going onto a pad of toilet tissue or into a disposable container and have a closer look. This can give you a lot of clues.

Blood on the Surface of the Poop

If fresh blood is on the surface or outside of the poop this indicates that the site of the bleeding is coming from the anus or very close to it.

In cases like these you will often see blood on the toilet tissue.

The water in the toilet bowel may turn pink from blood dripping down or which is on the outside of the poop.

This means that it could be caused by:

• Anal fissure: this is a tear in the anus often caused by passing very hard stools and is common with Crohn's disease. This is usually very sensitive and painful. It will usually heal up without treatment in a few weeks.
  
• Hemorrhoids (Piles). You may notice a swelling near the anus and sometimes itchiness and pain. Hemorrhoids are not anything to worry about but they can be very bothersome and so sometimes need treatment.
• Anal fistula: this is an extra channel which forms between the back passage and skin around the anus. Bleeding often happens during a bowel movement and is usually accompanied by pain. It is common with Crohn's disease.
  
• Proctitis is inflammation of the rectum or back passage which is more common if you suffer from inflammatory bowel disease.
• Cancer of the rectum.
  

Blood Which is Mixed In the Poop

If you notice that you have fresh blood in poop which is mixed in and not just on the surface then the site of the bleeding is more likely to be slightly higher up.

It will usually be coming from the colon/large intestine which is the bit of the bowel which comes before the rectum/back passage.

Causes include:

• Infections caused by bacteria, viruses or parasites like Salmonella, E Coli or C. Diff.
  
• Inflammatory bowel diseases like Ulcerative Colitis or Crohn's Disease.
  
• Diverticular Disease: the bleeding in diverticular disease can be a large amount and very rapid and is usually painless.
• Bowel polyps: these are not dangerous in themselves but they can be a forewarning that you are more at risk of cancer and so it is best to have them treated.
  
• Colon Cancer: the only symptom in the early stages may be blood in the stools.
  

Is Your Blood in Poop Caused by Anticoagulant Drugs?

Medication which is taken to prevent blood clots from forming like Aspirin and Coumadin/Warfarin can cause internal bleeding especially if they are not carefully monitored and so could lead to you seeing blood in your poop.

Can Blood in the Poop Be Caused by Sexual Activity Involving the Anus?

Yes. If you are practising this type of activity then you may have blood in poop caused by trauma or from sexually transmitted diseases.

Occult Blood 

The word occult means hidden. So occult blood is hidden blood that you cannot see with the naked eye. Small amounts of occult blood can be detected by using a fecal occult blood test which is a good screening tool for bowel cancer.

You may have blood in poop but you may not be aware it is there because you cannot always see it.

In many countries screening programs offer this poop test to all people over the age of 50 or 60 or tests can be bought privately to be done at home. Usually three samples are taken on separate days.

It is well worth doing as if you are one of the unlucky people who is found by the screening program to have bowel cancer, catching it early before you have other symptoms means that you will have a much higher chance of recovery.

Remember that not all blood in poop is visible.

Bloody Diarrhea

If you have blood in poop which is accompanied by diarrhea then this could be caused by an infection such as Salmonella, Campylobacter, cytomegalovirus or E.coli 0157 or if you have been traveling abroad or in off road areas, a parasite. 

If you have bloody diarrhea then you should seek medical help. If your diarrhea is very dark/black this is called melena and means that the bleeding is happening higher up in the gastrointestinal tract and you need urgent treatment.

I Am Embarrassed to Tell My Doctor

First of all when you are pooping blood your doctor may call it rectal bleeding (the rectum is the back passage) or blood in feces or blood in stool. He or she will be very used to seeing people with this problem and will expect you to come in and see them to investigate what is going on.

They have seen many, many other people with this same problem. Blood in poop is all in a days work to them, so don't be embarrassed they won't be!

What Tests Will I Need If I Find Blood in My Poop?

If you are pooping blood then it is very important to get further testing done. This page may give you some clues about what is going on but it is not a good idea to try and diagnose yourself.

Further tests are needed to narrow down the possibilities and make a definitive diagnosis.

You may find that you have something which is not serious and can be easily treated or something more concerning but the longer you delay before seeking help the more likely it is that treatment will be difficult or not possible.

I know that people worry about going to see a doctor because they don't look forward to having an awkward and embarrassing conversation but as I said earlier your doctor has had this conversation many times before so don't let that stop you.

People also worry about testing because they ask themselves. "Will it be really embarrassing?" "Will it be painful?" "What are they going to do to me?"

Read on to find out about the likely tests that you will have if you find blood in your poop.

Abdominal Examination

When you have blood in poop although usually there is nothing to worry about it can be an indication of something more serious like a tumor or a chronic disorder like inflammatory bowel disease. The doctor will palpate (examine by touch) your abdomen to look for any lumps or painful bits.

You will be asked to lie on your back and pull your clothes down to just above the tops of your legs so that the doctor will be able to see and feel your belly.

Digital Rectal Examination

Many people fear this test because they feel it is a bit humiliating. Men are more used to it than women as it is commonly done to check on the prostate gland.

You will be asked to remove your underwear and lie on your side with your knees up. You will usually do this behind a curtain and be given a cover to put over your bottom half. The doctor will come in when you are ready.

A tip for women is to wear a loose fitting skirt.

The doctor will first examine the anus visually to look for things like fissures or hemorrhoids.

The doctor will then slowly stick a gloved finger into your back passage to feel for abnormalities like tumors or hemorrhoids. They will use lubricant and although it can be a bit uncomfortable you should not experience much pain. If you do you should tell the doctor as this can be a sign of something amiss.

It helps a lot to try and relax the muscles in that area and to breathe in and out deeply and steadily if you are worried. Sometimes the doctor will ask you to try and contract the muscles so they can assess how strong or weak the rectal muscles are.

The whole test should only take 2-3 minutes.

Afterwards the doctor will usually leave you behind the curtain to wipe yourself with the tissues provided and get dressed.

Although having this test done would not be on the top of anybody's list of ways to pass the time, it is over quickly and can be a life saver.

Examination by Camera or X-ray

In order to see what is going on and discover why you have blood in poop your doctor (normally a GI specialist) or a specially trained nurse or technician will need to have a look inside your bowel. In order to do this it is important that your bowel is empty. If you still have poop in there then it may hide any abnormalities from view.

This is where the worst bit of these tests kicks in. The actual tests themselves are not too bad and do not require a stay in hospital but the preparation is the horrible bit.

You will be given a very strong laxative usually the day before the test and this will give you diarrhea like you have probably never experienced before. Just remember it is all in a good cause and do not move very far from the toilet!

Make sure to drink plenty of clear fluids (no milk) and you will probably be told to not eat any solid food the day before the test or sometimes you will be given a low fiber diet to follow. For more prep instructions see here.

You must not have any iron tablets for a few days before as they turn the bowel a black color and so make it hard to see any features. You must also stop taking anticoagulant medication. You will be given instructions about all of this.

On the day of the test you will normally be given a sedative to make you relaxed and drowsy but you will not be asleep.

Colonoscopy

This is a narrow flexible tube with a telescopic camera which allows the doctor to see the entirety of the rectum and the large intestine/colon up to its junction with the small intestine.

The doctor can look directly through the tube but normally the pictures are transmitted to a screen. Biopsies can be taken if necessary.

I have had this test myself and I did not find it uncomfortable. In fact I found it quite fascinating looking at the screen but maybe that's just me!

For more information about how this is done see here.

Virtual Colonoscopy or CT Colonography

This test involves inserting a tube into the rectum and then puffing the bowel up using gas. Pictures are then taken using a computerized tomography (CT) scanner.

This involves the use of x-rays and so is not suitable for pregnant women. It is a less invasive type of test than a straight forward colonoscopy as the tube does not have to go up as far and so is often used when the patient is fragile.

Sometimes you will be asked to take some iodine with your food beforehand to help make the pictures clearer.

Capsule Endoscopy (Pill Camera)

This involves swallowing a pill with a camera in it. The pill is about 1.25 inches long and 0.5 inches wide.

You have to wear a recording device and the test takes about 10 hours during which time you must take it easy and not exercise. You must be especially careful not to bend down or over. The pictures are transmitted wirelessly.

The FDA has approved this test (2014) for people where a standard colonoscopy has not been successful. This will probably be the future for this type of test.

This test is also very useful if bleeding or other problems are suspected in the small intestine.

Flexible Sigmoidoscopy

This is a shorter tube which only allows visibility of the rectum/back passage and the sigmoid colon (the last bit which comes just before the rectum). This is where most cancers are found.

Rigid Sigmoidoscopy

This is normally used for a quick examination of the rectum and lower bowel but it is not as comfortable as the flexible scope and does not give as good results. Hopefully it is falling out of fashion!

Barium Enema

To do this test you will be given an enema of barium which is a white liquid which will coat the inside of your bowel and show up on the x-rays which will be taken. Not suitable for pregnant women.

Other Tests

The main tests that you may have if you discover blood in your poop are outlined above but you will also be given standard blood tests and sometimes an MRI scan of your abdomen which uses magnets may be used.

Other tests will depend on symptoms that you may have alongside your blood in poop.

Blood in Poop - The Conclusion

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